Perceived stress, psychological resilience, hair cortisol concentration, and metabolic syndrome severity: A moderated mediation model

Chronic Parenting Stress in Parents of Children with Autism: Associations with Chronic Stress in Their Child and Parental Mental and Physical Health

Parents of children with ASD often demonstrate high levels of stress and associated health problems. A gap in knowledge exists regarding the associations between chronic stress and mental and physical health of parents of young children with ASD, in which fathers have been understudied. In 181 parents (98 mothers, 83 fathers) of 99 young children with ASD chronic stress was measured using parental self-report and hair cortisol concentration (HCC) analysis. Parental mental health and eating behavior was measured using questionnaires. Physical health was evaluated by Body Mass Index, waist circumference, blood pressure, cholesterol, triglycerides, and glucose.. Parental HCC was related with child HCC (rmothers = 0.51, p <.01; rfathers = 0.40, p <.01). Maternal HCC was associated with lower reported parenting stress (r = -.33, p <.01). Parental mental health problems and reported parenting stress were strongly related (r =.55-0.61, p <.01). Mental health problems were twice as frequent as in the norm-population (41.1-45.8% versus 20%). In both parents, reported parenting stress was associated with emotional eating behavior. HCC was associated with higher glucose levels in mothers. There were no associations between chronic stress and the other physical health measures in mothers and fathers. Parents of young children with ASD are at high risk for chronic stress, with impact for their mental and physical health. Additionally, chronic stress of parents, cannot be perceived isolated from the stress in their children with ASD. We encourage future research to investigate whether these correlations are generalizable to the whole ASD population.

Cardiovascular risk and allostatic load in PTSD: The role of cumulative trauma and resilience in affected and trauma-exposed adults

BACKGROUND

The pathophysiology of posttraumatic stress disorder (PTSD) involves dysregulation of stress-sensitive biological systems due to repeated trauma exposure, predisposing individuals to the development of cardiovascular disease (CVD). Allostatic load (AL), an indicator of maladaptive stress responses, could shed light on the underlying biological mechanisms. We determined whether CVD risk and AL were associated with trauma load and resilience in women with PTSD and trauma-exposed controls (TEC).

METHODS

Adults with PTSD N = 114 and TEC N = 95 were administered the Clinician Administered Posttraumatic Stress Disorder Scale for DSM-5, to assess for current PTSD diagnosis and severity, the Life Events Checklist for DSM-5 for lifetime exposure to potentially traumatic events (cumulative trauma) and the Connor-Davidson Resilience Scale. An AL score was calculated as a sum of dichotomous variables from four physiological systems (neuroendocrine, metabolic, cardiovascular, and inflammatory). CVD risk was assessed with the South African Framingham risk score.

RESULTS

In patients with PTSD, cumulative trauma was associated with higher AL (p = 0.04) and CVD risk (p = 0.02). In TEC, AL was inversely associated with resilience (p = 0.04). There was a significant interaction between cumulative trauma and resilience on AL (p = 0.009) in PTSD cases, with a stronger association between cumulative trauma and AL in those with higher resilience.

CONCLUSIONS

Resilience may have differential detrimental and protective effects on AL in individuals with PTSD and TEC. Cumulative trauma exposure may, independently, increase the likelihood of high AL and CVD risk in PTSD, with resilience moderating this effect. Remaining resilient while experiencing PTSD symptoms may impose a biological strain that could have long-term harmful effects.

Maternal Prenatal Stress and the Offspring Gut Microbiome: A Cross-Species Systematic Review

The prenatal period is a critical developmental juncture with enduring effects on offspring health trajectories. An individual's gut microbiome is associated with health and developmental outcomes across the lifespan. Prenatal stress can disrupt an infant's microbiome, thereby increasing susceptibility to adverse outcomes. This cross-species systematic review investigates whether maternal prenatal stress affects the offspring's gut microbiome. The study analyzes 19 empirical, peer-reviewed research articles, including humans, rodents, and non-human primates, that included prenatal stress as a primary independent variable and offspring gut microbiome characteristics as an outcome variable. Prenatal stress appeared to correlate with differences in beta diversity and specific microbial taxa, but not alpha diversity. Prenatal stress is positively correlated with Proteobacteria, Bacteroidaceae, Lachnospiraceae, Prevotellaceae, Bacteroides, and Serratia. Negative correlations were observed for Actinobacteria, Enterobacteriaceae, Streptococcaceae, Bifidobacteria, Eggerthella, Parabacteroides, and Streptococcus. Evidence for the direction of association between prenatal stress and Lactobacillus was mixed. The synthesis of findings was limited by differences in study design, operationalization and timing of prenatal stress, timing of infant microbiome sampling, and microbiome analysis methods.

Differences of Sedentary Behavior, Physical Activity, and Metabolic Syndrome Severity Among Metabolic Syndrome Clusters

Background: Sedentary behavior (SB), physical activity (PA), and metabolic syndrome (MetS) are risk indicators for cardiometabolic diseases. Novel methods for researching MetS by the 16 unique clusters (i.e., WC+FBG+BP) and as a continuous severity z-score (MetS-Z) have emerged. This study examined how SB, PA, and MetS-Z differed among MetS clusters and SB and PA differences by MetS-Z tertiles. Methods: Using 2015-2016 National Health and Nutritional Examination Survey (NHANES) data, participants with MetS (N = 792) were identified. Subsequently, sex-, race-, and ethnicity-specific MetS-Z were calculated. SB and PA differences were compared between MetS clusters and MetS-Z tertiles. Additionally, MetS-Z was compared between MetS clusters. Results: The WC+FBG+BP MetS cluster was prevalent among 23.80% of participants (95% CIs, 18.41-30.18) and the overall mean MetS-Z was 1.16 (1.08-1.24). Participants reported over 6 daily hours of SB (393.41 minutes⋅day-1 [370.07-416.75]). The TRI+FBG+BP+HDL MetS cluster had less SB than the WC+TRI+FBG+HDL, WC+TRI+HDL, and WC+FBG+BP MetS clusters. PA did not differ between MetS clusters and no differences in SB or PA between MetS-Z tertiles. Conclusions: Limited differences in SB and PA were observed. Participants with 4 or more MetS criteria had worse MetS-Z. Efforts should support replacing SB with PA to improve cardiometabolic health.

Differences in Self-Reported Stress Versus Hair and Nail Cortisol Among Adolescent and Young Adult Males

BACKGROUND

Chronic stress causes harmful physiological responses that yield increased inflammation and subsequent health conditions. Stress is an important measure among minoritized populations who face social situations that predispose risk to developing mental health problems. Hair and fingernail cortisol have been studied as retrospective measures of chronic stress and to demonstrate biological response to social situations.

OBJECTIVES

The objective of this study was to compare the Perceived Stress Scale (PSS) with hair and nail cortisol concentrations and assess the risk factors associated with stress levels among heterosexual and sexual and gender-minoritized adolescent males.

METHODS

We recruited a cohort of adolescents who were assigned male sex at birth. Approximately half of our cohort consisted of sexual and gender-minoritized people, and half consisted of heterosexual cisgender males. Participants provided hair and nail samples and completed a survey that included demographic and hair hygiene questions and the PSS. Hair and nail samples were processed in a laboratory, and survey results were analyzed descriptively.

RESULTS

Several samples were not provided or received, and some survey data were missing. Hair and nail cortisol values were significantly associated. There was no significant relationship between the PSS and hair and nail cortisol values. No significant differences were found between the heterosexual and sexual minoritized groups. Black participants reported lower perceived stress scores compared to White participants. Participants whose gender was nonbinary or genderqueer had higher hair cortisol values compared to those who identified as male. Older participants had higher hair cortisol values compared to younger participants.

DISCUSSION

Previous researchers have similarly found no correlation between self-report stress scales and cortisol values, increased stress experience among nonbinary or genderqueer individuals compared to cisgender individuals, and a positive correlation between aging and stress. Yet, our finding that Black participants reported lower stress levels than White participants is unexpected. Our study demonstrates a high correlation between hair and nail cortisol values, suggesting the potential to substitute these markers as needed.

