More than a feeling: A unified view of stress measurement for population science

Understanding sex differences in extinction retention: Pre-extinction stress and sex hormone status

Difficulties in fear regulation can sometimes result in maladaptive fear responses. To better understand how to improve fear regulation, it is important to determine how known factors, such as sex hormone status and stress, might interact to influence fear memory. Research has shown that women with high estradiol levels (mid-cycle) and men exhibit better extinction retention compared to women with low estradiol levels (women in the early follicular cycle or using oral contraceptives). Stress has also been demonstrated to affect both the learning and retention of extinction. Despite documented interactions between stress and sex hormones, their combined effects have not been thoroughly studied. This study aims to examine the impact of stress as a function of sex hormone status on extinction learning and retention. A total of 168 non-clinical participants were studied, including men (n = 46), women using oral contraceptives (n = 38), women in the early follicular phase (n = 40), and women in mid-cycle (n = 44). On Day 1, fear acquisition training was performed. On day 2, prior to extinction training, half of the participants were exposed to a psychosocial stressor, while the other half performed a non-stressful control task. On day 3, extinction retention was tested. Fear was quantified using skin conductance responses, while stress hormones were quantified through saliva samples. Exposure to stress prior to extinction training did not affect extinction learning, regardless of sex hormone status. In contrast, pre-extinction stress exposure had different effects on extinction retention depending on hormone status. Stressed men showed impairment in extinction retention compared to controls, while the experimental condition had no effect on naturally cycling women. Regardless of stress exposure, early follicular women exhibited a deficit in fear regulation, while mid-cycle women showed effective fear regulation. Among women using oral contraceptives, the stress group demonstrated better extinction retention compared to the control group. These results demonstrate the importance of considering sex hormone status and stress exposure during extinction learning, as both components may modulate extinction retention. These results could help identifying hormonal conditions that may enhance the effectiveness of extinction-based psychological therapies used in the treatment of fear-related disorders.

Affect regulation and allostatic load over time

OBJECTIVE

Emerging work suggests that affect regulation strategies (e.g., active coping, anger expression) predict disease and mortality risk, with sometimes divergent estimates by sex or education levels. However, few studies have examined potential underlying biological mechanisms. This study assessed the longitudinal association of affect regulation with future allostatic load.

METHOD

In 2004-2006, 574 participants from the Midlife in the United States study completed validated scales assessing use of nine general and emotion-specific regulatory strategies (e.g., denial, anger expression). As a proxy for how flexibly participants regulate their affect, variability in the use of regulatory strategies was operationalized using a standard deviation-based algorithm and considered categorically (i.e., lower, moderate, greater variability) to assess non-linear effects. Participants also provided data on relevant covariates and 24 allostatic load biomarkers (e.g., cortisol, blood pressure). In 2017-2021, these biomarkers were again collected. Linear regressions modeled betas (β) and 95 % confidence intervals (CI) examining associations of affect regulatory constructs with future allostatic load.

RESULTS

In fully-adjusted models including initial allostatic load, general regulatory strategies were unrelated to future allostatic load. Yet, greater versus moderate affect regulation variability levels predicted lower allostatic load (β=-0.14; 95 %CI: -0.27, -0.01). Only among more educated participants, greater use of anger expression predicted lower allostatic load, while the reverse was noted with anger control (βexpression=-0.12; 95 %CI: -0.20, -0.05; βcontrol=0.14; 95 %CI: 0.05, 0.24).

CONCLUSIONS

While general regulatory strategies appeared unrelated to allostatic load, greater variability in their use and anger-related strategies showed predictive value. Subsequent studies should examine these associations in larger, more diverse samples.

Using the online version of the Trier Social Stress Test to investigate the effect of acute stress on functional lateralization

How stress affects functional hemispheric asymmetries is relevant because stress represents a risk factor for the development of mental disorders and various mental disorders are associated with atypical lateralization. Using three lateralization tasks, we investigated whether functional hemispheric asymmetries in the form of hemispheric dominance for language (verbal dichotic listening task), emotion processing (emotional dichotic listening task), and visuo-spatial attention (line bisection task) were affected by acute stress in healthy adults. One hundred twenty right-handed men and women performed these lateralization tasks in randomized order after exposure to a mild online stressor (i.e., an online variant of the Trier Social Stress Test (TSST), TSST-OL) and a non-stressful online control task (friendly TSST-OL, fTSST-OL) in a within-subjects design. Importantly, the verbal and the emotional dichotic listening tasks were presented online whereas the line bisection task was completed in paper-pencil form. During these tasks, we found the expected hemispheric asymmetries, indicating that online versions of both the verbal and the emotional dichotic listening task can be used to measure functional hemispheric asymmetries in language and emotion processing remotely. Even though subjective and physiological markers confirmed the success of the online stress manipulation, replicating previous studies, we found no stress-induced effect on functional hemispheric asymmetries. Thus, in healthy participants, functional hemispheric asymmetries do not seem to change flexibly in response to acute stress.

Stress and cardiovascular disease: an update

Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.

Assessment of psychometric performance for the Chinese version of the Brief Inventory of Perceived Stress integrating exploratory graph analysis and confirmatory factor analysis

OBJECTIVE

This study was to evaluate measurement properties of the Chinese version of the Brief Inventory of Perceived Stress (BIPS-C) and confirm possible solutions for measuring the constructs underlying perceived stress.

METHODS

A total of 1356 community residents enrolled and were randomly split into two halves. The first half was used to explore the underlying constructs of the BIPS-C by exploratory graph analysis (EGA) and the second half was used to compare and confirm the constructs by confirmatory factor analysis (CFA).

RESULTS

The EGA identified a one-factor model of the BIPS-C with an accuracy of 99.3%. One-factor, three-factor, second-order, and bifactor models were compared by CFAs. The bifactor model with one general and three specific factors was found to be the most adequate [comparative fit index (CFI) = 0.990; Tucker-Lewis index (TLI) = 0.979; root mean square error of approximation (RMSEA) = 0.058] and was superior to the other models. The related bifactor indices showed a stronger existence of the general factor. The bifactor model of the BIPS-C also showed adequate internal consistency with McDonald's omega and omega subscales ranging from moderate to strong (0.677-0.869).

CONCLUSION

The BIPS-C demonstrates sufficient measurement properties for assessing general perceived stress.

A mixed-methods stress audit with midwives in the United Kingdom

PROBLEM

UK midwives report high work-related stress, which can negatively impact their health and wellbeing, with many considering leaving the profession.

BACKGROUND

An occupational stress audit guides the implementation of stress management intervention, by identifying which stressors have the most negative impact and why, and highlighting "at risk" groups.

AIM

To conduct a concurrent mixed-methods stress audit with UK midwives in an NHS Trust.

METHODS

Seventy-one midwives (Mage= 39 years, SD = 11) completed a survey assessing stressors (e.g., relationships), stress appraisals (i.e., challenge vs. threat), coping strategies (e.g., avoidance-focused), and outcomes (i.e., mental health, performance, and intention to leave). Ten midwives (Mage = 42 years, SD = 10) participated in semi-structured interviews.

