Daily and trait rumination: diurnal cortisol patterns in adolescent girls

Dispositional Active Coping Predicts Patterns of Adolescents' Cortisol Responsivity in the Context of School-related Stressors

OBJECTIVE

The goal of this study was to examine the direct and conditional effects of active coping and prior exposure to school-related stressors on cortisol reactivity and recovery in response to an academically salient, social stress task.

METHOD

Participants included N= 758 adolescents (50% male; M age = 12.03 years, SD = .49) enrolled in the 7th grade in Title 1 middle schools. Adolescents were predominantly ethnic minorities (62% Hispanic, 12% non-Hispanic White, 11% non-Hispanic Black, 7% Native American, and 8% "other"). Youth completed self-reported assessments of their dispositional use of active coping strategies, prior exposure to school hassles, pubertal status, medication use, and relevant demographic information. In addition, youth engaged in an academically salient group public speaking task adapted for adolescents and provided salivary cortisol sample pre-task, immediately post-task, 15-, and 30-minutes post-task.

RESULTS

Results from piecewise latent growth curve modeling revealed that active coping independently predicted lower cortisol reactivity to the stress task. Furthermore, active coping was associated with slower cortisol recovery when adolescents reported not having experienced any school hassles in the past three months and faster recovery when having experienced several school hassles in the past three months. Results from multinomial logistic regressions revealed that greater use of active coping strategies was less likely to predict a hyper-reactive pattern of cortisol responding compared to other patterns.

CONCLUSION

Findings provide support for active coping as a way to promote adaptive physiological responding to school-related stressors among ethnically diverse youth residing in low-income communities.

Lifetime discrimination, habitual and daily everyday discrimination, and diurnal cortisol among older African Americans adults

Experiences of discrimination can be major life events or daily chronic hassles that occur in various social contexts (e.g., housing, education, employment) and have been found to predict adverse health outcomes, including dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Previous work on daily cortisol dynamics has generally revealed an association between discrimination and flatter cortisol slopes, particularly among racial minorities. However, most of the existing studies have focused on youth and young adults, with little work among older adults. The current study aimed to investigate the relationship between three measures of discrimination (lifetime discrimination, habitual everyday discrimination, and daily everyday discrimination) and diurnal cortisol secretion in a sample of 203 older African Americans. Study results indicated that individuals reporting higher levels of lifetime discrimination experienced morning hypocortisolism and flatter diurnal cortisol slopes. Exploratory analyses also showed that prior daily everyday discrimination was significantly associated with blunted cortisol awakening response (CAR) the next day. Our findings underline the role of discrimination in modulating daily cortisol dynamics among older African American adults and advance knowledge on how social stressors influence healthy aging.

Chronotype and poor sleep quality in young adults - a pilot study on the role of rumination

BACKGROUND

Eveningness has been associated with poor sleep quality and depression. However, chronotype has also been shown to be a multidimensional construct, not limited to a merely morningness-eveningness orientation. It has also been proposed that other factors may also mediate the relationship between chronotype and its mental health sequelae. This pilot study explores the role of rumination as a mediator between chronotype and sleep quality, chronotype and depressive symptoms.

METHODS

A sample of 144 participants completed The Morningness-Eveningness-Stability-Scale Improved (MESSi), Pittsburgh Sleep Quality Index (PSQI), Rumination-Reflection Questionnaire (RRQ) and Center for Epidemiologic Studies Depression Scale (CES-D)). The results were tested using Spearman's rank correlation coefficient, multiple linear regression and the Sobel test.

RESULTS

Rumination was linked to poor sleep quality and increased depression. Morning affect and Distinctness (i.e. rigidity, or the subjective amplitude of the circadian rhythm) correlated with rumination. Rumination was a partial mediator of the associations between Morning Affect and sleep quality, Morning Affect and depression.

CONCLUSIONS

Rumination may play a role in the association between chronotype (particularly Morning Affect and Distinction) and sleep quality and depression. The recognition of this association might serve as a basis for clinical psychoeducational and therapeutic programs targeting both adjustment of the circadian rhythm and rumination as a psychopathological sign.