Socioeconomic mobility, metabolic health, and diet: mediation via subjective socioeconomic status

OBJECTIVE

Socioeconomic mobility, i.e., changing socioeconomic status (SES) between adolescence and adulthood, may impact health through changing resources, social status, and health-related behaviors. This analysis examined whether subjective SES contributes to associations of mobility with metabolic health (BMI and metabolic syndrome) and unhealthy diets (fast-food consumption and sugar-sweetened beverage [SSB] consumption).

METHODS

National Longitudinal Study of Adolescent to Adult Health data were used (n = 4132). Mobility was defined as the difference between adolescent (collected 1994-1995, ages 11-19 years) and adult (collected 2016-2018, ages 33-43 years) SES. Linear and logistic regressions examined associations of mobility with metabolic and dietary outcomes and mediation by subjective SES.

RESULTS

Substantial upward mobility was associated with lower risk of high SSB consumption compared with stable disadvantaged SES (risk difference: -0.10 [95% CI: -0.16 to -0.041]). Subjective SES mediated associations of upward, but not downward, mobility with risks of developing metabolic syndrome, high fast-food consumption, and high SSB consumption; upward mobility was associated with higher subjective SES and lower risks of poor metabolic and dietary outcomes.

CONCLUSIONS

The finding that subjective SES contributed to associations between upward mobility and better health may inform development of interventions designed to promote healthier diets and reduce socioeconomic disparities in metabolic health.

Resilience as a predictor of habituation

Habituation refers to the physiological adaptation to recurrent stressors, which can be measured by cortisol levels, and is considered a central mechanism in reducing allostatic load. Resilience, a potential factor influencing stress reduction, is the focus of this study. Specifically, the study aims to investigate the impact of resilience, as assessed by the Brief Resilience Scale (BRS), on habituation. The Trier Social Stress Test (TSST) was used as the recurrent stressor, and it was administered to each of the 56 subjects at 4 consecutive measurements. To assess habituation, various physiological parameters including the area under the curve with respect to the ground (AUCg) and with respect to the increase (AUCi), cortisol peak, slope from baseline to peak, and recovery were calculated. Mixed linear models were employed to examine the differences in the influence of resilience on habituation across the different time points. The findings indicate that the influence of resilience significantly varies from the first to the fourth measurement time point for AUCg (p = .048), while no significant differences were observed for the other cortisol parameters. The effects plot suggests that individuals with higher levels of resilience exhibit lower AUCg values throughout the measurements. These findings provide initial evidence supporting resilience as a predictor of cortisol habituation. However, future studies should also consider dynamic resilience models, utilizing longitudinally assessed resilience as a predictor for habituation, to explore whether resilience acts as a determinant of habituation or if habituation itself constitutes a resilience mechanism.

Exploring Food Insecurity and Perceived Stress on Daytime Sleepiness among Older Adults in New York City

The growing population of older adults in the U.S. is experiencing increased food insecurity and stress, which are associated with nocturnal sleep quality and consequently excessive daytime sleepiness. This study aimed to investigate the relationship between food insecurity and perceived stress on daytime sleepiness in older adults aged 60 and older living in New York City. This cross-sectional, quantitative study utilized the US Household Food Security Survey Module six-item questionnaire, the Perceived Stress Scale (PSS), and Sleepiness Total to collect data. Participants completed an online survey via Qualtrics. Linear and logistic regression models were used to assess the association between demographic variables and food insecurity, perceived stress, and daytime sleepiness outcomes. Three hundred seventy-eight (378) older adults participated in this study. Food insecurity was associated with age (p = 0.045), education (p = 0.022), and daytime sleepiness (p < 0.001). On average, participants with a BMI of over 30 had an increased daytime sleepiness total relative to a BMI < 25 (p = 0.029), and those with two to three health conditions and those with more than four health conditions had higher daytime sleepiness totals relative to those with zero to one condition (p = 0.007 and 0.007, respectively). Participants who had moderate and high stress, regardless of food security status, had higher daytime sleepiness totals than those with low stress (food secure; p = 0.002; food insecure; p < 0.001). Multifaceted interventions are needed to alleviate food insecurity, manage stress, and reduce excessive daytime sleepiness among older adults.

Role of Adverse Childhood Experiences in the Onset of Overweight/Obesity

PURPOSE OF REVIEW

The goal of this chapter was to summarize the literature on childhood adversity and obesity, discuss treatment implications with a case example, and provide recommendations for trauma-informed care for clinicians who work with individuals living with obesity.

RECENT FINDINGS

Adversity in childhood is related directly and indirectly to obesity development. Upstream contributors like adverse childhood experiences (ACEs) and other factors can lead to experiences of toxic stress and increased allostatic load, resulting in downstream effects of obesity and other chronic health conditions. A well-established literature has linked ACEs and obesity suggesting complex interactions between genetic, biological, behavioral, mental health, social, and environmental factors and obesity. Trauma-informed care strategies can be used to optimize care for individuals living with obesity. Care pathways should include individual (clinician) and systemic (organizational) evidence-based interventions.

Human immune and metabolic biomarker levels, and stress-biomarker associations, differ by season: Implications for biomedical health research

Although seasonal changes in physiology are well documented, little is known about how human immune and metabolic markers vary across seasons, and no studies have examined how stress → health biomarker associations differ across the year. To investigate these issues, we analyzed data from 2118 participants of the Midlife in the United States (MIDUS) study to determine whether there were differences in (a) levels of 19 immune and metabolic markers, and (b) the association between perceived stress and each biomarker across the year. Results of component-wide boosted generalized additive models revealed seasonal patterning for most biomarkers, with immune proteins generally peaking when days were shorter. Moreover, whereas levels of hemoglobin A1C rose from late fall to spring, triglycerides were elevated in the summer and fall, and high-density lipoprotein decreased steadily from January to December. Urinary cortisol and cortisone exhibited opposite patterns, peaking at the beginning and end of the year, respectively. Most critically, we found that the effects of perceived stress on 18 of the 19 health biomarkers assessed varied by month of measurement. In some cases, these differences involved the magnitude of the stress → biomarker association but, in other cases, it was the direction of the effect that changed. Studies that do not account for month of biomarker assessment may thus yield misleading or unreproducible results.

Diet Quality and Resilience through Adulthood: A Cross-Sectional Analysis of the WELL for Life Study

Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords' WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0-120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18-24), late young (25-34), middle (35-49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p < 0.001)) and within each age group (early young (β = 1.1 ± sd: 0.3, p < 0.001); late young (β = 1.2 ± sd: 0.3, p < 0.001); middle (β = 0.9 ± sd: 0.3, p < 0.001); and late adulthood (β = 1.0 ± sd: 0.3, p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults.

Telephone follow-up based on empowerment theory to improve resilience and quality of life among patients after coronary artery stent implantation: a randomized controlled trial

Background

Coronary heart disease has a high incidence rate, a high mortality rate, a high recurrence rate, and a high medical cost. In addition, some patients need to undergo percutaneous coronary artery stent implantation (CASI), which is a kind of traumatic treatment. Patients can easily experience negative emotions such as anxiety and depression after surgery, which seriously affects quality of life.

Objectives

The aim of this study was to evaluate the effectiveness of an empowerment-based telephone follow-up intervention on resilience and quality of life in patients who underwent CASI.

Design

The design of the study is a randomized controlled trial.

Methods

A total of 92 patients were recruited after CASI from the Internal Medicine Cardiovascular Department of a Grade A tertiary hospital in Xi'an, China. The patients were randomly divided into a control group and an intervention group. The control group performed routine care, whereas the intervention group developed a telephone follow-up program based on empowerment theory while carrying out routine care. Patients were investigated using the coronary heart disease-related knowledge questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the 36-Item Short-Form Health Survey (SF-36) to compare the effects of the intervention before and after 1 month of intervention.

Results

After a 1-month telephone follow-up intervention based on the empowerment theory for patients after CASI, the variations in knowledge related to coronary heart disease and all of its subscale scores were greater in the intervention group than in the control group. Except for the three dimensions of risk factor, induction factor, and rehabilitation-related knowledge, the variations in knowledge related to coronary heart disease and the other subscale scores were significantly different between the two groups (p < 0.05). The variations in resilience and scores on the three subscales in the intervention group were greater than those in the control group, and the difference between the two groups was statistically significant (p < 0.05). The variations in the quality of life and overall health, emotional functions, and social functions were significantly greater in the intervention group than in the control group (p < 0.05).

