Associations between coping and diurnal cortisol among children affected by parental HIV/AIDS

Psychological and Physical Abuse and Cortisol Response to Stress: The Moderating Role of Psychosocial Resources

Child abuse is associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis functioning. However, the unique effects of psychological and physical abuse and protective factors against these effects remain largely unknown. To close these gaps, the present study examined the unique effects of psychological and physical abuse on cortisol stress response and explored the moderating role of psychosocial resources in these associations among a sample of Chinese preadolescent children (N = 150; aged 9-13 years; M_age = 10.69 years; 51% boys). The results showed that both psychological and physical abuse were associated with blunted cortisol reactivity slopes. Psychological abuse, but not physical abuse, was associated with lower peak cortisol values and flatter cortisol recovery slopes. Further, psychosocial resources moderated the association between abuse and hyporesponsiveness of the HPA axis. The association between psychological abuse and lower peak cortisol values and the association between physical abuse and steeper cortisol recovery slopes (faster cortisol recovery following the stressor) were observed only among children with low levels of psychosocial resources. These findings indicate the differential effects of psychological and physical abuse on various phases of cortisol stress response, and the protective role of psychosocial resources. This study also has practical implications, given that preadolescence serves as a critical period for maximizing benefit of interventions of adversity.

Stress coping strategies and stress reactivity in adolescents with overweight/obesity

This study explored the associations between the frequency and effectiveness of habitual stress coping strategies on physiological and psychological stress responses to an acute laboratory stressor in adolescents with overweight/obesity (51 adolescents; 47% female; ages 14-19 years). Coping strategies were assessed using the Schoolager's Coping Strategies Inventory. Acute physiological stress responses were measured as salivary cortisol and α-amylase output during the Trier Social Stress Test and during a control condition. Acute psychological stress was measured using a Likert-type scale, and systolic blood pressure (SBP) and heart rate were measured at baseline. Results revealed that higher coping effectiveness was associated with lower log-based α-amylase during the stress (β = -0.025, p = 0.018) and control (β = -0.030, p = 0.005) conditions, but not with cortisol across either condition (all ps > 0.05). SBP moderated the association between coping effectiveness and α-amylase during the stress condition, with higher coping effectiveness associated with lower α-amylase only among individuals with lower SBP (β = 0.002, p = 0.027). Coping frequency was not associated with cortisol responses, neither was habitual stress coping strategies associated with psychological stress (all ps > 0.05). These findings provide preliminary evidence that effective use of stress coping strategies may provide a dampening effect on sympathetic activity in an at-risk adolescent population.

Effects of Peer Victimization and Perceived Social Support on Daily Negative Affect and Sleep Outcomes

OBJECTIVES

The purpose of this study was to examine the effects of peer victimization-measured at the daily and cumulative levels-on daily negative affect and multiple sleep parameters including subjective sleep quality, sleep duration, and sleep continuity (i.e., night awakening) among children affected by parental HIV from rural China. This study also aimed to test the moderation effects of perceived social support and sex in these associations.

METHODS

A total of 637 children (50.4% boys, 8-15 years of age) affected by parental HIV self-reported measures on cumulative peer victimization (i.e., the experience of victimization during the past 6 months) and perceived social support. They were also asked to report daily peer victimization, daily negative affect, and sleep outcomes over three consecutive days.

RESULTS

Multilevel models showed that cumulative peer victimization was associated with both daily negative affect and night awakenings, whereas these associations became statistically nonsignificant after controlling for trait negative affect. Daily peer victimization was significantly related to daily negative affect. All these associations were consistent for boys and girls. There were no buffering effects of perceived social support on these associations.

CONCLUSIONS

The results suggest that peer victimization may contribute to daily negative emotional experiences among children affected by parental HIV. Interventions targeting psychological wellbeing among children affected by parental HIV may need to incorporate peer victimization component.

Diurnal Cortisol in a Sample of Socioeconomically Disadvantaged Chinese Children: Evidence for the Shift-and-Persist Hypothesis

OBJECTIVE

Low socioeconomic status (SES) is one of the most well-established social determinants of health. However, little is known about what can protect the health of individuals (especially children) living in low-SES circumstances. This study explored whether the psychological strategy of "shift-and-persist" protects low-SES children from stress-related physiological risks, as measured through blunted (unhealthy) diurnal cortisol profiles.

METHODS

A sample of 645 children (aged 8-15 years) from low-SES backgrounds and having at least one HIV-positive parent completed a battery of psychological scales. Diurnal cortisol assessments included collection of saliva samples four times a day for 3 days, from which three cortisol parameters (cortisol at awakening, cortisol awakening response, and cortisol slope) were derived.

