Assessing the Perceived Stress Scale for African American adults with asthma and low literacy

Per- and polyfluoroalkyl substances (PFAS), perceived stress, and depressive symptoms in a prospective cohort study of black women

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals with neurotoxic properties. PFAS have been associated with depressive symptoms among women in some studies, but little research has evaluated the effects of PFAS mixtures. Further, no study has investigated interactions of PFAS-depression associations by perceived stress, which has been shown to modify the effects of PFAS on other health outcomes.

OBJECTIVE

In a prospective cohort study of reproductive-aged Black women, we investigated associations between PFAS and depressive symptoms and the extent to which perceived stress modified these associations.

METHODS

We analyzed data from 1499 participants (23-35 years) in the Study of Environment, Lifestyle, and Fibroids. We quantified concentrations of nine PFAS in baseline plasma samples using online solid-phase extraction-liquid chromatography-isotope dilution tandem mass spectrometry. Participants reported perceived stress via the Perceived Stress Scale (PSS-4; range = 0-16) at baseline and depressive symptoms via the Center for Epidemiologic Studies Depression Scale (CESD; range = 0-44) at the 20-month follow-up visit. We used Bayesian Kernel Machine Regression to estimate associations between PFAS concentrations, individually and as a mixture, and depressive symptoms, and to assess effect modification by PSS-4 scores, adjusting for confounders.

RESULTS

Baseline perfluorodecanoic acid concentrations were associated with greater depressive symptoms at the 20-month follow-up, but associations for other PFAS were null. The PFAS were not associated with depressive symptoms when evaluated as a mixture. The association between the 90th percentile (vs. 50th percentile) of the PFAS mixture with CES-D scores was null at the 10th (β = 0.03; 95 % CrI = 0.20, 0.25), 50th (β = 0.02; 95 % CrI = -0.16, 0.19), and 90th (β = 0.01; 95 % CrI = 0.18, 0.20) percentiles of PSS-4 scores, suggesting perceived stress did not modify the PFAS mixture.

CONCLUSION

In this prospective cohort study, PFAS concentrations-assessed individually or as a mixture-were not appreciably associated with depressive symptoms, and there was no evidence of effect modification by perceived stress.

Fourteen-item perceived stress scale assessment using item response theory among pregnant women

The current study aimed to assess the psychometric properties of the Spanish language version of the 14-item Perceived Stress Scale (PSS-S) in a population of pregnant women who speak Spanish in Peru using item response theory (IRT). Our study consisted of 5,435 pregnant women who participated in the Pregnancy Outcomes Maternal and Infant Study (PrOMIS) cohort in Peru. Exploratory and confirmatory factor analyses were conducted to determine dimensionality of the scale in this population, and item response theory was conducted to determine the applicability of the PSS. The PSS consisted of a 2-factor questionnaire measuring perceived stress and coping capacity accounting for 77% of variability. The IRT analysis showed differences in item difficulty and discrimination. Item difficulty represents the level of the latent construct where 50% of respondents endorse a particular response, and item discrimination determines the rate of change of the probability of endorsing an item for differing ability levels. For the first factor, perceived stress, item 12 was the least difficult and item 2 was the most difficult. For the second factor, coping capacity, item 9 was the least difficult and item 6 was the most difficult. The Spanish version of the 14-item PSS can be a useful assessment tool for perceived stress, but more IRT should be done to delve further into the psychometric properties of the questionnaire to inform clinicians and policy makers more appropriately.

A Feasibility Study to Assess Sleep and Subsequent Breast Milk Volume Among Mothers With Hospitalized Preterm Infants

BACKGROUND

Sleep is essential for optimal health, and disturbed postpartum sleep is associated with compromised infant attachment. The postpartum experience of mothers with preterm infants is unlike the biological norm, as they are separated from their infants and often express breast milk.

PURPOSE

The purpose of this study was to examine the feasibility of conducting a clinical research study among women with hospitalized preterm infants. We also explored for associations between maternal sleep patterns and sleep-related psychological states and subsequent breast milk volume.

METHODS

Participants were recruited from Magee-Womens Hospital, located in Pittsburgh, Pennsylvania New mothers completed daily sleep and pumping logs and scales to measure stress, trauma, depression, fatigue, and sleep quality.

RESULTS

A total of 78 women were screened, 18 women consented, and a total of 8 participants completed the study. Screening from the postpartum unit increased recruitment. The participants experience worsening sleep quality over time, moderate stress, and fatigue. Stress, postnatal depression, and fatigue are negatively associated with milk volume.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Postpartum recruitment with frequent follow-ups improved recruitment and retention. We present a preliminary association between maternal stress, fatigue, and depression, and subsequent breast milk volume. Sleep-related psychological states may negatively influence milk volume.

Changes in caregiver mental health and pediatric asthma control during COVID-19

OBJECTIVE

This study evaluated caregivers' stress and depressive symptoms, and children's asthma control, before COVID-19 began and after its onset among families in the RVA Breathes program.

