Cumulative cortisol exposure increases during the academic term: Links to performance-related and social-evaluative stressors

Chronic Stress Related to Cancer Incidence, including the Role of Metabolic Syndrome Components

Epidemiological results on the link between chronic stress and cancer initiation have been inconsistent. This study examined the relation between chronic biological stress, indicated as hair cortisol (HairF) and hair cortisone (HairE), and cancer incidence, adjusting for metabolic syndrome (MetS) components. We analyzed HairF and HairE samples from 6341 participants from the population-based cohort Lifelines in 2014. A linkage with the Dutch Nationwide Pathology Databank (Palga) provided the cancer incidence from 2015 to 2021. The association between dichotomized HairF and log-transformed HairE (LogHairE) and cancer incidence was estimated using Cox regression. MetS components were evaluated as confounders or moderators. Of the 2776 participants with known HairF levels and no cancer history, 238 developed cancer. The HairF level did not predict cancer incidence (HR: 0.993, 95%CI: 0.740-1.333). No confounders or moderators were identified. Among the 4699 participants with known HairE levels and no cancer history, 408 developed cancer. There was no association between LogHairE and cancer incidence (HR: 1.113, 95%CI: 0.738-1.678). When including age as a confounder and gender as a moderator, LogHairE was statistically significantly associated with cancer incidence (HR: 6.403, 95%CI: 1.110-36.92). In a population-based cohort, chronic biological stress, measured by HairE, was associated with cancer incidence, after controlling for age and gender.

Pain of Threatened Self: Explicit and Implicit Self-Esteem, Cortisol Responses to a Social Threat and Pain Perception

Background: Rejection, injustice, and exclusion from meaningful interpersonal relationships are often extremely painful and stress-generating experiences. This study aimed to define the role of explicit and implicit self-esteem in pain perception as a component of the physiological-psychological system that regulates the body's response to stress associated with the threat of social rejection. Methods: In total, 360 individuals participated in this study. The measurement of cortisol in saliva, the assessment of pain thresholds using thermal stimuli, the IAT to assess implicit self-esteem, and a questionnaire on global self-esteem and social pain were used. The study included three measurements: baseline and 15 and 45 min after the application of a laboratory socially threatening stimulus (the Trier Social Stress Test). Results: People experiencing chronic social pain (CSP) are more likely to have fragile self-esteem, higher pain thresholds, and tend to experience reduced pain tolerance in situations of acute social threat than people without CSP experience. In people with CSP and fragile self-esteem, after the introduction of a social threat, an increase in pain tolerance was observed along with a longer-lasting increase in cortisol levels. Conclusions: Fragile self-esteem, along with feelings of chronic exclusion, injustice, and rejection, may prolong stress reactions and produce a hypoalgesic effect.

Investigating Cortisol in a STEM Classroom: The Association Between Cortisol and Academic Performance

Science, technology, engineering, and mathematics (STEM) education can be stressful, but uncertainty exists about (a) whether stressful academic settings elevate cortisol, particularly among students from underrepresented racial/ethnic groups, and (b) whether cortisol responses are associated with academic performance. In four classes around the first exam in a gateway college STEM course, we investigated participants' (N = 271) cortisol levels as a function of race/ethnicity and tested whether cortisol responses predicted students' performance. Regardless of race/ethnicity, students' cortisol, on average, declined from the beginning to the end of each class and across the four classes. Among underrepresented minority (URM) students, higher cortisol responses predicted better performance and a lower likelihood of dropping the course. Among non-URM students, there were no such associations. For URM students, lower cortisol responses may have indicated disengagement, whereas higher cortisol responses may have indicated striving. The implication of cortisol responses can depend on how members of a group experience an environment.

Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students

AIMS

The impact of the extent of mentally demanding work on the next-day's strain is largely unknown, as existing studies generally investigate consequences of extended versus normal workdays. The present study sought to fill this gap by investigating how short work periods of mentally demanding academic work impact strain reactions in medical students preparing for an exam, using days of no work as reference category.