Conclusions

A telephone follow-up intervention based on the empowerment theory can effectively improve the resilience and quality of life of patients after CASI. This follow-up approach can provide a theoretical basis and practical reference for hospitals and communities to carry out targeted continuing nursing for patients after CASI. The long-term effects of the intervention and its underlying mechanisms require further study.

Clinical trial registration

http://www.chictr.org.cn/showproj.aspx?proj=173682, identifier ChiCTR2200064950.

Neuroendocrine mechanisms in the links between early life stress, affect, and youth substance use: A conceptual model for the study of sex and gender differences

Early life stress (ELS) is defined as an acute or chronic stressor that negatively impacts a child's development. ELS is associated with substance use and mental health problems. This narrative literature review focuses on sex and gender differences in the effects of ELS on 1) adolescent neuroendocrine development; 2) pubertal brain maturation; and 3) development of internalizing symptoms and subsequent substance use. We posit that ELS may generate larger hormonal dysregulation in females than males during puberty, increasing internalizing symptoms and substance use. Future research should consider sex and gender differences in neuroendocrine developmental processes when studying the link between ELS and negative health outcomes.

Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial

Objective

To assess the effectiveness of an educational intervention on perceived stress and metabolic syndrome parameters among adults with type 2 diabetes mellitus.

Method

Fifty-one adults (aged 48.73±7.84; 86.3% of women) were included in a non-randomized clinical trial performed in a healthcare unit for six months (Brazilian Clinical Trial Registry: RBR-43K52N). All participants were diagnosed with type 2 diabetes mellitus and metabolic syndrome (intervention group, n=26; control group, n=25). The intervention consisted of a nurse-led educational health-promoting program with a multidisciplinary approach organized in seven workshops. The primary outcome was decreased perceived stress, and the secondary outcome was improvement in metabolic syndrome parameters according to perceived stress levels. These outcomes were assessed at two points in time, at the baseline and follow-up.

Results

Participation in the intervention program resulted in a significant decrease in perceived stress (p=0.028). The stressed participants in the intervention group experienced a significant decrease in blood glucose levels (p=0.001) and a significant increase in high-density lipoprotein-cholesterol (p=0.003) concentrations after the six-month intervention.

Conclusion

The nurse-led educational health-promoting program decreased perceived stress among adults with type 2 diabetes mellitus and metabolic syndrome, improving fasting blood glucose and high-density lipoprotein cholesterol among the stressed participants in the intervention group.

Reactivity of Health-Related Quality of Life to Perceived Stress: The Buffering Role of Psychosocial Resources in a Longitudinal Study of Adults with and Without HIV

People with HIV now have increased longevity; however, their health-related quality of life (HRQoL) still lags significantly compared to people without HIV. Perceived stress negatively impacts HRQoL, whereas psychosocial resources are linked to better HRQoL. This longitudinal analysis aims to explore the buffering role of psychosocial resources on the relationship between HRQoL and perceived stress. Participants (N = 240) included 142 persons with HIV (PwH) and 98 without HIV, M(SD) = 50.9(8.1) years. Multilevel models over four study years examined longitudinal relationships between HRQoL (outcome) and perceived stress (predictor) and potential moderation by psychosocial resources (personal mastery, social support, and resilience) by HIV serostatus. Among PwH only, personal mastery (p = 0.001), social support (p = 0.015), and resilience (p = 0.029) were associated with an attenuated effect of perceived stress (less negative slopes) for physical HRQoL over time. Bolstering personal mastery, social support, and resilience may have relevance for improving physical well-being among PwH.

The association between psychological resilience and hair cortisol concentration in adults: A systematic review and meta-analysis

BACKGROUND

Resilience measures are typically based on subjective self-assessment, which is prone to bias. Objective biological/physiological measures of resilience are therefore needed. Hair cortisol concentration is a particularly promising candidate as a biomarker for resilience.

METHODS

We conducted a meta-analytic review from inception to April 2023 in PubMed, EMBASE, Cochrane Library, and Psych Info databases. All data were analyzed using a random-effects model.

RESULTS

Eight studies were identified that included a total of 1,064 adults. The random effects model demonstrated that resilience and hair cortisol concentration were inversely correlated (r = -0.18, 95% confidence interval [CI] = -0.27 to -0.09) with substantial heterogeneity (I2 = 54.2%, p = 0.03). The inverse association was stronger in those who were age 40 years or younger compared to those who were over 40 years. The correlation coefficients between psychological resilience and hair cortisol concentration among adults assessed by different resilience measures were r = -0.29 (95% CI = -0.49 to -0.08) for the CD-RISC-10; r = -0.21 (95% CI = -0.31 to -0.11) for the CDRISC- 25, and r = -0.08 (95% CI = -0.22 to 0.06) for the BRS. Six of eight studies examined the connection between resilience and perceived stress, where the weighted mean correlation coefficient was r = -0.45 (95% CI = -0.56 to -0.33), with considerable heterogeneity (I2 = 76.2%, p = 0.001).

CONCLUSIONS

There is a negative association between psychological resilience and hair cortisol concentration based on these eight studies. Additional research, particularly prospective studies, is needed to determine whether hair cortisol concentration can be used as a biomarker for psychological resilience.

Determination of cortisone and cortisol in human scalp hair using an improved LC-MS/MS-based method

OBJECTIVES

Human scalp hair is an easily available but complex matrix for determination of cortisone and cortisol, and has been shown to reflect long-term glucocorticoid exposure. Hair glucocorticoid analysis has been used to detect hypo- and hypercortisolism. In this study, we describe the development and validation of a LC-MS/MS method for quantification of cortisone and cortisol in human scalp hair, and provide a novel approach for analysis and interpretation of the results.

METHODS

Improved sample preparation using pulverization and solid phase extraction allowed for low sample volumes (10 mg). Baseline chromatographic separation without matrix interference was achieved by reversed phase chromatography and MRM measurement in negative ion mode. Run-to-run time was 8 min. Mixed model analyses were performed to create individual patterns of cortisone and cortisol concentrations.

RESULTS

Matrix matched calibration curves showed excellent linearity up to 100 pg (analyte)/mg (hair) for both cortisone and cortisol (R2>0.995). LLOQ was 1.5 and 1.0 pg/mg for cortisone and cortisol, respectively. Matrix effect was negligible for hair color (recoveries 95-105 %). Cortisone and cortisol concentrations decreased from proximal to distal hair segments, following a predictable, but subject-specific pattern, with less individual variation for cortisone than for cortisol.

CONCLUSIONS

This improved LC-MS/MS method is able to accurately quantify cortisone and cortisol in human hair with minimum matrix interference. This new way of data analysis and interpretation including individual patterns of cortisone and cortisol will be of help with detection of pathological concentrations in both the high - and the low ranges of glucocorticoids.

Psychological resilience and cortisol levels in adults: A systematic review

Resilience or the capacity to "bend but not break" refers to the ability to maintain or regain psychobiological equilibrium during or after exposure to stressful life events. Specifically, resilience has been proposed as a potential resource for staving off pathological states that often emerge after exposure to repeated stress and that are related to alterations in circulating cortisol. The aim of this systematic review of the literature was to gather evidence related to the relationship between psychological resilience and cortisol levels in adult humans. An extensive systematic search was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method in the PubMed and Web of Science databases. In total, 1256 articles were identified and, of these, 35 peer-reviewed articles were included in the systematic review. We categorized findings according to (1) the short and long-term secretion period covered by the cortisol matrices selected by studies and also according to (2) the differentiated diurnal, phasic (acute), and tonic (basal) components of the HPA output to which they refer and their relationships with resilience. Reported relationships between psychological resilience and distinct cortisol output parameters varied widely across studies, finding positive, negative, and null associations between the two variables. Notably, several of the studies that found no relationship between resilience and cortisol used a single morning saliva or plasma sample as their assessment of HPA axis activity. Despite limitations such as the great variability of the instruments and methods used by the studies to measure both resilience and cortisol, together with their high heterogeneity and small sample sizes, the evidence found in this systematic review points to the potential of resilience as a modifiable key factor to modulate the physiological response to stress. Therefore, further exploration of the interaction between the two variables is necessary for the eventual development of future interventions aimed at promoting resilience as an essential component of health prevention.