FINDINGS

Quantitative data revealed that more work-related demands, poorer peer support and relationships, and threat appraisals predicted worse mental health. Moreover, less control and more work-related demands predicted poorer performance, while less control, poorer manager support, more change-related demands, and threat appraisals predicted greater intention to leave. Qualitative data generated three themes: organisational pressures exacerbated by unexpected changes; individualised responses but largely debilitative emotions; and personal coping and power of social support.

DISCUSSION AND CONCLUSION

This study offered a comprehensive and novel insight into the stress experiences of UK midwives, highlighting targets for future stress management interventions, including key stressors (e.g., manager support), underlying mechanisms (e.g., stress appraisals), and "at-risk" groups (e.g., night shift workers). Practical recommendations are provided for stakeholders operating at multiple levels (e.g., midwife, trust, policy) to better support midwives with work-related stress.

Creating a resilient pedagogy: Character strengths intervention for aspiring educators

Teachers play a crucial role in guiding learners through life's challenges. They face educational and socio-economic shifts while striving to teach for a better future. Our study focuses on equipping future teachers, called pre-service teachers, with resilience-building resources during their teacher training program. A potential antecedent to resilience, which facilitates cognitive strategies and attentional processes, is cognitive flexibility. We first tested whether cognitive flexibility predicts resilience. Next, relying on the tenets of positive psychology, which studies resilience, we developed and tested the effectiveness of character strengths intervention in enhancing pre-service teachers' resilience and cognitive flexibility. An individual's belief in their ability to change personal resources could influence how an intervention manifests. Hence, we studied how mindset impacts the intervention's effect on cognitive flexibility and, thus, resilience. We adopted a multi-method approach, guided by Polk's theory of resilience, to test out objectives. Using a cross-sectional design, study one (n = 273) found that cognitive flexibility significantly predicted resilience. Study two (N = 193; nexp = 133, ncont = 60) was a multi-site field experiment. We found that intervention significantly enhanced resilience (experimental group M = 29.62, control group M = 28.33) and cognitive flexibility (experimental group M = 54.42, control group M = 52.01). Further, a growth mindset, was found to moderate the indirect effect of character strengths intervention on resilience via cognitive flexibility. The study contributes to theoretical and practical advancements in resilience. Taken together, the findings highlight the cognitive-affective-behavioural makeup of resilience and, importantly, the role of cognitive flexibility. The intervention can be seamlessly integrated into teacher training curricula for a resilient future.

Purpose in life and stress: Momentary associations from a micro-longitudinal study

Purpose in life is an aspect of well-being associated with less subjective stress. The present research sought to expand this literature by testing the association between both dispositional and momentary purpose with stress in daily life using a micro-longitudinal study design. Participants (N = 303) reported their dispositional purpose at baseline and reported their momentary purpose and stress three times a day for 8 days. Between-person, dispositional purpose was associated with less momentary stress across the 8 days tested with linear regression (β = -0.29, 95% CI = -0.39, -18, p < 0.001); it was unrelated to variability in stress (β = 0.05, 95% CI = -0.05, 0.14, p = 0.310). In contrast, the within-person analysis tested with multilevel modelling indicated that in moments when participants felt more purpose-driven than their average, they felt more stressed (b = 0.09, 95% CI = 0.06, 0.12, SE = 0.01, p < 0.001). This association was slightly stronger among participants with relatively lower dispositional purpose (binteraction = -0.04, SE = 0.02, 95% CI = -0.08, -0.01, p = 0.032). This study replicated the negative association between dispositional purpose and subjective stress when stress was measured at moments in daily life. It also found that feeling more purpose-driven than usual in the moment is stressful, a counterintuitive finding that, if replicated, suggests that striving for purpose can be stressful in the moment, even if feeling more purposeful in general is associated with lower stress.

Does stress from incarceration of family and friends contribute to signs of early vascular ageing in African American women?

BACKGROUND

Early vascular ageing (EVA) contributes to elevated risk of cardiovascular disease (CVD), which disproportionately affects African American women. Incarceration, an event disproportionately impacting African Americans, may be a stressor contributing to EVA in African American women. Further, the subjective perspective, commonly referred to as appraisal, of incarceration may also be important for health. We hypothesised that having family and/or friends incarcerated and appraising the incarceration as upsetting would be associated with indices of EVA.

METHODS

In a community-based cohort of African American women aged 30-46 living in Atlanta, Georgia (n=391), participants were asked, at baseline, about family and/or friend incarceration and to appraise how upsetting the incarceration was. Multivariable linear regression examined associations between: (1) family and/or friend incarceration and indices of EVA (pulse wave velocity, augmentation index, central systolic blood pressure (SBP) and pulse pressure amplification) and (2) appraisal of incarceration and EVA indices.

RESULTS

45% of participants (n=174) reported having a loved one incarcerated, and 59% (n=102) reported the incarceration as upsetting. Having a loved one incarcerated was associated with a higher central SBP (b=4.30; 95% CI 1.61, 6.99) and augmentation index (b=2.29; 95% CI 0.26, 4.33). Appraisal of incarceration was only associated with central SBP.

CONCLUSIONS

Family or friend incarceration was highly prevalent in this cohort of African American women and associated with indices of EVA. Mass incarceration of others may affect the physical health of African American women which may contribute to CVD disparities.

Age Differences Among Within-Person Indicators of Stress and Depressive Affect

We examined age differences in the within-person relationships among perceived stress (PS), perceived stress reactivity (PSR), and depressive affect (DA) as well as potential mechanisms of depression with a longitudinal moderated mediation model. Participants from the Notre Dame Study of Health & Wellbeing (N = 572) completed two to four waves of yearly assessments. Sequentially built multilevel models, in which year was nested within person, illustrated that only midlife adults experience an exacerbated effect of within-person fluctuations in PSR on the relationship between within-person PS and DA levels (γ41 = -.004, p < .01). Findings further suggest that PSR accounts for the PS-DA relationship. Furthermore, older adults illustrate successful emotion regulation strategies at the yearly level-resisting the negative ramifications of years of greater PS and PSR, whereas midlife adults who experience years of greater PSR would particularly benefit from stress management interventions and monitoring of DA levels.

Teachers' Heart Rate Variability and Behavioral Reactions in Aggressive Interactions: Teachers Can Downregulate Their Physiological Arousal, and Progesterone Favors Social Integrative Teacher Responses

Aggressive student behavior is considered one of the main risk factors for teacher stress. The present study investigated teachers' physiological and behavioral reactions when facing aggressive student behavior and examined which resources favor adaptive teacher reactions. The sample included 42 teachers. We assessed (a) teacher self-reports (i.e., resources, risk factors, and vital exhaustion) (b) classroom observations, (c) ambulatory assessments of teachers' heart rate and heart rate variability, and (d) teachers' progesterone concentrations in the hair. The present study focused on a subsample of ten teachers (9 females, Mage = 34.70, SD = 11.32) managing classes which were potentially very stressful as they had a high density of aggressive behavior. High levels of work satisfaction, hair progesterone, and a low level of work overload fostered social integrative teacher responses. Moreover, in 75% of the cases, teachers succeeded in downregulating their physiological reaction. Our results support the notion that teachers evaluate stressors in light of their resources. When they perceive their resources as insufficient for coping with a challenging situation, stress arises, and subsequently, they react inefficiently to aggressive behavior. Thus, teacher education could benefit from strengthening teacher resources and strategies for coping with aggressive student behavior.