METHOD

The observational design involved students repeatedly self-reporting fatigue, vigor, distress, and the preceding day's study duration. Hours of nocturnal sleep, attending paid work and compulsory classes, gender, and proximity to the exam were controls in the linear model (generalized estimating equations). Forty-nine students provided 411 self-reports (M = 8.6, SD = 7.0 self-reports/student).

RESULTS

Engaging in mentally demanding work was associated with increased distress and work periods > 4 h with increased fatigue. Distress, vigor loss, and fatigue increased in proximity to the exam.

CONCLUSION

Despite students' high control of their schedule, even short periods of mentally highly demanding work may impair next-day's well-being when task motivation is high. Freelancers and students might require health-promoting scheduling of work and leisure to avoid an accumulation of strain.

Academic stress and academic burnout in adolescents: a moderated mediating model

Objective

This study aims to investigate the relationship and mechanisms of action among academic stress, academic anxiety, academic self-efficacy, and academic burnout among adolescents.

Methods

A study of 929 Chinese adolescents (53.71% males, mean age = 11.94 years, SD = 0.77) was conducted using the Study Stress Questionnaire, Academic Anxiety Subscale, Junior Middle School Students' Learning Weariness Scale, and the Academic Self-efficacy Questionnaire.

Results

①Academic stress was significantly and positively correlated with academic anxiety and academic burnout, and significantly and negatively correlated with academic self-efficacy. ②Academic anxiety partially mediated the relationship between academic stress and academic burnout. ③Academic self-efficacy significantly moderated the direct effect of academic stress on academic burnout, and higher academic self-efficacy could buffer the negative effect of academic stress. ④Academic self-efficacy significantly moderated the second half of the mediated model's path (academic anxiety → academic burnout), that is, low academic self-efficacy amplified the risk effect of academic anxiety on academic burnout.

Conclusion

Academic anxiety partially mediates the relationship between academic stress and academic burnout, and this mediating role is moderated by academic self-efficacy.

Association between academic pressure, NR3C1 gene methylation, and anxiety symptoms among Chinese adolescents: a nested case-control study

BACKGROUND

Academic pressure is a prevalent stressor among Chinese adolescents and is often linked to anxiety symptoms, although the underlying mechanism remains unclear. This study aimed to investigate the association between NR3C1 gene methylation, academic pressure, and anxiety symptoms among Chinese adolescents.

METHODS

This nested-case control study included 150 adolescents (boys: 38.7%; baseline age: 12-17 years) from a school-based longitudinal study of Chinese adolescents. Cases (n = 50) were defined as those with anxiety symptoms at both baseline and follow-up, while controls (n = 100) were randomly selected from those without anxiety symptoms at both timepoints. The cases and controls were 1:2 matched by age. Academic pressure, anxiety symptoms, and potential covariates were measured using a self-report questionnaire. Peripheral whole blood samples were collected from each participant for the detection of cortisol level (i.e., morning serum cortisol level) and DNA methylation. The methylation analysis included a total of 27 CpG units at the NR3C1 promoter region.

RESULTS

The final adjusted models showed that students with heavy academic pressure at baseline were at a higher risk of anxiety symptoms at follow-up compared to those with mild academic pressure (β estimate: 6.24 [95% CI: 3.48 ~ 9.01]). After adjusting for covariates, the methylation level of one CpG unit (NR3C1-16 CpG10) in NR3C1 differed significantly between cases and controls (F = 6.188, P = 0.014), and the difference remained significant after correction for multiple testing (P < 0.025). The adjusted regression models showed that moderate (β estimate = 0.010 [95% CI: 0.000 ~ 0.020], P = 0.046) and heavy (β estimate = 0.011 [95% CI: 0.001 ~ 0.020], P = 0.030) academic pressure were significantly associated with the methylation level of NR3C1-16 CpG 10. Further mediation analysis demonstrated that the association of academic pressure and anxiety symptoms was significantly mediated by the methylation of NR3C1-16 CpG 10 (β estimate for indirect effect = 0.11 [95% CI: 0.005 ~ 0.32]; indirect/total effect = 8.3%).

