A non-linear association between self-reported negative emotional response to stress and subsequent allostatic load: prospective results from the Whitehall II cohort study

Disruptions in self-regulatory processes predict depression and sleep disturbance in bereaved young adults

Losing a loved one is both common and profoundly stressful for young adults. Little research has examined the longitudinal course of post-loss cognitive processing, depression, and sleep difficulties. Further, little is known about the context of other stressors or the role of individual regulatory resources, such as attentional regulation, that might determine whether loss-related cognitive processing reduces distress. This prospective study examined changes in depression and sleep disturbance over 9 weeks as a function of within- and between-person variation in stress exposure, loss-related cognitive processing, and attention regulation. Participants were 108 recently bereaved college students completing a lab-based assessment of attention regulation and four self-report surveys, spaced three weeks apart. Results revealed that most participants gradually reduced loss-related processing over the study period, with corresponding improvements in depression and sleep. Stress exposure was associated with increased processing, depression, and sleep disturbance. In exploratory analyses, high attentional alertness and slow re-orienting strengthened the association of within-person loss processing with sleep disturbance. Both within- and between-person variation in stress appear to engender risk for a prolonged course of bereavement. Future research should integrate objective attention measures with self-reported adjustment to stress to illuminate reciprocal links between depression, sleep, and loss-related cognitive processing.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Changes in Emotional Vitality as a Predictor of Levels and Change in Allostatic Load: Longitudinal Results From the Whitehall II Cohort Study

OBJECTIVE

Increasing evidence has shown an association between reduced psychological well-being and long-term morbidity. However, longitudinal studies addressing potential biobehavioral mechanisms, such as physiological function, are lacking. The aim of this study is to examine the association between changes in emotional vitality on levels and changes in allostatic load (AL), a measure of multisystem physiological dysregulation, as well as its composite risk markers.

METHODS

Participants comprised 5919 British civil servants from phases 3, 5, and 7 of the Whitehall II study. Psychological well-being was operationalized as emotional vitality. AL was measured using nine biomarkers of the cardiovascular, metabolic, and immune system. Linear mixed-effect models were used to determine the association between changes in emotional vitality between phases 3 and 5 and subsequent levels and change in AL from phases 5 to 7. Generalized linear models were used to address the association between changes in emotional vitality and individual risk markers.

RESULTS

Increase in emotional vitality was associated with a lower mean level of AL, whereas the AL slope was not markedly affected. Among the included risk markers, only interleukin-6 was weakly associated with changes in emotional vitality, with a 7% reduced risk of high levels of interleukin-6 per one-unit increase in emotional vitality.

CONCLUSION

This study found that an increase in emotional vitality was associated with subsequent lower levels, but not rate of change, of AL over time. Further research is needed to address the relationship between trajectories of psychological well-being and physiological dysregulation.

Life Events, Emotions, and Immune Function: Evidence from Whitehall II Cohort Study

Stressful life events have been shown to increase vulnerability to infections. However, the effects may be dependent on specific emotional responses associated with these events. In general, negative emotions are thought to exacerbate and positive emotions to protect from the adverse effects of stressors on health. In this study, we adopted an evolutionary and functionalist perspective on emotions and hypothesized that both positive and negative emotions in response to stressful events are protective, whereas absence of emotional reactions exacerbates vulnerability to infections. We assessed immune function using lymphocytes to white blood cells ratio as a proxy for current viral infection in 3,008 British civil workers (30% women). No main effect of stressful life events or emotions on lymphocyte ratio was observed in either sex. However, in men, there was an interaction of life events with both positive and negative emotions as well as a combined measure of general affect. Supporting our hypothesis, stressful life events were associated with impaired immune function in men who reported very low levels of both positive and negative emotions but not in others. We discuss potential benefits of negative and positive emotions in the context of stress and immunity.

Externalizing Behaviors Buffer the Effects of Early Life Adversity on Physiologic Dysregulation

The present study examined the counterintuitive hypothesis that externalizing behaviors such as aggression, although in many respects detrimental, may be functional and protect against the detrimental health consequences of early life adversity. In particular, in line with evolutionary models of development, we argue that externalizing problems moderate the association between chronic stress exposure and allostatic load, a biological marker of chronic physiological dysregulation. Prospective interactive effects of externalizing behaviors and cumulative risk (a confluence of multiple risk factors) on children's allostatic load were assessed in 260 children (46% female, baseline age = 9). Exposure to early life adversity was assessed at baseline using a cumulative risk index. Externalizing behaviors were reported by parents at baseline. Allostatic load was measured at baseline and at ages 13 and 17, using endocrine, cardiovascular and metabolic parameters. Results of linear-mixed effects models indicated that the association between cumulative risk and allostatic load was attenuated for adolescents who scored high on externalizing behaviors. Further examination of sex differences indicated that the findings were more pronounced among males than females.

Moderate emotional reactions to stressful life events are associated with lowest risk of increased alcohol consumption: evidence from the Whitehall II study

BACKGROUND

Research investigating the associations between stress-related negative emotions and alcohol consumption often assumes a linear dose-response relationship. Based on the current theories of emotions, we questioned this assumption and hypothesized that both very low and very high levels of negative emotional response (NER) to stressful life events are related to increased alcohol consumption.

METHODS

We used data from Phases 1 (1985-88) and 2 (1989-90) of the British Whitehall II study. At both phases, participants reported on their alcohol consumption, recent stressful events and the NER to the events. Two thousand and sixteen participants without recent stressful events at baseline were selected. Logistic regression was used to model the association between emotional response at baseline and increased frequency of alcohol consumption between the two phases.

RESULTS

The likelihood of increased alcohol consumption increased with the number of recent stressful events. Among participants with at least one event, 17% increased alcohol consumption, compared with 14% of those who reported no events. Participants with average NER were at lowest risk (14%) of increasing alcohol consumption after major life events. Those with highest NER were significantly more likely to increase alcohol consumption (20%) than those with average NER, but the difference between those with highest NER and those with lowest NER (17%) was not statistically significant.

CONCLUSIONS

Increases in alcohol consumption following stressful events are least likely if people experience moderate levels of NER to events. Negative emotions in moderate doses should not be regarded as a risk factor for unhealthy behaviours, but rather a potentially protective factor.

Associations of Positive Affect and Negative Affect With Allostatic Load: A Lifelines Cohort Study

OBJECTIVE

Allostatic load (AL) reflects the deteriorating influences of stress on the body and comprises a selection of biological markers. AL is associated with negative life events, stress, and negative affect (NA), as well as poor health outcomes. However, whether AL is also associated with positive affect (PA) is not clear. The present study therefore explores the association between PA and AL, accounting for age, sex, NA, and health behaviors.

METHODS

Data of 45,225 individuals from the first wave of the multidisciplinary prospective population-based cohort study Lifelines were used. AL was operationalized as the sum of 12 inflammatory, cardiovascular, and metabolic markers. The association between PA and AL was tested in a cross-sectional study design using multiple linear regression analysis, adjusting for NA, confounders, and health behaviors. In addition, we explored whether the relation was moderated by age, sex, and NA.

RESULTS

The AL profile was inversely associated with PA (B = -0.083, p < .001) when adjusted for NA, age, and sex. The association between AL and PA remained significant after adjusting for health behaviors (B = -0.076, p < .001). A significant moderating effect was found for sex (PA by sex: B = 0.046, p = .001), indicating that the association between PA and AL was stronger in women than in men.

CONCLUSIONS

PA was associated with a more favorable AL profile, especially in women. These results add to the evidence that PA might be of relevance to the etiology of disease.