RESULTS

Higher levels of shift-and-persist, considered as a single variable, were associated with higher cortisol at awakening (B = 0.0119, SE = 0.0034, p < .001) and a steeper cortisol slope (B = -0.0007, SE = 0.0003, p = .023). These associations remained significant after adjusting for covariates and did not vary by age. In supplementary analyses, where shifting and persisting were treated as separate variables, the interaction between these two coping strategies significantly predicted cortisol at awakening (B = 0.0250, SE = 0.0107, p = .020) and the cortisol slope (B = -0.0022, SE = 0.0011, p = .040), suggesting that the combination of shift-and-persist is important for predicting diurnal cortisol profiles.

CONCLUSIONS

Our findings demonstrate that shift-and-persist is associated with healthier diurnal cortisol profiles among socioeconomically disadvantaged children and introduce the possibility that this coping strategy is protective against other stressors, such as those uniquely faced by children in our study (i.e., being affected by parental HIV).

HIV-related stigma and quality of life in people living with HIV and depressive symptoms: indirect effects of positive coping and perceived stress

Despite a strong evidence on the negative association between HIV-related stigma and quality of life (QoL), few studies have examined the indirect effects of this relationship. This study aimed to examine the association between HIV-related stigma and QoL and the indirect effects of positive coping and perceived stress in people living with HIV and depressive symptoms (PLWHD). This study used baseline date from a randomized controlled trial. Structural equation model was used to examine the association between HIV-related stigma and QoL as well as the indirect effects of positive coping and perceived stress. Perceived and internalized stigma had negative direct (β = -0.14, p < 0.05) effect on QoL. Moreover, perceived and internalized stigma had indirect effects on QoL through decreased positive coping and increased perceived stress (β = -0.23, p < 0.001). Multilevel interventions to reduce perceived and internalized stigma and perceived stress as well as programs to enhance positive coping may improve QoL of PLWHD. Integrated interventions that both enhance positive coping and reduce perceived stress and stigma are potentially more effective in improving QoL than programs that focus on only one aspect of stigma reduction among PLWHD.

Peer victimization and diurnal cortisol rhythm among children affected by parental HIV: Mediating effects of emotional regulation and gender differences

The hypothalamic-pituitary-adrenal (HPA) axis activity has been demonstrated as one of the physiological mechanisms underlying the long-lasting effects of peer victimization on physical and mental health. However, the mechanisms linking peer victimization to dysregulations of HPA axis activity remain inadequately understood. The present study examined the potential mediating role of emotional regulation in the association between peer victimization and HPA axis activity in a large community-based sample of 645 children affected by parental HIV (Mage = 10.67 years, ranging from 8 to 15 years old). The three-level growth curve model revealed that higher peer victimization was associated with lower emotional regulation, which in turn was related to lower cortisol at awakening and more blunted diurnal slopes in girls, but not in boys. The findings highlight the protective effect of emotional regulation in relation to HPA axis activity in victimized children, particularly in girls.

Tests of Simple Slopes in Multiple Regression Models with an Interaction: Comparison of Four Approaches

In multiple regression researchers often follow up significant tests of the interaction between continuous predictors X and Z with tests of the simple slope of Y on X at different sample-estimated values of the moderator Z (e.g., ±1 SD from the mean of Z). We show analytically that when X and Z are randomly sampled from the population, the variance expression of the simple slope at sample-estimated values of Z differs from the traditional variance expression obtained when the values of X and Z are fixed. A simulation study using randomly sampled predictors compared four approaches: (a) the Aiken and West ( 1991 ) test of simple slopes at fixed population values of Z, (b) the Aiken and West test at sample-estimated values of Z, (c) a 95% percentile bootstrap confidence interval approach, and (d) a fully Bayesian approach with diffuse priors. The results showed that approach (b) led to inflated Type 1 error rates and 95% confidence intervals with inadequate coverage rates, whereas other approaches maintained acceptable Type 1 error rates and adequate coverage of confidence intervals. Approach (c) had asymmetric rejection rates at small sample sizes. We used an empirical data set to illustrate these approaches.

HPA-axis and inflammatory reactivity to acute stress is related with basal HPA-axis activity

INTRODUCTION

Inflammation is drawing attention as pathway between psychosocial stress and health, and basal HPA axis activity has been suggested to exert a consistent regulatory influence on peripheral inflammation. Here we studied the relationship between basal HPA axis activity and inflammatory and HPA axis acute stress reactivity.

METHODS

We recruited 48 healthy individuals and collected saliva for diurnal cortisol sampling at 6 points. Participants were previously exposed to the Trier Social Stress Test (TSST) on two consecutive days. Plasma interleukin-6 (IL-6) and salivary cortisol reactivity to acute stress were measured, and their relationships with basal HPA axis activity were analyzed.