CONCLUSION

The present study suggests that NR3C1-16 CpG 10 DNA methylation might be a potential mechanism that partially explains the lasting effects of academic pressure on subsequent anxiety symptoms among adolescents. Further studies with larger sample sizes are recommended to replicate this finding.

The association between study conditions and hair cortisol in medical students in Germany - a cross-sectional study

BACKGROUND

Medical students often experience high levels of stress due to adverse study conditions, which may have adverse health consequences. Hair cortisol concentration (HCC) has been described as a physiological marker for chronic stress and might thus help to identify students under stress and examine the study conditions being responsible for long-term physiological stress responses. This study therefore investigated the association between study conditions and HCC in a sample of medical students.

METHODS

Fifty-five students from a medical school in Germany completed a paper-based questionnaire and had hair samples collected between May 2020 and July 2021. Study conditions were assessed with student versions of questionnaires based on the Job-Demand-Control-Support model (StrukStud, 25 items) and Effort-Reward Imbalance model (Student ERI, nine items). HCC of two centimeters closest to the scalp were determined by a cortisol luminescence immunoassay. Linear multiple regression analyses were performed to examine associations between study conditions and HCC.

RESULTS

Demands (B = 0.23, p = 0.002), effort (B = 0.12, p = 0.029) and the effort-reward-ratio (B = 0.28, p = 0.007) were positively associated with HCC in separate regression analyses, adjusted for age and sex. Only the association between demands and HCC remained significant when all components of the respective questionnaire were considered in the same model (B = 0.22, p = 0.003).

CONCLUSION

The results suggest that adverse study conditions may be associated with activation of the hypothalamic-pituitary-adrenal axis stress response as reflected by increased HCC. Longitudinal research is needed to confirm these cross-sectional results and examine effects of more prolonged stress due to adverse study conditions.

Interactive teaching enhances students' physiological arousal during online learning

The pure transfer of face-to-face teaching to a digital learning environment can be accompanied by a significant reduction in the physiological arousal of students, which in turn can be associated with passivity during the learning process, often linked to insufficient levels of concentration and engagement in the course work. Therefore, the aim of this study was to investigate whether students' psychobiological stress responses can be enhanced in the context of anatomical online learning and how increased physiological parameters correlate with characteristics of learning experiences in a digital learning environment. Healthy first-year medical students (n = 104) experienced a regular practical course in Microscopic Anatomy either in face-to-face learning, in passive online learning or in an interaction-enhanced version of online learning. Compared to passive online learning, students engaged in the interaction-enhanced version of online learning displayed a significantly reduced Heart Rate Variability (P 0.001, partial η² = 0.381) along with a strong increase in salivary cortisol (P 0.001, partial η² = 0.179) and salivary alpha-amylase activity (P 0.001, partial η² = 0.195). These results demonstrated that the physiological arousal of students engaged in online learning can be enhanced via interactive teaching methods and pointed towards clear correlations between higher physiological responses and elementary criteria of learning experience such as engagement and attention.

Decreased sympathetic cardiovascular influences and hormone-physiological changes in response to Covid-19-related adaptations under different learning environments