Dimensions of child maltreatment and longitudinal diurnal cortisol patterns: The roles of resilience and child sex

Informed by the dimensional approach to adversity, this study disaggregated child maltreatment effects to examine how abuse versus neglect influenced cortisol at the baseline assessment and longitudinal changes in diurnal cortisol among a sample of Chinese children and adolescents (N = 312; aged 9-13 years; M age = 10.80, SD = 0.84; 67% boys). The moderating roles of resilience and sex differences in these associations were also explored. Results revealed distinct effects of abuse versus neglect on diurnal cortisol in girls, but not boys, which varied by the time scale of assessment and type of cortisol measure. Specifically, abuse was associated with girls' longitudinal changes in awakening cortisol, cortisol awakening response, and diurnal cortisol slope over one year, whereas neglect was associated with girls' awakening cortisol and cortisol awakening response at the baseline assessment. Further, resilience moderated the effects of abuse on girls' baseline awakening cortisol and longitudinal changes in diurnal cortisol slope, suggesting both the potential benefits and costs of resilience. Findings support the application of the dimensional approach to research on stress physiology and deepen our understanding of individual differences in the associations between child maltreatment and diurnal cortisol.

Association of mindfulness on state-trait anxiety in choking-susceptible athletes: mediating roles of resilience and perceived stress

Introduction

It is a well-documented psychological phenomenon for athletes to experience abnormal performance on the field, often called choking. Negative emotions such as perceived stress and state-trait anxiety have been linked to this phenomenon. In an effort to delve into the intricate relationship between mindfulness and state-trait anxiety among athletes susceptible to choking, this study was conducted in Central China during the period from October to November 2022.

Methods

The sample selection process employed a combination of cluster sampling and random sampling, resulting in a total of 377 viable samples encompassing choking-susceptible athletes who frequently grapple with state-trait anxiety and demonstrate performance deviations. The data analysis was executed utilizing AMOS v.26.

Results

The results indicate a negative association between mindfulness and perceived stress (standardized coefficient = -0.224, p < 0.001), resilience and perceived stress (standardized coefficient = -0.237, p < 0.001), as well as perceived stress and state-trait anxiety (standardized coefficient = 0.510, p < 0.001). The positive impact of mindfulness on state-trait anxiety is mediated by resilience and perceived stress (standardized indirect effect = 0.237, p < 0.001). The explanatory power of this study is R2 = 0.35.

Discussion

Drawing from these substantial findings, a key recommendation is to implement mindfulness training programs for athletes prone to choking. This proactive measure, facilitated by sports departments, clubs, and coaches, could potentially alleviate state-trait anxiety, enhancing athletes' mental well-being and optimizing their performance outcomes during competitions.

Investigating resilience and its association with stress, anthropometrics, and metabolic health in adolescents with obesity: a pilot study

The increasing prevalence of children with obesity has contributed to a higher risk of developing cardiometabolic comorbidities. Adversity and chronic stress are negatively linked to cardiometabolic outcomes, and resilience is positively associated with improved outcomes. However, whether resilience is protective against metabolic disturbances preceding disease presentation is less understood. This study explored correlations between stress, anthropometrics, and metabolic parameters with resilience (total, individual, family, peers, school, community), and determined which resilience domains predict metabolically unhealthy obesity. Adolescents with obesity (n = 39; 12-18y) completed anthropometrics, an oral glucose tolerance test, the Adolescent Resilience Questionnaire, and Perceived Stress Scale. Lower stress (r = -0.70, p < 0.001), BMI (r = -0.42, p = 0.01), fat mass (ρ = -0.41, p = 0.01), and fat-free mass (ρ = -0.41, p = 0.01) were associated with greater resilience. Greater school resilience was associated with lower risk for having metabolically unhealthy obesity (odds ratio = 0.87, 95% Confidence Intervals, 0.78-0.98, p = 0.02). Our findings suggest that resilience is associated with lower adiposity, and that lower school resilience is an independent predictor of having metabolically unhealthy obesity. Further work exploring correlations between school resilience, perceived stress, and metabolic outcomes, would optimize programs for obesity-related chronic conditions.

Stressors and resilience are associated with well-being in young adult college students

Objective: The purposes were to describe stressors and resilience behaviors of college students and examine the relationships among stressors, resilience, and well-being. Hypothesis: Resilience will modify the relationship between stressors and well-being. Participants: The sample included 1,010 college students, ages 18-26, from an urban Midwestern university. Methods: A secondary analysis of cross-sectional data from an anonymous survey was conducted using multiple regression and simple slopes analysis. Results: Resilience did not modify the relationship between stressors and well-being. Stressors (β = -.44, p < .0001) and resilience (β = .33, p < .0001) accounted for 42% of the variance in well-being (adjusted R² = .42, F_2,999 = 365.98, p < .0001). The most frequently endorsed stressors were sleep problems, anxiety, and relationships. Conclusions: Stressors and resilience warrant special attention in the allocation of resources and development of programs to improve student well-being.

Relational and individual stress pathways linking discrimination and ageing cardiometabolic health

Perceived discrimination is a significant risk factor for worse ageing health outcomes. Yet, the specific individual and relational stress pathways linking discrimination to disease are less understood, especially in the context of cardiometabolic health. We tested family stress and psychophysiological distress (negative affect and high-risk lipid/fat metabolism) as mediators linking perceived discrimination to cardiometabolic morbidity and health appraisal over 20 years for midlife adults. Using data from participants who completed the Biomarker Project (2004-2009) of the Midlife in the U.S. project, and examining data over the study's three waves (1995-1996, 2004-2006, and 2013-2014), we used structural equation modelling to test pathways for participants who reported zero cardiometabolic conditions at baseline (n = 799). Greater Time 1 discrimination was associated with greater Time 2 family strain, which was in turn associated with worse negative affect; worse Time 2 negative affect was associated with worse Time 3 health appraisal; metabolic lipids risk did not serve as an indirect pathway to Time 3 cardiometabolic morbidity (χ²  = 147.74, p < 0.001; RMSEA = 0.056; CFI = 0.902; SRMR = 0.047). The inclusion of family in interventions to mitigate the impact of discrimination may be indicated for promoting cardiometabolic wellness.

Hair glucocorticoid concentration, self-perceived stress and their associations with cardiometabolic risk markers in Swedish adolescents

BACKGROUND

While hair cortisol is proposed as a biomarker for chronic stress and a possible mediator linking chronic stress and cardiovascular risk in adults, studies in adolescents are scarce. We explored the associations between self-perceived stress, hair cortisol (HairF) and cortisone (HairE), and cardiometabolic risk markers in adolescents. Further, we examined whether association between self-perceived stress and HairF may depend on the use of the coping strategies "shift-persist".

METHODS

Participants were 7th grade pupils recruited to the STudy of Adolescence Resilience and Stress (STARS) and data from the baseline examinations were used. Adolescents (n = 1553, 26 % boys, Mage=13.6, SD = 0.4) completed questionnaires assessing perceived stress and coping strategies "shift-persist", provided hair sample, and examined for cardiometabolic risk factors including waist circumference (WC), body mass index (BMI) z-score, blood pressure, and white blood cell counts (WBC). HairF and HairE were analysed using liquid chromatography with tandem mass spectrometry. We conducted descriptive analyses (Student's t-test, Wilcoxon Signed Ranks test, Chi-square test) and linear regression analyses.

RESULTS

Perceived stress was not associated with HairF, neither had the use of coping strategies "shift-persist" any influence on this association. Both HairF and HairE were positively associated with BMI z-score (beta coefficients (β): 0.178 (p < 0.001) and 0.119 (p < 0.001) for boys; 0.123 (p < 0.001) and 0.089 (p < 0.01) for girls) and WC (β: 0.089 (p > 0.05) and 0.098 (p < 0.05) for boys; 0.103 (p < 0.01) and 0.076 (p < 0.05) for girls). Perceived stress was also positively associated with BMI z-score and WC. Perceived stress, but not HairF, remained associated with WC in boys (β = 0.200, p < 0.001) in the models with HairF and perceived stress presented simultaneously. Modest association between HairE and WBC was found in boys (β = 0.149, p < 0.01).

CONCLUSIONS

The study supports the association between chronic stress and overweight/obesity in adolescents. Hair cortisol and self-perceived stress capture different aspects of how chronic stress is related to overweight/obesity in adolescents.