Ambiguity potentiates effects of loneliness on feelings of rejection

For social species, having strong and high-quality social relationships is an important safety cue. Loneliness occurs when an individual perceives they have insufficient relationships resulting in feelings of lack of safety. States of perceived unsafety are linked to an increased tendency to construe ambiguous information - information lacking a unique clear interpretation - as threatening. Here, we explore whether the ambiguity of social cues of interpersonal rejection moderates effects of loneliness on feelings of rejection while undergoing social exclusion. Data were collected in 2021; 144 adults completed a progressive social exclusion paradigm where they were randomly assigned to be equally included, excluded, or over-included. Social exclusion/inclusion cues became more pronounced over the course of multiple rounds of a ball-tossing game (Cyberball) resulting in a scenario where ambiguity was highest in earlier rounds and decreased over time. Participants reported feelings of loneliness prior to the task and feelings of rejection throughout the task. Results demonstrated that higher loneliness predicted increased feelings of rejection regardless of exclusion condition. Notably, this positive relationship was strongest during earlier rounds when social cues were most ambiguous. These findings contribute to our understanding of how loneliness modulates social perception to enable organisms to adequately adapt to changing circumstances.

Childhood Interpersonal Trauma and Depression of Middle-Aged and Older Adults in China: The Mediation Effect of Social Integration

Objectives: This study investigates the associations between five types of childhood interpersonal trauma (CIT) and depression in mid-later life, as well as the mediation roles of social integration in the associations. Methods: Two waves of data from a nationally representative survey in China were used, with participants aged 45 years and older (N = 14,180). Measures of CIT included physical abuse, physical neglect, emotional neglect, bullying victimization, and exposure to interparental violence. Binary logistic regression and Karlson-Holm-Breen mediation analysis were used as statistical methods. Results: People who were bullied, physically abused, and witnessed interparental violence during childhood were more likely to develop depression in mid-later years. The associations between CIT and depression were mediated by satisfaction with marriage, satisfaction with children, and perceived social support. Discussion: Although CIT elevates the risk of depression in later life, effective interventions that strengthen integration across family and social domains could benefit mental health.

Momentary stress-induced food craving: An ecological momentary assessment study comparing perceived interpersonal and non-interpersonal stressors

Daily-life stressors and food cravings are dynamic and vary within and across persons. Some evidence suggests interpersonal stressors increase appetite. However, little is known about the association of food craving with different types of stressors at the momentary level in the general population. We aimed to explore the momentary relationships between daily-life stressful events and food craving in a non-clinical community sample, and to compare the associations with food craving when the most stressful event was perceived as interpersonal versus non-interpersonal. We used ecological momentary assessment (EMA) to collect reports on the most stressful event, perceived stressor type, stressor appraisal, and food craving from 123 adults three times a day scheduled at fixed intervals over 10 days. Mixed effects random intercepts and slopes models examined the within- and between-person associations. Experiencing a stressor was significantly positively associated with within-person food craving at the same measurement. No differences in momentary food craving were found when the most stressful event was perceived as interpersonal or non-interpersonal (within-person level). However, frequently reporting the most stressful event as interpersonal (vs. non-interpersonal) was positively associated with food craving across the study (between-person level), particularly when the stressor was appraised as more unpleasant. Daily-life stressors were associated with momentary food craving. Individuals who generally perceived interpersonal stressors as their most stressful event tended to experience food cravings. Future research could further investigate the role of interpersonal stressors as a factor for overeating in daily life and the potential benefits of stress management in interventions.

Estimating survival in data-driven phenotypes of mental health symptoms and peripheral biomarkers: A prospective study

Background

Chronic psychological stress has widespread implications, including heightened mortality risk, mental and physical health conditions, and socioeconomic consequences. Stratified precision psychiatry shows promise in mitigating these effects by leveraging clinical heterogeneity to personalize interventions. However, little attention has been given to patient self-report.

Methods

We addressed this by combining stress-related self-report measures with peripheral biomarkers in a latent profile analysis and survival model. The latent profile models were estimated in a representative U.S. cohort (n = 1255; mean age = 57 years; 57% female) and cross-validated in Tokyo, Japan (n = 377; mean age = 55 years; 56% female).

Results

We identified three distinct groups: "Good Mental Health", "Poor Mental Health", and "High Inflammation". Compared to the "Good Mental Health" group, the "High Inflammation" and "Poor Mental Health" groups had an increased risk of mortality, but did not differ in mortality risk from each other.

Conclusions

This study emphasizes the role of patient self-report in stratified psychiatry.

When virtual reality becomes psychoneuroendocrine reality: A stress(or) review

This review article was awarded the Dirk Hellhammer award from ISPNE in 2023. It explores the dynamic relationship between stressors and stress from a historical view as well as a vision towards the future of stress research via virtual reality (VR). We introduce the concept of a "syncytium," a permeable boundary that blurs the distinction between stress and stressor, in order to understand why the field of stress biology continues to inadequately measure stress alone as a proxy for the force of external stressors. Using Virtual Reality (VR) as an illustrative example to explicate the black box of stressors, we examine the distinction between 'immersion' and 'presence' as analogous terms for stressor and stress, respectively. We argue that the conventional psychological approaches to stress measurement and appraisal theory unfortunately fall short in quantifying the force of the stressor, leading to reverse causality fallacies. Further, the concept of affordances is introduced as an ecological or holistic tool to measure and design a stressor's force, bridging the gap between the external environment and an individual's physiological response to stress. Affordances also serve to ameliorate shortcomings in stress appraisal by integrating ecological interdependencies. By combining VR and psychobiological measures, this paper aims to unravel the complexity of the stressor-stress syncytium, highlighting the necessity of assessing both the internal and external facets to gain a holistic understanding of stress physiology and shift away from reverse causality reasoning. We find that the utility of VR extends beyond presence to include affordance-based measures of immersion, which can effectively model stressor force. Future research should prioritize the development of tools that can measure both immersion and presence, thereby providing a more comprehensive understanding of how external stressors interact with individual psychological states.

The effects of acute exercise on stress reactivity assessed via a multidimensional approach: a systematic review

Psychological stress is associated with numerous deleterious health effects. Accumulating evidence suggests acute exercise reduces stress reactivity. As stressors activate a wide array of psychological and physiological systems it is imperative stress responses are examined through a multidimensional lens. Moreover, it seems prudent to consider whether stress responses are influenced by exercise intervention characteristics such as modality, duration, intensity, timing, as well as participant fitness/physical activity levels. The current review therefore examined the role of acute exercise on stress reactivity through a multidimensional approach, as well as whether exercise intervention characteristics and participant fitness/physical activity levels may moderate these effects. Stress reactivity was assessed via heart rate, blood pressure, cortisol, catecholamines, and self-report. A systematic search following PRISMA guidelines of five databases was updated in November 2022. Reviewed studies met the following criteria: English language, participants aged ≥ 18, use of acute exercise, use of a validated stress-inducing task, and assessment(s) of stress reactivity. Thirty-one studies (1386 participants) were included. Acute exercise resulted in reliable reductions to blood pressure and cortisol. Acute exercise yielded mostly negligible effects on heart rate reactivity and negligible effects on self-report measures. As for exercise intervention characteristics, intensity-dependent effects were present, such that higher intensities yielded larger reductions to reactivity measures, while limited evidence was present for duration, modality, and timing-dependent effects. Regarding participant fitness/physical activity levels, the effects on stress reactivity were mixed. Future work should standardize the definitions and assessment time points of stress reactivity, as well as investigate the interaction between physiological and psychological stress responses in real-world contexts.