To examine the implications of the transition from face-to-face to online learning from a psychobiological perspective, this study investigated potential differences in physiological stress parameters of students engaged in online or face-to-face learning and determined whether these can be identified as possible mediators between learning experience and achievement emotions. In a randomized experimental field study, medical students (n = 82) attended either regular face-to-face classes of the microscopic anatomy course or the same practical course online using Zoom videoconferencing platform. The present study investigated Heart Rate Variability (HRV) and salivary cortisol concentration as stress correlates, within the contexts of online and face-to-face learning and compared these parameters with a control group that was measured at rest. Additionally, participants completed a standardized questionnaire about their experienced emotions in relation to task achievement and subjective stress levels. A significant reduction in HRV was found in face-to-face learning, suggesting stronger stress responses in the face-to-face learning environment (η²  = 0.421, P < 0.001). Furthermore, participants engaged in face-to-face learning showed significantly higher cortisol concentrations (η²  = 0.115, P = 0.032). Additionally, increased sympathetic activation correlated with the discrete positive emotion of enjoyment exclusively within the face-to-face condition (r = 0.365, P = 0.043). These results indicate that the transfer of a face-to-face practical course in microscopic anatomy to an online learning environment is associated with decreased sympathetic and enhanced vagal cardiovascular influences, together with lower cortisol concentrations in healthy medical students.

Daily life stress and the cortisol awakening response over a 13-months stress period - Findings from the LawSTRESS project

The LawSTRESS project is a controlled prospective-longitudinal study on psychological, endocrine, central nervous and genetic predictors of responses to long-lasting academic stress in a homogenous cohort. In this first project report, we focused on the association between daily life stress and the cortisol awakening response (CAR). The CAR, a distinct cortisol rise in the first 30-45 min after morning awakening, is a well-established marker of cortisol regulation in psychoneuroendocrinology. Law students from Bavarian universities (total n = 452) have been studied over a 13-months period at six sampling points starting 12 months prior exam. The stress group (SG) consisted of students experiencing a long-lasting and significant stress period, namely the preparation for the first state examination for law students. Law students assigned to the control group (CG) were studied over an equally long period without particular and sustained stress exposure. To investigate stress related alterations in the CAR, we examined a subsample of the LawSTRESS project consisting of 204 students with 97 participants from the SG (69.1% female, mean age = 22.84 ± 1.82) and 107 from the CG (78.5% female, mean age = 20.95 ± 1.93). At each sampling point, saliva samples for cortisol assessment were collected immediately upon awakening and 30 as well as 45 min later. Perceived stress in daily life was measured by repeated ambulatory assessments (about 100 queries over six sampling points). The time course of perceived stress levels in the two groups differed significantly, with the SG showing an increase in perceived stress until the exam and a decrease thereafter. Stress levels in the CG were relatively stable. The CAR was not significantly different between groups at baseline. However, a blunted CAR in the SG compared to the baseline measure and to the CG developed over the measurement timepoints and reached significance during the exam. Remarkably, this effect was neither associated with the increase in perceived stress nor with anxiety and depression symptoms, test anxiety and chronic stress at baseline. The present study successfully assessed multidimensional stress trajectories over 13 months and it documented the significant burden, law students preparing for the first state examination are exposed to. This period was related to a blunted CAR with presumed physiological consequences (e.g., on energy metabolism and immune function). Mean psychological stress levels as well as the CAR returned to baseline levels after the exam, suggesting a fast recovery in the majority of the participants.

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.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off

OBJECTIVE

to assess salivary cortisol concentrations in hematology/oncology nurses on working days and days off.

METHODS

a cross-sectional study carried out with 28 nurses from a university hospital. A sociodemographic, employment and health profile questionnaire was applied. For saliva collection, Salivette® tubes were used. Descriptive and analytical analysis was used.

RESULTS

there was no significant difference in cortisol concentrations between working days and days off (p>0.05). The high cortisol concentration was associated with not having children (0.621±0.340; p=0.046), not using medication (0.623±0.133; p=0.017) and birth control pills (0.556 ± 0.228; p=0.047) and intention to leave work (0.951±0.154; p=0.001). A positive correlation was identified between cortisol and absence from work due to health issues (0.72; p=0.05) and weight gain (0.935; p=0.02).

CONCLUSION

in general, cortisol concentration is within the reference parameters, with no significant difference in its secretion on working days and days off.