Relations among perceived stress, fatigue, and sleepiness, and their effects on the ambulatory arterial stiffness index in medical staff: A cross-sectional study

Objective

To explore the relations among perceived stress, fatigue, sleepiness, and the pathway of their effects on the ambulatory arterial stiffness index (AASI) among medical staff.

Methods

This cross-sectional study was conducted at a tertiary hospital in Wuhan, China. Perceived stress, fatigue, and sleepiness were measured using the perceived stress scale (PSS), Fatigue assessment scale (FAS), and Epworth Sleepiness Scale (ESS), respectively. AASI was obtained from 24-h ambulatory blood pressure monitoring. Path analysis was used to clarify the relations among the PSS, FAS, and ESS scores, and their relations to AASI values.

Results

A total of 153 participants were included herein. The PSS and FAS correlated with the ESS (r = 0.424, p < 0.001), and the PSS correlated with the FAS (r = 0.614, p < 0.001). In addition, the ESS correlated with the AASI (r = 0.225, p = 0.005). According to the path analysis results, the PSS and FAS had no direct effect on the AASI, but did have an indirect effect on this index (β = 0.059, 95% confidence interval [CI] = 0.017-0.128, p = 0.005; β = 0.059, 95%CI = 0.016-0.135, p = 0.006, respectively) by influencing the ESS (β = 0.263, β = 0.262, p = 0.004).

Conclusion

Sleepiness was a mediator of the effects of perceived stress and fatigue on AASI.

Sex-specific interventions to prevent and manage frailty

There is growing interest in interventions that delay, slow, and even reverse frailty. In this narrative review, we explore the evidence on exercise, nutrition, medication optimisation and social support interventions for frailty and consider how these relate to underlying frailty pathophysiology. We also consider pathophysiological mechanisms underpinning sex differences in frailty before evaluating the limited evidence for sex-specific frailty interventions that is currently available. Through this review of the literature, we generate a list of potential sex-specific interventions for frailty. While individual-level recommendations are certainly important, future work should turn the focus towards population-level interventions that take into account sex differences in frailty, including changes to healthcare and socioeconomic systems, as well as changes to the built environment to promote healthy behaviours.

Increases in Circulating Cortisol during the COVID-19 Pandemic are Associated with Changes in Perceived Positive and Negative Affect among Adolescents

The Coronavirus Disease 2019 (COVID-19) pandemic has spread across the world and resulted in over 5 million deaths to date, as well as countless lockdowns, disruptions to daily life, and extended period of social distancing and isolation. The impacts on youth in particular are astounding, with shifts in learning platforms, limited social outlets, and prolonged uncertainty about the future. Surveys have shown that mental health among youth has severely suffered during the pandemic. However, limited research to date has reported on physiological indices of stress surrounding the pandemic, such as cortisol. Cortisol is a stress hormone that typically increases during stressful situations and can have deleterious effects on mental and physical health when chronically heightened. The present study leveraged hair cortisol concentration measurements, which allowed the retrospectiveinvestigation of circulating cortisol prior to- versus after pandemic-related local lockdowns during the first wave of the pandemic. A final sample of 44 youth ages 10- to 18-years-old provided hair samples and reported on their perceived affective well-being and level of concern regarding pandemic-related stressors between May and June of 2020. We found significant levels of concern and decreases in affective well-being following local lockdowns. Moreover, we saw that cortisol robustly increased following local lockdowns, and those increases were predictive of changes in affect. These findings provide critical insights into the underlying neuroendocrinology of stress during the pandemic and support the need for resources to support youths’ mental health and well-being during this globally significant event.

Relationship between perceived stress and depression in Chinese front-line medical staff during COVID-19: A conditional process model

BACKGROUND

Sustained stress during COVID-19 may be associated with depression in front-line medical staff, which would expose them to severe threats. This study aimed to examine whether the relationship between perceived stress and depression is mediated by insomnia, and whether this mediation is moderated by resilience.

METHODS

For front-line medical staff, this study used online questionnaire to evaluate their perceived stress, depression, insomnia and resilience. A conditional process model was performed to examine the relationship between perceived stress and depression, as well as the mediating effect of insomnia and the moderating effect of resilience.

RESULTS

A total of 606 front-line medical staff completed the survey. Higher level of perceived stress was significantly positively related to severe insomnia and depression. In addition, insomnia was positively related to depression, while resilience could moderate the effect of perceived stress on depression by direct and indirect paths.

LIMITATIONS

The causality among perceived stress, depression, insomnia and resilience is difficult to be verified.

CONCLUSIONS

Perceived stress is positively related to depression, and insomnia can mediate the effect of perceived stress on depression. In addition, the effect of perceived stress on depression, whether direct or indirect, is moderated by resilience, which is a protective factor for mental health.

Hair cortisol, perceived stress, and resilience as predictors of coronary arterial disease

The widespread prevalence of cardiovascular disease underscores the continuing need for identifying modifiable risk factors and novel targets for therapeutic intervention. Hair cortisol concentration (HCC) is a promising biomarker for evaluating the contribution of chronic stress to the pathogenesis and prognosis of coronary arterial disease (CAD). In this cross-sectional study of 24 participants, we assessed the risk of CAD associated with HCC and with perceived chronic stress (Perceived Stress Score), controlling for the established risk factors of age, diabetes, hypertension, dyslipidemia, and obesity. In fully adjusted Poisson regression models, we additionally evaluated CAD risk with the simultaneous inclusion of psychological and physiologic resilience measures (CD-RISC, DHEA-S). Our results show that HCC, but not PSS, is significantly associated with CAD (incident rate ratio 0.99, confidence interval 0.98-1.00, p = 0.01), but the magnitude of the association is weak and inverse, and less than with dyslipidemia and age. The association remained significant after inclusion of the sum of resilience measures via a combined resiliency score. Resilience was not independently significantly associated with CAD. Our findings indicate the contribution of HCC to CAD risk is small in an average-risk population and remains after adjustment for multisystem resilience.

Stressor-Induced Temporal Cortisol Deficiency as a Primary Trigger for Adaptation to Stress

BACKGROUND

Inconsistencies in measurements of cortisol response to stress have caused disagreements in the direction of the change in cortisol concentrations immediately after the onset of stress. Researchers typically observe increased cortisol levels in response to a stressor, perceiving occasional decreases as a sign of possible disorders. Reports indicate the relative ease of standardizing a physical stressor compared with a mental stressor, and cross-stressor adaptation is observable only in elite athletes.

METHODS

We investigated the cortisol response to top-intensity physical exertion by analyzing the course of the cortisol response, the changes in this response resulting from adaptation to intense exercise, and the possible convergence between the cortisol changes and body fat content. We examined 16 male athletes, members of the Polish National Rowing Team, competing in the World Rowing Championships, in top form, of an average training experience of seven years. The measurements were performed before and after the training camp preparatory to the Championships. We performed the measurements before and after the training camp preparatory to the Championships.

RESULTS

Before the camp, the athletes consistently reacted to the exertion test with a decrease in cortisol concentration and elevated cortisol levels after rest compared with baseline. After the camp, the post-exertion cortisol decrease as well as the post-rest cortisol elevation was much smaller and less consistent.

CONCLUSIONS

The transient decrease in cortisol concentration at the onset of stress thus represents a physiological reaction, and the stress response counteracts the resulting cortisol deficiency to support cortisol availability during stress. Adaptation to stress enhanced this counteracting effect by (1) increasing the baseline cortisol concentration and (2) speeding up the response to its decline. This enhanced effect was boosted by adipose tissue.

"If You Love Me, You Must Do..." Parental Psychological Control and Cyberbullying Perpetration Among Chinese Adolescents

Considering the prevalence of cyberbullying, the current study explores the factors associated with its perpetration. Using self-determination theory, the association of parental psychological control (PPC) with cyberbullying perpetration was examined. To explore this influencing mechanism further, psychological reactance (PRt) and materialism were examined as two mediators in this relationship. Moreover, according to the diathesis-stress model and cognitive model of resilience, psychological resilience (PRl) was examined as a moderator in the direct and indirect link between PPC and cyberbullying perpetration. To test our expectations, 804 adolescents (M = 13.12, SD = 1.16) participated in the current study using a cross-sectional design and multiple questionnaires, namely, the Chinese version of the Parental Control Questionnaire, Revised Cyber Bullying Inventory, Hong Psychological Reactance Scale, Material Values Scale for Children, and Resilience Scale for Chinese Adolescents. Correlation analysis indicated that PPC, PRt, materialism, and cyberbullying perpetration were significantly and positively correlated, and were significantly and negatively related to PRl. Moderated mediation analysis revealed that PRt and materialism played multiple mediating roles in the relationship between PPC and cyberbullying perpetration. Multiple mediation analysis indicated that PRl weakened the direct associations of PPC, PRt, and materialism with cyberbullying perpetration, further alleviating the indirect and direct associations of PPC with cyberbullying perpetration, supporting the moderated mediation model. Specifically, adolescents high in PPC were more likely to have stronger PRt and materialistic values, which further triggered cyberbullying perpetration. PRl can protect adolescents high in PPC from cyberbullying perpetration via weakening the direct and indirect associations of PPC with cyberbullying.