Exploring the interplay of psychological and biological components of stress response and telomere length in the transition from middle age to late adulthood: A systematic review

Ageing and chronic stress have been linked to reduced telomere length (TL) in mixed-age groups. Whether stress response components are linked to TL during the midlife-to-late adulthood transition remains unclear. Our study aimed to synthesise evidence on the relationship between psychological and biological components of stress response on TL in middle-aged and older adults. We conducted a systematic review of studies obtained from six databases (PubMed, CINAHL, EMBASE, PsycINFO, Web of Science, and Scopus) and evaluated by two independent reviewers. Original research measuring psychological and biological components of stress response and TL in human individuals were included. From an initial pool of 614 studies, 15 were included (n = 9446 participants). Synthesis of evidence showed that higher psychological components of the stress response (i.e., global perceived stress or within a specific life domain and cognitive appraisal to social-evaluative stressors) were linked to shorter TL, specifically in women or under major life stressors. For the biological stress response, cortisol, dehydroepiandrosterone sulphate and IGF-1/cortisol imbalance, IL-6, MCP-1, blood pressure, and heart rate presented a significant association with TL, but this relationship depended on major life stressors and the stress context (manipulated vs. non-manipulated conditions). This comprehensive review showed that psychological and biological components of the stress response are linked to shorter TL, but mainly in women or those under a major life stressor and stress-induced conditions. The interaction between stressor attributes and psychological and biological reactions in the transition from middle to late adulthood still needs to be fully understood, and examining it is a critical step to expanding our understanding of stress's impact on ageing trajectories.

Specific challenges of researching stress in the context of quiet political repression

Political repression beneath the threshold of criminal prosecution is a phenomenon of past and present, predominantly authoritarian, regimes. This so-called quiet repression includes measures such as the limitation of freedom of speech, surveillance of (perceived) political opponents, or the spreading of rumors to socially isolate targets. Such experiences of chronic stress show significant psychological and physiological health consequences in affected individuals. However, societal awareness of quiet repression measures remains limited, hindering victims' access to support and complicating healthcare interventions. In the current paper, we present the design of a study conducted with individuals who endured quiet repression measures in the former German Democratic Republic (GDR), a socialist state closely aligned with the former Soviet Union. We discuss the challenges encountered over the course of the study, and present the solutions found. Although every study population has their unique challenges and needs, we wish to inform future sensitive research within the realm of quiet political repression. Given the limited understanding of the phenomenon, there is a pressing need for further investigation aiming to improve acceptance and care for past and future victims.

Stress exposure, perceived stress, protective psychosocial factors, and health status in Ukraine after the full-scale invasion

The concept of stress as a cause of ill health has received much attention in social sciences. The distinction between stress exposure and perceived stress emphasizes the importance of cognitive dimension of stress. This quantitative study (N = 213) conducted in Ukraine in November 2022 collected self-reported cognitive data on stress exposure, perceived stress, and self-rated heath. The goals of the study included (1) testing if stress exposure and perceived stress differ in terms of breadth and depth of their impact; (2) isolating psychosocial factors that reduce stress; and (3) testing if individuals who have relocated within Ukraine or abroad to escape the war had worse health outcomes than those who remained at their domiciles. The results suggest that while perceived stress was a stronger predictor of negative health outcomes, optimism and social support served as protective psychosocial factors. Having moved abroad predicted higher stress levels and more adverse health symptoms.

Traumatic stress symptoms in civilians after the 2020 Nagorno-Karabakh war: The protective role of self-compassion and emotional intelligence

Exposure to war is linked to negative mental health outcomes. Self-compassion and emotional intelligence may foster post-war adjustment processes differently depending on the time since the event happened. This study examines post-traumatic stress symptoms (PTSS) in civilians exposed to the 2020 Nagorno-Karabakh war shortly after and 6 months post-conflict, while investigating self-compassion and emotional intelligence's protective role. War-exposed civilians self-reported on PTSS, self-compassion, and trait emotional intelligence at two phases. Results showed greater PTSS shortly after war relative to 6 months later. Lower self-compassion scores were related to more PTSS at the first phase, whereas lower emotional intelligence was associated with more symptoms 6 months later. These data show how war-exposed Armenians coped, highlighting individual characteristics' effects, and suggest varying resource utilization during post-war adjustment. Specifically, self-compassion may be a protective factor shortly after war, whereas emotional intelligence may protect individuals against having adverse health outcomes later on.

Effects of Mediterranean and Western dietary patterns on perceived stress and mental distress

Compared to the Western diet, the Mediterranean diet has many known benefits for both mental health and physical health; however, little is known about the effect of these dietary patterns on perceived stress and mental distress. To assess the relationship between dietary patterns, perceived stress and mental wellbeing, an anonymous online questionnaire targeting adults 18 and older was distributed via several social media platforms and email listservs. The survey included demographic questions, the Food-Mood Questionnaire, the Perceived Stress Scale and the Kessler Psychological Distress scale (K-6). A total of 1591 participants completed the survey. The data was analyzed using Principal Component Analysis and Pearson Correlation Coefficient in SPSS version 28.0. The results showed significant negative correlations between perceived stress and mental distress with several components of the Mediterranean diet, such as whole grains, seafood, fruits, vegetables, and beans. Despite being attributed to the Western diet, meat produced a negative correlation with perceived stress and mental distress. However, significant positive correlations between perceived stress and mental distress and the Western diet, such as fast food and high glycemic index food, were detected. Our findings provide evidence that dietary patterns modulate the stress response and suggest that incorporating components of the Mediterranean diet is beneficial for mental wellbeing and stress reduction.

Efficacy of mental health smartphone apps on stress levels: a meta-analysis of randomised controlled trials

The management of stress has evolved in recent years due to widespread availability of mobile-device applications (apps) and their capacity to deliver psychological interventions. We evaluated the efficacy of mental health apps on stress and sought to identify characteristics associated with effect size estimates. Sixty-nine randomised controlled trials (RCTs) were included. Random effects meta-analyses were performed and putative moderators were examined at univariate and multivariate (combinations and interactions) levels. From 78 comparisons, we observed a small but significant pooled effect of apps over control conditions on perceived stress levels (g = 0.27; 95% CI = 0.20, 0.34; I2 = 68%). This effect weakened after taking into account small-study bias according to the trim-and-fill procedure (g = 0.10; 95% CI = 0.02, 0.19; I2 = 78%). Delivery of apps with stress monitoring features produced smaller efficacy estimates, although this association interacted with other trial features (small sample size and inactive control group) in multivariate analyses, suggesting that this effect may have been explained by features characteristic of low-quality trials. Mental health apps appear to have small, acute effects on reducing perceived stress. Future research should shift focus towards identifying change mechanisms, longitudinal outcomes, features that facilitate sustained app usage, and tangible pathways to integrating apps into real-world clinical settings.

The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review

Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.

Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory

Although stress and adversity are largely universal experiences, people exposed to greater hardship are at increased risk for negative health consequences. Recent studies identify accelerated biological aging as a mechanism that could explain how trauma and adversity gives rise to poor health, and advances in this area of study coincide with technological innovations in the measurement of biological aging, particularly epigenetic profiles consistent with accelerated aging derived from DNA methylation. In this review, we provide an overview of the current literature examining how adversity might accelerate biological aging, with a specific focus on social and health behaviors. The most extensive evidence in this area suggests that health-compromising behaviors, particularly smoking, may partially explain the association between adversity and accelerated aging. Although there is relatively less published support for the role of social behaviors, emerging evidence points to the importance of social connection as a mechanism for future study. Our review highlights the need to determine the extent to which the associations from adversity to accelerated aging are consistent with causal processes. As we consider these questions, the review emphasizes methodological approaches from the causal inference literature that can help deepen our understanding of how stress and trauma might result in poor health. The use of these methodologies will help provide evidence as to which behavioral interventions might slow aging and improve health, particularly among populations that more often experience adversity and trauma.

An update on factors affecting umbilical cord care among mothers: A review

Umbilical cord care remains a critical aspect of newborn health, yet practices vary significantly across different cultures and healthcare settings. This paper aims to provide an updated synthesis of the factors influencing umbilical cord care among mothers. The umbilical cord is a vital link between the fetus and the placenta during pregnancy, but after birth, it requires proper care to prevent infections. Numerous factors influence a mother's approach to umbilical cord care, including cultural beliefs, socio-economic status, access to healthcare information, and traditional practices passed down through generations. Understanding these factors is crucial for healthcare providers to offer tailored guidance and support to mothers, ensuring the optimal care for newborns. This paper examines recent research and literature encompassing diverse cultural perspectives, socio-economic considerations, healthcare access, and educational interventions related to umbilical cord care. It also highlights the impact of technological advancements, such as telemedicine and digital health platforms, in disseminating crucial information to mothers, especially in remote or underserved areas. Moreover, the review delves into the role of healthcare professionals in promoting evidence-based practices and addressing misconceptions regarding umbilical cord care. It emphasizes the importance of culturally sensitive and context-specific interventions in enhancing maternal knowledge and practices related to neonatal care. In conclusion, this review presents an updated overview of the multifactorial influences on umbilical cord care among mothers. It calls for continued research and concerted efforts to bridge gaps in knowledge, cultural beliefs, and healthcare access, ultimately contributing to the promotion of optimal newborn health outcomes.

A long and resilient life: the role of coping strategies and variability in their use in lifespan among women

OBJECTIVES

Associations of stress-related coping strategies with lifespan among the general population are understudied. Coping strategies are characterized as being either adaptive or maladaptive, but it is unknown the degree to which variability in tailoring their implementation to different contexts may influence lifespan.

METHOD

Women (N = 54,353; Mage = 47) completed a validated coping inventory and reported covariate information in 2001. Eight individual coping strategies (e.g., Acceptance, Denial) were considered separately. Using a standard deviation-based algorithm, participants were also classified as having lower, moderate, or greater variability in their use of these strategies. Deaths were ascertained until 2019. Accelerated failure time models estimated percent changes and 95% confidence intervals (CI) in predicted lifespan associated with coping predictors.

RESULTS

In multivariable models, most adaptive and maladaptive strategies were associated with longer and shorter lifespans, respectively (e.g., per 1-SD increase: Active Coping = 4.09%, 95%CI = 1.83%, 6.41%; Behavioral Disengagement = -6.56%, 95%CI = -8.37%, -4.72%). Moderate and greater (versus lower) variability levels were similarly and significantly related to 8-10% longer lifespans. Associations were similar across age, racial/ethnic, residential income, and marital status subgroups.

CONCLUSIONS

Findings confirm the adaptive and maladaptive nature of specific coping strategies, and further suggest benefits from both moderate and greater variability in their use for lifespan among women.

Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study

INTRODUCTION

Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations.

METHODS

Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables.

RESULTS

The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05).

CONCLUSIONS

Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.

Prenatal maternal negative life events associated with child emotional and behavioral problems in the French EDEN cohort

INTRODUCTION

Prenatal negative life events (NLEs) have been linked to adverse health outcomes in children. However, few studies examine this relationship during late childhood using trajectory analyses. Additionally, the impact of specific NLEs domains on child development remains unclear. This study aims to longitudinally explore the association between NLEs (cumulative score and specific NLEs domains) and child outcomes from birth to late childhood.

METHODS

1135 mother-child pairs from the French EDEN cohort were followed from 24 to 28 weeks of pregnancy up to 11 years of age. Maternal self-reports of prenatal NLEs were collected immediately after birth, then analyzed as a cumulative score and by NLEs domain. Children's emotional and behavioral symptoms were assessed at 4 timepoints through the Strengths and Difficulties Questionnaire.

RESULTS

Children of mothers exposed to ≥3 NLEs were more likely to follow trajectories of high levels of peer relationship problems (aOR [95 % CI] = 5.69 [1.74-18.69]), emotional symptoms (aOR [95 % CI] = 3.05 [1.08-8.63]), and conduct problems (aOR [95 %] = 3.53 [1.20-10.42]). Among the domains of NLEs, only events related to housing, finance, and living conditions were significantly associated with high emotional and behavioral difficulties trajectories (aOR [95%CI] = 2.71[1.26-5.81]).

LIMITATIONS

Potential attrition bias due to a higher dropout rate for children experiencing early indications of emotional and behavioral difficulties.

CONCLUSION

Findings support the relationship between prenatal NLEs and child outcomes, underscoring the importance of assessing prenatal stressors across life domains to identify mothers who might be in need of support.

Improving stress mindset through education and imagery

BACKGROUND

Research suggests interventions such as education and imagery can elicit a greater stress-is-enhancing mindset. The present study examined the individual and combined effect of stress-is-enhancing education and/or imagery delivered virtually in altering stress mindset. Three 3-minute online video interventions: (1) education, (2) imagery, (3) education with imagery were compared to each other and a control comparison.

DESIGN AND METHODS

Participants (N = 164; 103 = female; Mage = 20.03, SD = 1.39 years) completed the Stress Mindset Measure (SMM) before being randomly assigned to a group to watch a three-minute video and completing the SMM again.

RESULTS

The 2-time × 4-group ANOVA showed a significant time effect, F(1, 158) = 50.45, p < .001, ηp2 = .242, no group effect, F(3, 158) = 0.89, p = .449, ηp2 = .017, and a significant time × group interaction, F(3, 158) = 4.48, p = .005, ηp2 = .078. All three experimental groups reported greater stress-is-enhancing mindset post-intervention compared to pre-intervention. At post-intervention the education with imagery group had a significantly more stress-is-enhancing mindset compared to the control group.

CONCLUSIONS

Results suggest that online stress mindset videos may be effective with a combined stress education and imagery intervention being most effective.