Which adolescents are well-suited to app-based mindfulness training? A randomized clinical trial and data-driven approach for personalized recommendations

OBJECTIVE

Rumination heightens risk for depression and anxiety, which increase substantially during adolescence. Smartphone apps offer a convenient and cost-effective means for adolescents to access mindfulness training, which may reduce rumination. Despite their increasing popularity, it is unclear which adolescents benefit from mindfulness apps.

METHOD

Adolescents (n = 152) with elevated trait rumination were randomly assigned to 3 weeks of app-based mindfulness training or a mood-monitoring control. Multilevel models tested group differences in state rumination change, assessed via ecological momentary assessment. Baseline adolescent characteristics were submitted to elastic net regularization models to develop a "Personalized Advantage Index" indicating an individual's expected outcome from the mindfulness app relative to the mood-monitoring control. Finally, we translated a predictive model (developed in an external sample) for personalized recommendations of expected benefit from the mindfulness app.

RESULTS

Adolescents in the mindfulness app condition reported significantly greater reductions in rumination than adolescents in the control condition. Individuals predicted to have better outcomes from the mindfulness app relative to mood monitoring had significantly greater reductions in rumination if randomly assigned to the mindfulness condition. In contrast, between-condition differences in outcome were not significant for adolescents predicted to have better outcomes in the mood-monitoring condition.

CONCLUSIONS

Findings support the efficacy of a mindfulness app to reduce state rumination in adolescents, particularly among adolescents high in trait rumination. A predictive model is put forth, which could be used to objectively communicate expected mindfulness app outcomes to adolescents prior to engagement in app-based mindfulness training. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The relationship between sex, personality traits, and the hypothalamic-pituitary-adrenocortical axis

The aim of our study was to examine whether there are sex-based differences in the relationship between personality traits and hypothalamic-pituitary-adrenal (HPA) axis measures. A total of 106 healthy volunteers (56.6% women; age: 48.0 ± 15.8 years) were studied. The revised temperament and character inventory (TCI-R) and the Childhood Trauma Questionnaire (CTQ) were administered. HPA axis function was assessed using three dynamic measures: the cortisol awakening response (CAR), the diurnal cortisol slope, and the cortisol suppression ratio with 0.25 mg of dexamethasone (DSTR). Female sex was associated with an increased CAR and a more flattened diurnal cortisol slope, although a negative significant interaction between harm avoidance and female sex was found. Regarding the DSTR, perseverance was associated with increased cortisol suppression after dexamethasone; sex did not affect this association. Our study suggests that the relationship between specific personality traits (harm avoidance) and HPA axis measures (CAR, diurnal slope) differs according to sex.

Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort

In this prospective study of mental health, we examine the influence of three interrelated traits - perceived stress, rumination, and daytime sleepiness - and their association with symptoms of anxiety and depression in early adolescence. Given the known associations between these traits, an important objective is to determine the extent to which they may independently predict anxiety/depression symptoms. Twin pairs from the Queensland Twin Adolescent Brain (QTAB) project were assessed on two occasions (N = 211 pairs aged 9-14 years at baseline and 152 pairs aged 10-16 years at follow-up). Linear regression models and quantitative genetic modeling were used to analyze the data. Prospectively, perceived stress, rumination, and daytime sleepiness accounted for 8-11% of the variation in later anxiety/depression; familial influences contributed strongly to these associations. However, only perceived stress significantly predicted change in anxiety/depression, accounting for 3% of variance at follow-up after adjusting for anxiety/depression at baseline, although it did not do so independently of rumination and daytime sleepiness. Bidirectional effects were found between all traits over time. These findings suggest an underlying architecture that is shared, to some degree, by all traits, while the literature points to hypothalamic-pituitary-adrenal (HPA) axis and/or circadian systems as potential sources of overlapping influence and possible avenues for intervention.