Hair Cortisol Concentration, Perceived Stress, Mental Well-Being, and Cardiovascular Health in African American Older Adults: A Pilot Study

(1) Background: African Americans experience high rates of psychological stress and hypertension, which increases their risk of cardiovascular disease with age. Easy-to-collect psychological and biological stress data are valuable to investigations of this association. Hair cortisol concentration (HCC), as a proxy biomarker of chronic stress exposure, provides such advantages in contrast to collection of multiple daily samples of saliva. Objective: To examine the relationships among HCC, perceived stress, mental well-being, and cardiovascular health (systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)). (2) Methods: Cross-sectional secondary data (N = 25) were used from a mind–body intervention study in hypertensive African Americans ages 65 and older. Data included HCC, a four-item perceived stress scale, SF-36 mental components summary, and SBP/DBP. SBP + 2 (DBP)/3 was used to calculate MAP. (3) Results: The relationship between mental well-being and perceived stress (r = −0.497, p ≤ 0.01) and mental well-being and DBP (r = −0.458, p = 0.02) were significant. HCC change was not significant. In a regression model, every unit increase in well-being predicted a 0.42 decrease in DBP (β = −0.42, 95% CI (−0.69–0.15)) and a 1.10 unit decrease in MAP (β = −1.10, 95% CI (−1.99–0.20)). (4) Conclusions: This study contributes to the knowledge of physiologic data regarding the relationship between MAP and well-being. Findings from this study may aid in the development of interventions that address mental well-being and cardiovascular health in African American older adults with hypertension.

Psychological Resilience, Cardiovascular Disease, and Metabolic Disturbances: A Systematic Review

Background

Positive psychosocial factors can play an important role in the development of cardiovascular disease (CVD). Among them, psychological resilience (PR) is defined as the capacity of responding positively to stressful events. Our aim was to assess whether PR is associated with CVD or metabolic disturbances through a systematic review.

Methods

We gathered articles from PubMed, Web of Science, PsycInfo, and Google Scholar up to October 28, 2021. We included articles that were in English, were observational, and had PR examined as exposure. The CVD outcomes were either clinical or metabolic outcomes (i.e., dyslipidemia, obesity, metabolic syndrome, hypertension, and diabetes).

Results

Our literature search identified 3,800 studies, of which 17 met the inclusion criteria. Of them, seven were longitudinal and 10 cross-sectional, and 13 were on adults and four on children. The exposure assessment was heterogeneous, i.e., 12 studies used different kinds of self-administered questionnaires and five used interviews with a psychologist. Regarding outcomes, five studies investigated CVD, seven obesity, one metabolic syndrome, two hypertension, four dyslipidemia, and four diabetes. In longitudinal studies, PR was found to have an inverse association with included outcomes in five studies from the Swedish military conscription cohort but had no association with CVD in a study on African-American women and was associated with slower progression of diabetes in a general population. The cross-sectional studies showed that the prevalence of disease was not associated with PR in many cases but the progression of disease was associated with PR.

Conclusion

PR seems to have a possibly favorable association with CVD and metabolic disturbances that differs according to the type of outcome and population. Our study limitations are given by the small number of studies available and the heterogeneity in PR measurement.

Systematic Review Registration

[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=237109], identifier [CRD42021237109].

A 14-day ecological momentary assessment study on whether resilience and early family risk moderate daily stress and affect on cortisol diurnal slope

This study examined whether resilience capacity moderates the association of daily perceived stress and affect with cortisol diurnal slope among relocated emerging adults. Relocated undergraduates (N = 98; aged 18-25 years) were recruited from three groups: Resilient, Vulnerable, and Control. The Resilient group required Risky Family Questionnaire (RFQ) scores ≥ 29 and Brief Resilience Scale (BRS) scores ≥ 3.6. The Vulnerable group required RFQ scores ≥ 29 and BRS scores ≤ 3. The comparison Control group required RFQ scores ≤ 21 and T-scores < 60 on PROMIS anxiety and depression symptoms. Mixed-effects models were used to test the unique associations of perceived stress, negative affect, and positive affect x group interactions (predictors) on diurnal cortisol slope (outcome) across 14 consecutive days. The Resilient group did not moderate the associations between daily stress or affect on cortisol diurnal slope. Instead, both the Resilient and Vulnerable groups with early family risk, showed a steeper diurnal slope unique to higher stress and a flatter slope unique to higher negative affect. Results suggest that riskier early family life was significantly associated with altered cortisol diurnal slope outcomes to stress (i.e., demand) and negative affect (i.e., distress). These associations were not attenuated by current resilience capacity.

Three-Faceted Approach to Perceived Stress: A Longitudinal Study of Stress Hormones, Personality, and Group Cohesion in the Real-Life Setting of Compulsory Basic Military Training

Compulsory basic military training is characterized not only by being challenging but also by being stressful. Assuming a high frequency of perceived stress events as a negative outcome of training, this article provides evidence on how the perceived frequency of stressful situations is affected by three types of factors: (i) biological stress response variables measured by hair steroid hormone levels, (ii) personality traits measured using the Big Five personality test, and (iii) group cohesion measures in military squads. A total of 112 conscripts in 11 squads participated in the research at the beginning (T1), in the middle (T2), and at the end (T3) of compulsory basic military training. Hair steroid hormone levels (cortisol, cortisone, and dehydroepiandrosterone (DHEA)) levels were measured by liquid mass spectrometry; other data were collected using self-report questionnaires. The results of the Poisson regression analysis indicated that hair steroid hormone cortisol had a statistically significantly impact and could increase the perceived frequency of stressful situations by up to 1.317 (e0.275, T2) times. The concentrations of other hormones (cortisone = 1.157, e0.146, T3 and DHEA = 1.020, e0.020, T3) also had a statistically significant effect. Other factors had a decreasing effect on the frequency. Extraversion was significant with an effect of 0.907 (e−0.098, T2) and 0.847 (e−0.166, T3), while task cohesion had an effect of 0.946 (e−0.056) and norm cohesion of 0.954 (e−0.047). The research indicates that the three groups of factors affect the perceived frequency of stressful situations during compulsory basic military training, but their impacts are considerably different.

Perceived stress and hair cortisol concentration in a study of Mexican and Icelandic women

Hair cortisol concentration (HCC) represent a potential biomarker of chronic psychological stress. Previous studies exploring the association between perceived stress and HCC have been limited to relatively small and selected populations. We collected hair samples from 881 women from the Mexican Teachers' Cohort (MTC) and 398 women from the Icelandic SAGA pilot-cohort following identical protocols. HCC was quantified using liquid chromatography coupled with tandem mass spectrometry. The self-reported Perceived Stress Scale (PSS, 10 and 4 item, range 0-40 and 0-16) was used to assess psychological stress. We conducted multivariable linear regression analyses to assess the association between perceived stress and log-transformed HCC in the combined sample and in each cohort separately. MTC participants had slightly higher HCC and PSS scores than SAGA participants (median HCC 6.0pg/mg vs. 4.7pg/mg and mean PSS-10 score 12.4 vs. 11.7, respectively). After adjusting for sociodemographic factors and health behaviors, we observed a 1.4% (95% CI 0.6, 2.1) increase in HCC for each unit increase in the PSS-10 score in the combined sample. Furthermore, PSS-10 quintiles were associated with a 24.3% (95% CI 8.4, 42.6, mean logHCC 1.8 vs 1.6) increase in HCC when comparing the highest to the lowest quintile, after multivariable adjustment. Similar results were obtained when we analyzed each cohort separately and when using the PSS-4. Despite relatively small absolute differences, an association between perceived stress and HCC was found in a sample of women from two diverse geographical and cultural backgrounds supporting the hypothesis that HCC is a viable biomarker in studies of chronic psychological stress.