High-speed train drivers' human error under fatigue and stress: the role of situation awareness and individual differences

Fatigue and stress are critical variables that impair railway train drivers' safety performance, and individual differences may influence these effects. This study investigates how fatigue and stress affect high-speed train drivers' human error and the role of individual differences. We hypothesised that situation awareness (SA) mediates the effects of fatigue and stress on human error, and individual differences (age and work experience) moderate these effects. We surveyed 1,391 male drivers from eight Chinese railway bureaus and used PROCESS Macro for data analysis. The results revealed that fatigue and stress increased human error, directly and indirectly through SA. Age and work experience moderated the effect of fatigue and stress on SA, respectively. Older drivers had better SA under high fatigue, while more experienced drivers had better SA under high stress. These findings can inform more tailored safety management strategies to lower human error and enhance the safety of high-speed train operations.

Black-white differences in chronic stress exposures to predict preterm birth: interpretable, race/ethnicity-specific machine learning model

BACKGROUND

Differential exposure to chronic stressors by race/ethnicity may help explain Black-White inequalities in rates of preterm birth. However, researchers have not investigated the cumulative, interactive, and population-specific nature of chronic stressor exposures and their possible nonlinear associations with preterm birth. Models capable of computing such high-dimensional associations that could differ by race/ethnicity are needed. We developed machine learning models of chronic stressors to both predict preterm birth more accurately and identify chronic stressors and other risk factors driving preterm birth risk among non-Hispanic Black and non-Hispanic White pregnant women.

METHODS

Multivariate Adaptive Regression Splines (MARS) models were developed for preterm birth prediction for non-Hispanic Black, non-Hispanic White, and combined study samples derived from the CDC's Pregnancy Risk Assessment Monitoring System data (2012-2017). For each sample population, MARS models were trained and tested using 5-fold cross-validation. For each population, the Area Under the ROC Curve (AUC) was used to evaluate model performance, and variable importance for preterm birth prediction was computed.

RESULTS

Among 81,892 non-Hispanic Black and 277,963 non-Hispanic White live births (weighted sample), the best-performing MARS models showed high accuracy (AUC: 0.754-0.765) and similar-or-better performance for race/ethnicity-specific models compared to the combined model. The number of prenatal care visits, premature rupture of membrane, and medical conditions were more important than other variables in predicting preterm birth across the populations. Chronic stressors (e.g., low maternal education and intimate partner violence) and their correlates predicted preterm birth only for non-Hispanic Black women.

CONCLUSIONS

Our study findings reinforce that such mid or upstream determinants of health as chronic stressors should be targeted to reduce excess preterm birth risk among non-Hispanic Black women and ultimately narrow the persistent Black-White gap in preterm birth in the U.S.

Subjective Stress Appraisals Over Time: the Evolving Structure of the COVID-19 Stressor Scale

The COVID-19 Stressors Scale measures individuals' appraisals of stressors related to the pandemic. Measurement of perceptions of stressors is necessary to understand the socioemotional impacts of not only the COVID-19 pandemic, but other disasters. The study examined the factor structure of the scale among adults in the U.S. over six time points. A shortened version was used, and the fit was examined over time. The results of the study show contextual appraisals change over time and offer important implications for the measurement of stressfulness of disasters, a critical step in designing and assessing impacts of social programs aimed to reduce the deleterious effects of disasters.

Emotion dysregulation and family functioning moderate family caregiving burden during the pandemic

OBJECTIVES

Since the onset of COVID-19 pandemic, additional risk factors affecting family caregivers' mental health have arisen. Therefore, personal stress coping strategies and family dynamics became important factors in reducing the impact of the pandemic on family caregivers' mental health. The present research aimed to estimate the association between COVID-19 stressors and family caregiving burden. Moreover, moderating effects of emotion dysregulation and family functioning on this association were investigated.

METHODS

This study analyzed data collected in April 2021 from 154 family caregivers (Mage = 38.79, SDage = 9.36, range = 22-64) recruited through Amazon's Mechanical Turk (MTurk). The impact of COVID-19 stressors on family caregiving burden was tested, and moderating impacts of emotion dysregulation and family functioning were also investigated.

RESULTS

Both COVID-19 stress exposure and stress appraisal were positively associated with family caregiving burden. Emotion dysregulation and problematic family functioning were also positively associated with family caregiving burden. A significant moderating effect of emotion dysregulation was found, such that family caregivers with higher emotion dysregulation were likely to feel more caregiving burden when they experienced more COVID-19 stressors.

SIGNIFICANCE OF RESULTS

The current research highlighted the role of emotion regulation in reducing the negative impact of COVID-19 stressors on family caregiving burden. The research also emphasizes the need for intervention programs to improve emotion regulation strategies to decrease family caregiving burden during the pandemic.

Stepping back or stepping in: A qualitative investigation of self-distanced versus self-immersed stressor reflections with competitive swimmers

High performance sport consists of stressor events which can disrupt an athletes' functioning and negatively influence performance. The way in which one reflects upon stressor events and develops insights regarding how they coped is essential to overcoming similar experiences in the future. We conducted a pilot randomised controlled trial with a qualitative analysis to explore the coping insights among 48 highly trained/national level swimmers in the lead up to major swimming competitions, who reflected on stressor events from self-distanced or self-immersed perspectives over a 3-week period. Using the self-reflection and coping insight framework as a guideline, we captured divers coping insights across both groups. Irrespective of the group to which they were assigned, athletes showed positive signs towards re-interpreting their stressor experience and embracing the stressor event, whereas consideration of individual values and adoption of a future-focus viewpoint were areas lacking. The emotionality described by athletes in their written reflections varied across both groups and influenced the development of coping insights. Our findings indicate a necessity to examine the emotionality associated with unique stressor events and consider integrating reflection strategies, while also enhancing the operational definitions within conceptual models of stress reflection protocols.

'Ask a hundred people, you get a hundred definitions': A comparison of lay and expert understanding of stress and its associations with health

The understanding an individual holds about stress can influence their appraisal of it and have implications for subsequent health, yet knowledge of such understanding is scarce. This study explored discrepancies between lay and expert understanding of stress and links made between stress and health. Twenty-six lay members of the local community aged 18-62 years, and seven expert stress researchers, participated in individual semi-structured interviews. Thematic analysis of the two datasets was conducted separately, then findings compared to identify similarities and differences between lay and scientific understanding. Whilst many similarities were identified, we found three important discrepancies: (i) Lay participants demonstrated a strong awareness of the indirect effects of stress on health via health behaviours; (ii) compared to experts, lay participants showed less awareness of a direct path between stress and physical health; (iii) lay participants showed less understanding of social determinants of stress and collective measures for stress management that went beyond individual responsibility. Discrepancies identified serve to highlight potential misunderstandings in lay conceptualisation of stress and its links with health. These findings have potential to facilitate the work of practitioners who serve as intermediaries to translate scientific knowledge into therapeutic benefit, through improved awareness and communication surrounding stress understanding.

Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP)

Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.

Computational Approaches for Connecting Maternal Stress to Preterm Birth

Multiple studies have hinted at a complex connection between maternal stress and preterm birth (PTB). This article describes the potential of computational methods to provide new insights into this relationship. For this, we outline existing approaches for stress assessments and various data modalities available for profiling stress responses, and review studies that sought either to establish a connection between stress and PTB or to predict PTB based on stress-related factors. Finally, we summarize the challenges of computational methods, highlighting potential future research directions within this field.