RESULTS

Steeper cortisol awakening response (CAR) linear increase was related with stronger cortisol stress reactivity (γ=0.015; p=0.042) and marginally significantly with greater habituation (γ=0.01; p=0.066). Greater curvilinearity of CAR was related with stronger cortisol reactivity (γ=-0.014; p=0.021) and greater cortisol habituation (γ=-0.011; p=0.006). Steeper daily linear decline was related with significant or marginally significantly stronger cortisol and IL-6 reactivity (cortisol: γ=-0.0004; p=0.06; IL-6: γ=-0.028; p=0.031) and greater habituation (cortisol: γ=-0.002; p=0.009, IL-6: γ=-0.015; p=0.033). Greater curvilinearity of daily decline was related with stronger IL-6 reactivity (γ=0.002; p=0.024) and also greater cortisol and IL-6 habituation (cortisol: γ=0.00009; p=0.03, IL-6: γ=0.001; p=0.024).

CONCLUSIONS

Patterns of basal HPA axis activity that are related with healthier outcomes were found to be related with stronger initial cortisol and IL-6 reactivity and greater habituation. This is an important step in understanding the long-term health implications of acute stress responsiveness, and future studies should employ longitudinal designs to identify the direction of these relationships.

The impact of daily and trait loneliness on diurnal cortisol and sleep among children affected by parental HIV/AIDS

Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and disruptions of restorative processes (e.g., sleep) have been proposed as two key mechanisms through which loneliness leads to medical morbidity in adults and late adolescents. Whether loneliness acts through these biological and behavioral intermediaries in children as well remains unexplored. In a sample of 645 children aged 8-15 affected by parental HIV/AIDS in rural China, trait and state (i.e., daily) loneliness were measured in a 3-day diary study, wherein participants also provided cortisol samples and sleep measures. Whereas high levels of trait loneliness were found to predict lower morning cortisol levels, longer time in bed, lower sleep quality, and a higher number of night awakenings, daily loneliness was associated with a flatter diurnal cortisol slope and shorter time in bed. Although the association between trait loneliness and daily loneliness with HPA activity remained significant after controlling for psychological constructs that overlap with loneliness (e.g., depression and daily negative affect), some of the associations between loneliness and sleep measures became non-significant after including these additional covariates. These findings provide the first empirical evidence to our knowledge of associations between trait and state loneliness and health-related outcomes among school-aged children and young adolescents.

Individual and Day-to-Day Differences in Active Coping Predict Diurnal Cortisol Patterns among Early Adolescent Girls

Prior work has identified alterations in activity of the hypothalamic-pituitary-adrenal axis as a potential mechanism underlying stress-induced emotional health problems, which disproportionately impact girls beginning in mid-adolescence. How adolescent girls differ from one another in dispositional coping tendencies and shift specific coping strategies in response to varying stressors have been theorized as important predictors of their adaptation, health, and well-being during this dynamic period of development. The goal of this study was to examine whether individual and day-to-day (within-person) differences in adolescent girls' coping responses are associated with daily patterns of hypothalamic-pituitary-adrenal axis activity, indexed by cortisol. Participants were 122 early adolescent girls (M _age = 12.39) who provided three saliva samples per day for 3 days and completed daily coping reports, as well as a standard coping survey. Participants and primary caregivers also completed objective life stress interviews. On average, girls who were more likely to respond to interpersonal stress with voluntary engagement (active) coping exhibited generally adaptive daily physiological regulation-steeper diurnal cortisol slopes, lower total diurnal cortisol output, and lower cortisol awakening responses. Chronic interpersonal stress level significantly moderated these associations in different ways for two distinct components of the diurnal pattern-the slope and cortisol awakening responses. Regarding within-person differences, using active coping more than usual was associated with higher waking cortisol the following morning, which may help to prepare adolescent girls for perceived daily demands. These findings highlight the interactive influence of stress and coping in the prediction of daily hypothalamic-pituitary-adrenal axis activity and support the stress-buffering role of active coping for adolescent girls.

Perceived Stigmatization, Resilience, and Diurnal Cortisol Rhythm Among Children of Parents Living With HIV

Stigmatization often puts at risk the health and well-being of children from marginalized groups. One potential protective factor for such children is resilience--one's capability to adapt flexibly, persistently, and resourcefully to stressful situations. In this study, we investigated the associations among stigmatization, resilience, and hypothalamic-pituitary-adrenal (HPA) axis function in a sample of 645 youths affected by parents infected with HIV. Perceived stigmatization was associated with lower cortisol levels at awakening and flatter cortisol slopes, whereas resilience was independently associated with higher levels of salivary cortisol at awakening and steeper cortisol slopes. We found evidence for an indirect effect of resilience on diurnal cortisol through lower perceived stigmatization. These associations remained significant after we controlled for demographic and health factors and stressful life events. Our findings demonstrate that perceived stigmatization and resilience are associated with HPA-axis functioning in childhood. Broadly, the data suggest that resilience-promoting and stigma-reducing efforts should be considered to improve the health of children from disadvantaged groups.