Association of primary allostatic load mediators and metabolic syndrome (MetS): A systematic review

Allostatic load (AL) exposure may cause detrimental effects on the neuroendocrine system, leading to metabolic syndrome (MetS). The primary mediators of AL involve serum dehydroepiandrosterone sulfate (DHEAS; a functional HPA axis antagonist); further, cortisol, urinary norepinephrine (NE), and epinephrine (EPI) excretion levels (assessed within 12-h urine as a golden standard for the evaluation of the HPA axis activity and sympathetic nervous system activity). However, the evidence of an association between the primary mediators of AL and MetS is limited. This systematic review aimed to critically examine the association between the primary mediators of AL and MetS. PubMed and Web of Science were searched for articles from January 2010 to December 2021, published in English. The search strategy focused on cross-sectional and case-control studies comprising adult participants with MetS, obesity, overweight, and without chronic diseases. The STROBE checklist was used to assess study quality control. Of 770 studies, twenty-one studies with a total sample size (n = 10,666) met the eligibility criteria. Eighteen studies were cross-sectional, and three were case-control studies. The included studies had a completeness of reporting score of COR % = 87.0 ± 6.4%. It is to be noted, that cortisol as a primary mediator of AL showed an association with MetS in 50% (urinary cortisol), 40% (serum cortisol), 60% (salivary cortisol), and 100% (hair cortisol) of the studies. For DHEAS, it is to conclude that 60% of the studies showed an association with MetS. In contrast, urinary EPI and urinary NE had 100% no association with MetS. In summary, there is a tendency for the association between higher serum cortisol, salivary cortisol, urinary cortisol, hair cortisol, and lower levels of DHEAS with MetS. Future studies focusing on longitudinal data are warranted for clarification and understanding of the association between the primary mediators of AL and MetS.

Association of Psychological Resilience with All-Cause and Cardiovascular Mortality in a General Population in Italy: Prospective Findings from the Moli-Sani Study

Psychological resilience (PR) is the capacity to adapt positively in face of adversity. Its role as an independent protective factor has been acknowledged in recent years. We aimed to test the association of PR with all-cause and cardiovascular disease (CVD) mortality in a general adult population. We performed longitudinal analyses on 10,406 CVD-free individuals from the Moli-Sani cohort (follow up = 11.2 year). PR was assessed by the 25-item Connor and Davidson resilience scale. PR factors were identified through polychoric factor analysis. Associations with mortality were tested using multivariable Cox regressions. Higher levels of PR were associated with reduced all-cause mortality in a model including sex and age (HR = 0.78; 95%CI 0.62-1.00). The association decreased after inclusion of socioeconomic, clinical, and behavioral factors into the model (HR = 0.80; 95%CI 0.62-1.03). No relation was observed with cardiovascular mortality in the fully adjusted model (HR = 0.89; 95%CI 0.56-1.39). An inverse association of Factor 1 (reflecting positive acceptance of change) with all-cause mortality (HR = 0.89; 95%CI 0.82-0.98; p value = 0.01) was found. However, at a borderline non-significant way, PR predicts all-cause mortality in a general population of Italian adults. This is supported by the findings demonstrating a significant association between the PR's domain reflecting a positive acceptance of change and all-cause mortality.

Latent profile analysis of stress and resilience among rural women: A cross-sectional study

Stress is a cardiovascular disease risk factor, and resilience may serve as a buffer for stress. Little is known about stress and resilience among rural women.

OBJECTIVE

The purposes of this study were to identify profiles of rural women based upon indicators of psychosocial and environmental stress and to examine the relationships between the identified profiles and resilience.

DESIGN AND SAMPLE

A cross-sectional, descriptive design was used to explore stress, social support, and resilience among a representative sample of women (n = 354).

MEASURES

Data were collected to measure perceived stress, social support, chronic stress, and resilience.

RESULTS

A latent profile analysis identified three profiles (59.9% Low Stress, 25.4% Moderate Stress, and 14.7% High Stress). Women in the High Stress profile were less likely to afford necessities and have attended college and more likely to be employed. Women in the Low Stress profile had the highest scores for all five resilience subscales.

CONCLUSION

The current study demonstrates the social and environmental impact of stress and how this stress can manifest differently for different women. Underserved women may benefit from strategies that reduce stress and improve social support and resilience. Future research is needed for advancing health equity in rural populations.

Cognitive Reserve and Anxiety Interactions Play a Fundamental Role in the Response to the Stress

The aims of the present study were to assess the possible interaction between Cognitive Reserve (CR) and State Anxiety (SA) on adrenocortical and physiological responses in coping situations. Forty healthy, middle-aged men completed the Cognitive Reserve Scale and the State-Trait Anxiety Inventory. We used an Observational Fear Conditioning (OFC) paradigm in order to assess emotional learning and to induce stress. Electrodermal activity (EDA) and salivary cortisol concentrations were measured throughout the conditions. Our results indicate that those who indicated having higher state anxiety showed a lower capacity for learning the contingency, along with presenting higher salivary cortisol peak response following the observational fear-conditioning paradigm. The most prominent finding was the interaction between cognitive reserve and state anxiety on cortisol response to the post observational fear-conditioning paradigm. Thus, those who showed a high anxiety-state and, at the same time, a high cognitive reserve did not present an increased salivary cortisol response following the observational fear-conditioning paradigm. Given these results, we postulate that the state anxiety reported by participants, reflects emotional activation that hinders the attention needed to process and associate emotional stimuli. However, cognitive reserve has an indirect relation with conditioning, enabling better emotional learning. In this context, cognitive reserve demonstrated a protective effect on hormonal response in coping situations, when reported anxiety or emotional activation were high. These findings suggest that cognitive reserve could be used as a tool to deal with the effects of stressors in life situations, limiting development of the allostatic load.

Association of stress and resilience with cardiometabolic health among American Indian and Alaska Native adults

Evidence suggests that perceived stress and psychological resilience are related to the presence and severity of cardiometabolic disease. Despite increased stress and cardiometabolic disease burden among American Indian and Alaska Native (AI/AN) people, the relationships between these factors are not well established in these populations. The objective of this study was to evaluate the relationships of stress with five cardiometabolic health indicators and to assess whether psychological resilience mediates these relationships in AI/AN adults. Four hundred and ninety-six AI/AN attendees were surveyed at three powwows. The questionnaire included sociodemographic items, questions on self-reported obesity, prediabetes, diabetes, high blood pressure, and high cholesterol, the Perceived Stress Scale, and the Brief Resilience Scale. Multivariable logistic regression models were used to measure associations of health indicators with Perceived Stress Scale and Brief Resilience Scale scores while controlling for sociodemographic characteristics. Among respondents, obesity was the most common cardiometabolic health indicator reported (48%), followed by high blood pressure, prediabetes, diabetes, and high cholesterol. Mean Perceived Stress Scale and Brief Resilience Scale scores were 16.1 (6.4 SD) and 3.5 (0.7 SD), respectively. Higher Perceived Stress Scale scores were associated with greater odds of self-reported prediabetes and diabetes. Brief Resilience Scale scores did not serve as a mediator. These results suggest that perceived stress is associated with some self-reported indicators of cardiometabolic health among AI/AN adults, but findings are limited by the convenience sample, reliance on self-report, and cross-sectional design. Future work should capitalize on nationally representative data, longitudinal designs, and objective measures of cardiometabolic health.

Factors Associated with Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data

Background

The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact.

Objective

This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress.

Methods

HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally.

Results

A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial.

Conclusions

High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic.

The effect of diet and regular exercise on psychological resilience in obese or overweight women

AIM

This study aimed to investigate the effects of diet and regular exercise on resilience in obese or overweight women.

METHODS

The study was conducted with the 109 patients who applied to the obesity polyclinics. The patients were divided into three groups by their current disease conditions and willingness; those who were willing to both diet and exercise (diet + exercise group) (n: 35), those who were willing to only diet (diet group) (n: 37) and those who were not willing to recommended diet or exercise (control group) (n: 37). The "Connor-Davidson Resilience Scale" (CD-RISC) was applied to all the participants through face-to-face interviews. The CD-RISC scale was repeated 8 weeks after the first evaluation.