Applying a synergistic mindsets intervention to an esports context

Affective responses during stressful, high-stakes situations can play an important role in shaping performance. For example, feeling shaky and nervous at a job interview can undermine performance, whereas feeling excited during that same interview can optimize performance. Thus, affect regulation-the way people influence their affective responses-might play a key role in determining high-stakes outcomes. To test this idea, we adapted a synergistic mindsets intervention (SMI) (Yeager et al. 2022 Nature 607, 512-520 (doi:10.1038/s41586-022-04907-7)) to a high-stakes esports context. Our approach was motivated by the idea that (i) mindsets both about situations and one's stress responses to situations can be shaped to help optimize stress responses, and (ii) challenge versus threat stress responses will be associated with improved outcomes. After a baseline performance task, we randomly assigned gamers (n = 300) either to SMI or a control condition in which they learned brain facts. After two weeks of daily gaming, gamers competed in a cash-prize tournament. We measured affective experiences before the matches and cardiovascular responses before and throughout the matches. Contrary to predictions, gamers did not experience negative affect (including feeling stressed), thus limiting the capacity for the intervention to regulate physiological responses and optimize performance. Compared with the control participants, synergistic mindsets participants did not show greater challenge responses or improved performance outcomes. Though our adaptation of Yeager et al.'s SMI did not optimize esports performance, our findings point to important considerations regarding the suitability of an intervention such as this to different performance contexts of varying degrees of stressfulness.

Trajectories and determinants of acute stress disorder during the COVID-19 centralized quarantine: A latent class growth analysis

COVID-19 centralized quarantine may cause acute stress disorder (ASD). However, it is unknown how individuals present heterogeneous ASD trajectories during the COVID-19 centralized quarantine and what factors contribute to these patterns. This study aimed to identify the ASD trajectories and their determinants during the centralized quarantine period, and the mediating effects of resilience on these associations. A longitudinal survey with three waves was conducted in a randomly selected quarantine hotel in Shenzhen, China from October to November 2020. A total of 273 participants completed online measures assessing ASD symptoms, Eysenck's personality constructs of extraversion (E), neuroticism (N), psychoticism (P), and resilience on Day 1, and reported ASD symptoms on Days 7 and 14 during their 14-day centralized quarantine periods. Latent class growth analysis identified three trajectories: constantly high symptoms (CHS, 4.76%), decreasing symptoms (DS, 11.72%), and constantly low symptoms (CLS, 83.52%). The CHS and DS subgroups both reported lower E and higher N scores, but not P, compared with the CLS subgroup. Resilience mediated the effects of three personality constructs on ASD trajectories, except for the association between N and DS membership. Our study highlights the heterogeneity in stress responses to the COVID-19 centralized quarantine. The high-risk subgroup with persistent ASD symptoms was characterized by lower E and higher N. The resilience process accounted for the effects of personality in shaping distinct ASD trajectories. Our findings have implications to detect the populations vulnerable to ASD and provide insights for developing timely resilience enhancement intervention programs.

The tendency to appraise stressful situations as more of a threat is associated with poorer health and well-being

It has been argued that habitually appraising stressful events as more of a threat (i.e., situational demands exceed personal coping resources) may increase one's risk of ill-health (e.g., depression). However, while first theorized 15 years ago, little research has tested this assertion. Thus, this study offered a novel test of the associations between trait challenge and threat appraisals and health-related outcomes (i.e., mental health symptomology, psychological well-being, and physical health complaints). Three hundred and ninety-five participants (251 female, 144 male; Mage = 22.50 years, SD = 5.33) completed valid and reliable measures of trait challenge and threat appraisals, mental health (i.e., symptoms of depression and anxiety), well-being (e.g., subjective vitality), and physical health complaints (e.g., respiratory illnesses). Regression analyses revealed that trait challenge and threat appraisals accounted for a significant proportion of variance in all outcomes after controlling for age and gender, with a tendency to appraise stressful events as more of a threat associated with poorer mental health (i.e., greater depression symptomology), well-being (e.g., lower vitality), and physical health (e.g., more respiratory illnesses). Taken together, the findings highlight the importance of trait challenge and threat appraisals for health, although further research is needed using stronger designs (e.g., longitudinal) to enable a more causal understanding.

Integrative Review of Sources of Baccalaureate Nursing Students' Clinical Practice Anxiety

BACKGROUND

Nursing education research and anecdotal literature has revealed that undergraduate nursing students report anxiety related to clinical practice. Most published studies have focused on the effectiveness of interventions to reduce anxiety; only a few identify specific sources of clinical practice anxiety.

METHOD

We conducted an integrative literature review to understand the sources of nursing students' practice-related anxiety and how this anxiety has been measured.

RESULTS

We classified sources of practice-related anxiety into nine themes grouped into five categories: consequences of making a mistake; fear of the unknown; incivility of staff members or teachers; threat to self-concept, image, or health; and theory-practice gap. Practice-related anxiety was measured quantitatively with various surveys and qualitatively using semistructured individual or group interviews and students' journal entries.

CONCLUSION

Different sources of practice-related anxiety likely require distinct interventions. Further research is recommended to identify effective interventions to reduce anxiety related to each of the identified themes. [J Nurs Educ. 2024;63(6):349-355.].

A perspective-based analysis of attachment from prenatal period to second year postnatal life

Attachment is one of the foundational themes in the history of the psychological development of human beings. For this reason, we assume that it must be approached by taking into account multiple scientific perspectives. The present review aims at analyzing the state of the art regarding the genetic, neurobiological and cognitive mechanisms underlying the development of attachment bonding, considering the child as the frame of reference. We hypothesize that attachment may be present in prototypical forms even in the prenatal period, thus our analysis has a temporal origin in the intrauterine period preceding birth. The intrauterine period is assumed to be a period of maximum sensitivity to stimuli and in particular to those coming from a potential primary caregiver: the biological mother. We conclude with a reframing of the state of the art and propose that future research work would benefit from a superordinate model of attachment, capable of containing and regulating all its components and variables.

From the COVID-19 lockdown to the new normal: Two-year changes in daily stress and positive event processes

The emergence of the novel COVID-19 disease and the social distancing measures implemented to curb its spread affected most aspects of daily life. Past work suggests that during times of more severe stress, people respond to daily stressors with relatively higher negative affect. However, little is known about how people responded to daily stressors and positive events at different moments in time during the COVID-19 pandemic. Thus, we examined longitudinal changes in daily event-related affect (covariation of daily stressors or positive events with same-day affect) from Spring 2020 (wave 1) to 2022 (wave 2). The sample consisted of 324 adults aged 18-80 (mean = 52 years; 89% women) from the US and Canada who completed weeklong daily diaries at both waves. The results revealed improvements in affective well-being, stressor-related affect (i.e., smaller fluctuations in affect on stressor days vs. nonstressor days), and positive event-related affect (i.e., lower negative affect on days with vs. without positive events). Furthermore, as people gradually resumed their social activities from 2020 to 2022, people reported being exposed to an increased frequency of both stressors and positive events. This study highlights the potential influence of socio-historical phenomena, such as an ongoing pandemic, on the events that people encounter and how they emotionally respond to them.