Emotion Regulation and Diurnal Cortisol: A Longitudinal Study of Early Adolescents

Aberrant patterns of diurnal cortisol, a marker of stress reactivity, predict adverse physical and mental health among adolescents. However, the mechanisms underlying aberrant diurnal cortisol production are poorly understood. Thus, the objective of this study was to investigate, for the first time, whether the core emotion regulation (ER) strategies of rumination (brooding, reflection), reappraisal, and suppression were prospectively associated with individual differences in diurnal cortisol during the COVID-19 pandemic, a period of significant stress. A community sample of 48 early adolescents (M_age=13.45; 60% males) was recruited from British Columbia, Canada. Participants completed ER measures before the pandemic, and diurnal cortisol was assessed by collecting eight saliva samples over two days during the first COVID-19-related lockdown in the region. As expected, brooding predicted elevated waking cortisol and a blunted cortisol awakening response (CAR), whereas reflection predicted lower waking cortisol and suppression predicted a steeper CAR. Unexpectedly, reappraisal was not associated with diurnal cortisol production. Results indicate that ER strategies may represent a mechanism underlying individual differences in biological markers of wellbeing during stress.

App-based Mindfulness Training for Adolescent Rumination: Predictors of Immediate and Cumulative Benefit

Objectives

Rumination is a transdiagnostic risk factor for depression and anxiety, which surge during the adolescent years. Mindfulness training - with its emphasis on metacognitive awareness and present-moment attention - may be effective at reducing rumination. Mindfulness apps offer a convenient, engaging, and cost-effective means for accessing mindfulness training for teens. Despite their increasing popularity among adolescents, no study to date has investigated which teens are well-suited to app-based mindfulness training.

Methods

Eighty adolescents (M age = 14.01 years, 45% girls) with elevated rumination were enrolled in a 3-week trial of app-based mindfulness training. Repeated daily ecological momentary assessment (EMA) surveys assessed problem-focused and emotion-focused rumination immediately prior to and following each mindfulness exercise. Elastic net regularization (ENR) models tested baseline predictors of "immediate" (post-mindfulness exercise) and "cumulative" (post-3-week intervention) benefit from app-based mindfulness training.

Results

Ninety percent (72/80) of adolescents completed the 3-week trial, and the mean number of mindfulness exercises completed was 28.7. Baseline adolescent characteristics accounted for 14%-25% of the variance in outcomes (i.e., reduction in problem-focused or emotion-focused rumination). Higher baseline rumination, and lower emotional suppression, predicted better immediate and cumulative outcomes. In contrast, female gender and older age predicted better immediate, but not cumulative, outcomes. Differences in results across outcome timeframes (immediate vs. cumulative) are discussed.

Conclusions

Findings from this study highlight the potential of data-driven approaches to inform which adolescent characteristics may predict benefit from engaging with an app-based mindfulness training program. Additional research is needed to test these predictive models against a comparison (non-mindfulness) condition.

Daily rumination about stress, sleep, and diurnal cortisol activity

Rumination is an involuntary cognitive process theorized to prolong arousal and inhibit proper emotion regulation. Most available research has examined individual differences in cognitive dispositions to ruminate about stress as a risk marker for psychopathology and other health problems. This intensive longitudinal study extended previous research by examining day-to-day associations of rumination about stress with objectively-measured actigraph-based sleep and diurnal salivary cortisol activity. Sixty-one healthy participants (Mage = 20.91) completed up to five ecological momentary assessments (EMA) each day and wore actigraph wristwatches for eight days (N = 488). On three of these days, participants provided five saliva samples assayed for cortisol (N = 910). On average, greater daily stress levels were associated with shorter sleep duration and higher waking cortisol levels. In day-to-day analyses, greater daily stress levels, when combined with ruminating about daily stress more than usual, was associated with higher waking cortisol levels the following morning. Ruminating more than usual about daily stress, in the context of low-stress days, was also associated with flatter diurnal cortisol slopes the next day. These findings highlight the potential influences of daily stress, and rumination about stress, on sleep and diurnal cortisol activity - two important markers of health and well-being.