RESULTS

There was a significant difference between the total score and subscores of the scale in the intra-group comparison before and after the intervention (P < .05). When the groups were compared after the intervention, a significant difference was found between the diet group and the control group as well as the exercise +diet group and the control group (P < .05).

CONCLUSION

We found that diet and exercise practices increased psychological endurance in obese or overweight women. In addition, positive improvements were also detected in psychological resilience subgroups such as perseverance and personal competence, tolerance to negative events and spiritual disposition.

Stress, Social Support, and Resilience in Younger Rural Women: A Structural Equation Model

Cardiovascular disease is a global public health problem and leading cause of death. Stress is a modifiable cardiovascular disease risk factor. The objectives of this study were to examine whether stress was a predictor of resilience among rural younger women and to explore whether social support mediated the relationship between acute stress and resilience and between chronic stress and resilience. The study had a cross-sectional, descriptive design. A total of 354 women were randomly recruited in the rural, southeastern United States. Survey instruments were used to collect data about acute stress, chronic stress, social support, and resilience. A structural equation model was fit to test whether social support mediated the relationship between perceived stress and resilience and between chronic stress and resilience. Chronic stress predicted family and belongingness support and all the resilience subscales: adaptability, emotion regulation, optimism, self-efficacy, and social support. Acute stress predicted the self-efficacy subscale of resilience. Family support partially mediated the relationship between chronic stress and self-efficacy. Belongingness support partially mediated the relationships between chronic stress and the social support subscale of resilience.

Childhood trauma, the stress response and metabolic syndrome: A focus on DNA methylation

Childhood trauma (CT) is well established as a potent risk factor for the development of mental disorders. However, the potential of adverse early experiences to exert chronic and profound effects on physical health, including aberrant metabolic phenotypes, has only been more recently explored. Among these consequences is metabolic syndrome (MetS), which is characterised by at least three of five related cardiometabolic traits: hypertension, insulin resistance/hyperglycaemia, raised triglycerides, low high-density lipoprotein and central obesity. The deleterious effects of CT on health outcomes may be partially attributable to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which coordinates the response to stress, and the consequent fostering of a pro-inflammatory environment. Epigenetic tags, such as DNA methylation, which are sensitive to environmental influences provide a means whereby the effects of CT can be biologically embedded and persist into adulthood to affect health and well-being. The methylome regulates the transcription of genes involved in the stress response, metabolism and inflammation. This narrative review examines the evidence for DNA methylation in CT and MetS in order to identify shared neuroendocrine and immune correlates that may mediate the increased risk of MetS following CT exposure. Our review specifically highlights differential methylation of FKBP5, the gene that encodes FK506-binding protein 51 and has pleiotropic effects on stress responding, inflammation and energy metabolism, as a central candidate to understand the molecular aetiology underlying CT-associated MetS risk.

Association between hair cortisol concentration and metabolic syndrome

Metabolic syndrome (MetS) is a highly prevalent disorder defined as a cluster of cardiometabolic risk factors including obesity, hyperglycemia, hypertension, and dyslipidemia. It is believed that excessive cortisol secretion due to psychosocial stress-induced hypothalamic-pituitary-adrenal axis activation might be involved in the pathogenesis of MetS. We sought to explore the association between MetS and psychosocial risk factors, as well as cortisol concentration measured in different biological specimens including saliva, blood serum, and hair samples. The study was conducted on a sample of 163 young and middle-aged men who were divided into groups according to the presence of MetS. Hair cortisol concentration (HCC) was determined using high performance liquid chromatography with UV detection, while blood serum and salivary cortisol levels were measured by enzyme-linked immunoassay. Lipid metabolism biomarkers were determined using routine laboratory methods. Anthropometric and lifestyle characteristics, as well as self-reported psychosocial indicators, were also examined. Significantly higher HCC and lower social support level among participants with MetS compared with individuals without MetS were found. However, no significant differences in blood serum and salivary cortisol levels were observed between men with and without MetS. In conclusion, chronically elevated cortisol concentration might be a potential contributing factor to the development of MetS.

A Conditional Process Model to Explain Somatization During Coronavirus Disease 2019 Epidemic: The Interaction Among Resilience, Perceived Stress, and Sex

Background

More than 15% of Chinese respondents reported somatic symptoms in the last week of January 2020. Promoting resilience is a possible target in crisis intervention that can alleviate somatization.

Objectives

This study aims to investigate the relationship between resilience and somatization, as well as the underlying possible mediating and moderating mechanism, in a large sample of Chinese participants receiving a crisis intervention during the coronavirus disease 2019 epidemic.

Methods

Participants were invited online to complete demographic information and questionnaires. The Symptom Checklist-90 somatization subscale, 10-item Connor–Davidson resilience scale, and 10-item Perceived Stress Scale were measured.

Results

A total of 2,557 participants were included. Spearman correlation analysis revealed that lower resilience was associated with more somatic symptoms (p < 0.001). The conditional process model was proved (indirect effect = −0.01, 95% confidence interval = [−0.015, −0.002]). The interaction effects between perceived stress and sex predicted somatization (b = 0.05, p = 0.006).

Conclusion

Resilience is a key predictor of somatization. The mediating effects of perceived stress between resilience and somatization work in the context of sex difference. Sex-specific intervention by enhancing resilience is of implication for alleviating somatization during the coronavirus disease 2019 epidemic.

Correlates of psychological resilience and risk: Prospective associations of self-reported and relative resilience with Connor-Davidson resilience scale, heart rate variability, and mental health indices

BACKGROUND

There are several ways to determine psychological resilience. However, the correlation between each measurement is not clear. We explored associations of baseline relative "resilience" and risk with later self-reported trait resilience and other biological/mental health indices.

METHODS

We utilized baseline and follow-up survey data from 500 participants aged 30-64 in the community cohort. Baseline "relative" resilience was defined by: (a) negative life events (NLEs) in the six months before baseline and (b) depressive symptoms at baseline, yielding four groups of individuals: i) "Unexposed and well," "Vulnerable (depression)," "Reactive (depression)," and "Resilient." "Trait" resilience at follow-up was self-reported using the Connor-Davidson Resilience Scale (CD-RISC). Associations between relative resilience at baseline, CD-RISC, and heart rate variability (HRV) indices at follow-up were assessed with generalized linear regression models after adjustments. Associations between baseline resilience and subsequent loneliness/depression indices were also evaluated.

RESULTS

Overall trait resilience and its subfactors at follow-up showed strong negative associations with "Reactive" at baseline (adj-β for total CD-RISC score: -11.204 (men), -9.472 (women)). However, resilience at baseline was not associated with later HRV, which was compared with the significant positive association observed between CD-RISC and HRV at the same follow-up time point. The "Reactive" exhibited significantly increased depressive symptoms at follow-up. The overall distribution pattern of CD-RISC subfactors differed by baseline resilience status by sex.

CONCLUSIONS

The "relative" resilience based on the absence of depression despite prior adversity seems to be highly related with trait resilience at follow-up but not with HRV. The sub-factor pattern of CD-RISC was different by sex.

What If Violent Behavior Was a Coping Strategy? Approaching a Model Based on Artificial Neural Networks

The aggressor sets in motion dysfunctional and violent behaviors with others in the dynamic of bullying. These behaviors can be understood as misfit coping strategies in response to environmental demands perceived as stressful, putting at risk the quality of education. The aim of this study was to develop a predictive model based on artificial neural networks (ANN) to forecast a violent coping strategy based on perceived stress, resilience, other coping strategies and various socio-demographic variables. For this purpose, the Stress Coping Questionnaire (SCQ), the Perceived Stress Scale (PSS) and the Brief Resilient Coping Scale (BRCS) were administered to 283 participants from the educational field (71.5% women). The design was cross-sectional. An inferential analysis (multilayer perception ANN) was performed with SPSS version 24. The results showed a predictive model that took into consideration the subject’s stress levels, personal assessment and strategies such as negative self-targeting or avoidance to predict open emotional expression (a coping strategy defined by violent behaviors) in approximately four out of five cases. The conclusions emphasis the need for considering problem solving, stress management and coping skills to prevent school violence and improve the social environment through sustainable psychological measures.