Personalized Stress Detection Using Biosignals from Wearables: A Scoping Review

Stress is a natural yet potentially harmful aspect of human life, necessitating effective management, particularly during overwhelming experiences. This paper presents a scoping review of personalized stress detection models using wearable technology. Employing the PRISMA-ScR framework for rigorous methodological structuring, we systematically analyzed literature from key databases including Scopus, IEEE Xplore, and PubMed. Our focus was on biosignals, AI methodologies, datasets, wearable devices, and real-world implementation challenges. The review presents an overview of stress and its biological mechanisms, details the methodology for the literature search, and synthesizes the findings. It shows that biosignals, especially EDA and PPG, are frequently utilized for stress detection and demonstrate potential reliability in multimodal settings. Evidence for a trend towards deep learning models was found, although the limited comparison with traditional methods calls for further research. Concerns arise regarding the representativeness of datasets and practical challenges in deploying wearable technologies, which include issues related to data quality and privacy. Future research should aim to develop comprehensive datasets and explore AI techniques that are not only accurate but also computationally efficient and user-centric, thereby closing the gap between theoretical models and practical applications to improve the effectiveness of stress detection systems in real scenarios.

Effects of hearing acuity on psychophysiological responses to effortful speech perception

In recent studies, psychophysiological measures have been used as markers of listening effort, but there is limited research on the effect of hearing loss on such measures. The aim of the current study was to investigate the effect of hearing acuity on physiological responses and subjective measures acquired during different levels of listening demand, and to investigate the relationship between these measures. A total of 125 participants (37 males and 88 females, age range 37-72 years, pure-tone average hearing thresholds at the best ear between -5.0 to 68.8 dB HL and asymmetry between ears between 0.0 and 87.5 dB) completed a listening task. A speech reception threshold (SRT) test was used with target sentences spoken by a female voice masked by male speech. Listening demand was manipulated using three levels of intelligibility: 20 % correct speech recognition, 50 %, and 80 % (IL20 %/IL50 %/IL80 %, respectively). During the task, peak pupil dilation (PPD), heart rate (HR), pre-ejection period (PEP), respiratory sinus arrhythmia (RSA), and skin conductance level (SCL) were measured. For each condition, subjective ratings of effort, performance, difficulty, and tendency to give up were also collected. Linear mixed effects models tested the effect of intelligibility level, hearing acuity, hearing asymmetry, and tinnitus complaints on the physiological reactivity (compared to baseline) and subjective measures. PPD and PEP reactivity showed a non-monotonic relationship with intelligibility level, but no such effects were found for HR, RSA, or SCL reactivity. Participants with worse hearing acuity had lower PPD at all intelligibility levels and showed lower PEP baseline levels. Additionally, PPD and SCL reactivity were lower for participants who reported suffering from tinnitus complaints. For IL80 %, but not IL50 % or IL20 %, participants with worse hearing acuity rated their listening effort to be relatively high compared to participants with better hearing. The reactivity of the different physiological measures were not or only weakly correlated with each other. Together, the results suggest that hearing acuity may be associated with altered sympathetic nervous system (re)activity. Research using psychophysiological measures as markers of listening effort to study the effect of hearing acuity on such measures are best served by the use of the PPD and PEP.

Testing the model of judicial stress using a COVID-era survey of U.S. federal court personnel

Non-judicial court personnel, critical to a well-functioning justice system, experience overloaded dockets and the responsibility of making significant decisions, contributing to cognitive stress. Understanding and mitigating their stress is essential for maintaining judicial efficiency. We adapted Miller and Richardson's Model of Judicial Stress to assess stress in a broad sample of non-judicial court personnel (n = 122), including judges, lawyers, and administrative staff. Participants responded to surveys about their stress levels, job performance, and health; they also completed cognitive performance tasks. The findings indicated that stress negatively affected employee outcomes including cognitive performance, job performance, job satisfaction, and health outcomes. Notably, perceived job performance had declined compared to the previous year, suggesting that the pandemic was an additional significant stressor. Based on the data, the Model of Judicial Stress is also applicable to other types of courtroom personnel, underlining its relevance across various judicial roles.

Unpacking workplace stress and forensic expert decision-making: From theory to practice

Workplace stress can affect forensic experts' job satisfaction and performance, which holds financial and other implications for forensic service providers. Therefore, it is important to understand and manage workplace stress, but that is not simple or straightforward. This paper explores stress as a human factor that influences forensic expert decision-making. First, we identify and highlight three factors that mitigate decisions under stress conditions: nature of decision, individual differences, and context of decision. Second, we situate workplace stress in forensic science within the Challenge-Hindrance Stressor Framework. We argue that stressors in forensic science workplaces can have a positive or a negative impact, depending on the type, level, and context of stress. Developing an understanding of the stressors, their sources, and their possible impact can help forensic service providers and researchers to implement context-specific interventions to manage stress at work and optimize expert performance.

Impact of the heartfulness program on stress and sleep among healthcare professionals: Pre experimental study

Background

Healthcare professionals (HCPs) worldwide suffer from stress and poor sleep and the COVID-19 pandemic has further raised these issues. This study sought to determine whether HCPs had reduced stress and increased sleep quality while participating in a heartfulness meditation program.

Subjects and Methods

For a 2-month (8 weeks) heartfulness meditation program, we included 41 individuals in a prospective one-group pretest post-test intervention design from February 2023 to April 2023. Scores on the Perceived Stress Scale and Pittsburgh Sleep Quality Index were gathered at baseline and 8 weeks. Forty-one (76%) of the 54 participants completed this study for 8 weeks.

Results

Results showed a substantial decline in stress (preintervention mean ± standard deviation [SD] = 20.54 ± 4.46; postintervention mean ± SD = 18.42 ± 6.14; t-value = -1.947 [0.05*]) and improvement in sleep quality (preintervention mean ± SD = 6.63 ± 3.82; postintervention mean ± SD = 5.29 ± 2.44) among HCPs after following this 8-week heartfulness meditation program. In the end, a substantial decrease in perceived stress score and an improvement in the sleep quality index was found.

Conclusion

Additionally, practicing heartfulness meditation may aid in developing the traits of empathy, acceptance, and inner serenity. We draw the conclusion that more extensive research is required to fully understand the impact of heartfulness meditation practice.

A stress-is-enhancing mindset is associated with lower traumatic stress symptoms during the COVID-19 pandemic

BACKGROUND

A stress-is-enhancing mindset is associated with lower perceived stress and better coping. However, work examining the prospective associations of stress mindset on perceived traumatic stress symptoms during a stressful real-world life event is limited. The present prospective study explored whether stress-is-enhancing mindset measured before the onset of the COVID-19 global pandemic was associated with later traumatic stress symptoms in response to the COVID-19 global pandemic.

METHODS

University students (N = 179; 68% female; Mage = 19.31, SD = 0.79 years) completed the Stress Mindset Measure (SMM) prior to COVID-19 pandemic onset as part of a larger study. The Impact of Event Scale-Revised (IES-R) with respect to the COVID-19 pandemic was completed 1 year into the pandemic.

RESULTS

SMM negatively predicted the IES-R subscales intrusion, avoidance, and hyperarousal such that a more stress-is-enhancing mindset was associated with lower intrusion, avoidance, and hyperarousal following the onset of COVID-19.

CONCLUSIONS

Results suggest a more positive stress mindset is associated with fewer traumatic stress symptoms following a traumatic life event. Altering stress mindset may be an avenue for future interventions to cope with stress.