A time to be chronically stressed? Maladaptive time perspectives are associated with allostatic load

Living in the past, the present, or the future can affect stress and health. Our group has shown that acute stress (cortisol reactivity) is modulated by time perspectives, the ways we psychologically relate to time. Here, we expand this research with a comprehensive measure of multi-systemic chronic stress (allostatic load). Among 204 healthy adults (60 men; 144 women), we examined whether time perspectives modulate allostatic load measured with 23 neuroendocrine, immune, metabolic, and cardiovascular biomarkers. Five time perspective categories were measured (past negative, past positive, present hedonistic, present fatalistic, future). Multiple regressions controlling for sex, age, and depressive symptoms were used. Increased present fatalistic time perspective was positively correlated with allostatic load, while future time perspective was negatively correlated with allostatic load. Our preliminary findings link time perspective to multisystemic chronic stress and are discussed in the context of potential clinical implications.

Overestimating Self-Blame for Stressful Life Events and Adolescents' Latent Trait Cortisol: The Moderating Role of Parental Warmth

Cognitive interpretations of stressful events impact their implications for physiological stress processes. However, whether such interpretations are related to trait cortisol-an indicator of individual differences in stress physiology-is unknown. In 112 early adolescent girls (M age = 12.39 years), this study examined the association between self-blame estimates for past year events and latent trait cortisol, and whether maternal warmth moderated effects. Overestimating self-blame (versus objective indices) for independent (uncontrollable) events was associated with lower latent trait cortisol, and maternal warmth moderated the effect of self-blame estimates on latent trait cortisol for each dependent (at least partially controllable) and interpersonal events. Implications for understanding the impact of cognitive and interpersonal factors on trait cortisol during early adolescence are discussed.

Hypothalamic-pituitary-adrenal axis activity in the comorbidity between obsessive-compulsive disorder and major depression

Major depressive disorder (MDD) is the most common psychiatric comorbidity in patients with obsessive-compulsive disorder (OCD). Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been described in both disorders and might play a role in the association between them. We aimed to study the role of HPA axis activity in the comorbidity between OCD and MDD, while controlling for psychopathological dimensions such as anxiety and depressive symptoms. We studied 324 participants belonging to four diagnostic groups: 1) MDD (n = 101), 2) OCD with comorbid MDD (n = 33), 3) OCD without MDD (n = 52), and 4) healthy subjects (n = 138). State anxiety, trait anxiety and depressive symptoms were assessed. Three HPA axis measures were analyzed in saliva: cortisol awakening response (CAR), diurnal cortisol slope (calculated using two formulas: [1] awakening to 11 p.m. [AWE diurnal slope]; [2] considering fixed time points [FTP diurnal slope] from 10 a.m. to 11 p.m.), and dexamethasone suppression test ratio after 0.25 mg of dexamethasone (DSTR). Multiple linear regression analyses were conducted to explore the contribution of clinical diagnosis and symptom dimensions to each HPA axis measure. A more flattened FTP diurnal cortisol slope was observed for OCD patients with comorbid MDD. Regarding the CAR and DSTR, a significant interaction was found between trait anxiety and OCD, as OCD patients with greater trait anxiety showed an increased CAR and reduced cortisol suppression after dexamethasone administration. Our results suggest that trait anxiety plays an important role in the relationship between HPA axis measures and OCD/MDD comorbidity.

Trait Rumination Predicts Elevated Evening Cortisol in Sexual and Gender Minority Young Adults

Stress may contribute to illness through the impaired recovery or sustained activity of stress-responsive biological systems. Rumination, or mental rehearsal of past stressors, may alter the body’s stress-responsive systems by amplifying and prolonging exposure to physiological mediators, such as cortisol. The primary aim of the current investigation was to test the extent to which the tendency to ruminate on stress predicts diminished diurnal cortisol recovery (i.e., elevated evening cortisol) in a sample of sexual and gender minority young adults. Participants included 58 lesbian, gay, bisexual, and transgender young adults (M_age = 25.0, SD = 4.1) who completed an initial online survey that assessed trait rumination and current depressed mood. Participants completed daily evening questionnaires and provided salivary cortisol samples at wake, 45 min post-wake, 12 h post-wake, and at bedtime over seven consecutive days. Trait rumination predicted significantly higher cortisol concentrations at bedtime, but was unrelated to other cortisol indices (e.g., morning cortisol, diurnal slope, total output). The association with trait rumination was not accounted for by daily negative affect, and was largely independent of depressed mood. These results have implications for identifying and treating those who may be at risk for impaired diurnal cortisol recovery and associated negative health outcomes.