METHODS

The RVA Breathes intervention, which took place in an urban city in the United States, includes asthma education delivered by a community health worker (CHW), a home assessment, and school nurse components. Participants included 125 children (5-11 years) with asthma and their caregivers (48% household income <$25,000) enrolled prior to the pandemic. Families were randomized to an active intervention arm (full intervention or intervention without school nurse component) or the control group. Caregivers completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Perceived Stress Scale (PSS); children and caregivers completed the Childhood Asthma Control Test (cACT). Assessments pre-COVID-19 were compared to those completed after the pandemic's onset.

RESULTS

Children in both intervention groups had better cACT scores after the start of COVID-19 compared to before (t(55) = -2.131, p = .019; t(28) = -2.893, p = .004). Caregivers in the intervention groups had lower PSS scores after the start of COVID-19 compared to pre-COVID-19 (t(53) = 3.928, p < .001; t(28) = 2.568, p = .008). Furthermore, CES-D scores improved among caregivers in the full intervention (t(48) = 1.789, p = .040). Caregivers in the control condition did not report significant changes in stress or depressive symptoms.

CONCLUSIONS

Findings suggest that support from interventionists, including CHWs, might have alleviated stress and depressive symptoms during COVID-19, as well as improved asthma control during the pandemic.

Associations of Cumulative Perceived Stress with Cardiovascular Risk Factors and Outcomes: Findings from The Dallas Heart Study

Background

Data remain sparse regarding the impact of chronic stress on cardiovascular disease (CVD) risk factors and outcomes. Prior work has been limited by incomplete assessments of perceived stress and focus on single stress domains. We evaluated the association between a composite measure of perceived stress and CVD risk factors and outcomes.

Methods

Participants from the Dallas Heart Study phase 2 (2007-2009) without prevalent CVD who completed questionnaire assessments of perceived stress were included (n=2685). Individual perceived stress subcomponents (generalized stress, psychosocial, financial, and neighborhood stress) were standardized and integrated into a single cumulative stress score (CSS) with equal weighting for each component. Associations between CSS and demographics, psychosocial variables and cardiac risk factors were assessed in univariable and multivariable analyses. Cox proportional hazards models were used to determine associations of the CSS with atherosclerotic CVD (ASCVD) and Global CVD (ASCVD, heart failure, and atrial fibrillation) after adjustment for demographics and traditional risk factors.

Results

Median age of the study population was 48 years, 55% were female, 49% Black and 15% Hispanic/Latinx. CSS was higher among participants who were younger, female, Black or Hispanic, and those with lower income and educational attainment (p<.0001 for each). Higher CSS was associated with self-report of racial/ethnic discrimination, lack of health insurance and last medical contact > one year previously (p<.0001 for each). In multivariable regression models adjusting for age, gender, race/ethnicity, income and education, higher CSS associated with hypertension, smoking, and higher body mass index, waist circumference Hemoglobin A1C, hs-CRP and sedentary time (p< 0.01 for each). Over a median follow-up of 12.4 years, higher CSS associated with ASCVD (adjusted HR 1.22 per SD, 95% CI 1.01-1.47) and Global CVD (HR 1.20, 95% CI 1.03-1.40). No interactions were seen between CSS, demographic factors, and outcomes.

Conclusion

Composite multidimensional assessments of perceived stress may help to identify individuals at risk for CVD who may be targeted for stress mitigation or enhanced prevention strategies. These approaches may be best focused on vulnerable populations, given the higher burden of stress in women, Black and Hispanic individuals, and those with lower income and education.

WHAT IS NEW?

A novel measure of cumulative stress was created that integrates generalized, psychosocial, financial, and neighborhood perceived stress.Cumulative stress was higher among women, Black and Hispanic participants, younger individuals and persons with lower income and educational attainment and was associated with adverse health behaviors and increased burden of cardiovascular disease (CVD) risk factors.In a diverse cohort, higher cumulative stress associated with incident CVD after adjustment for demographics and traditional risk factors. No interactions were seen based on demographic factors.

CLINICAL IMPLICATIONS

Although associations of chronic stress with CVD were similar across demographic subgroups, the higher burden of stress among younger individuals, women, Black and Hispanic participants, and those with lower SES suggests that CVD risk associated with higher stress affects marginalized groups disproportionately.Cumulative Stress is associated with modifiable risk factors and health behaviors. Future studies should explore targeting behavioral modification and risk factor reduction programs, as well as stress reduction strategies, to individuals with high cumulative stress.Additional research is needed to uncover mechanisms that underly the association between chronic stress and cardiovascular disease.

Depression Symptoms, Perceived Stress, and Loneliness During the COVID-19 Pandemic Among Diverse US Racial-Ethnic Groups

Introduction

Studies have reported increases in psychological distress during the COVID-19 pandemic. This study aimed to estimate associations between race-ethnicity and psychological distress during the COVID-19 pandemic among nationally representative samples of all major racial-ethnic groups in the United States.

Methods

We conducted a nationally representative cross-sectional survey between December 2020 and February 2021 of Asian, black/African American, Latino (English and Spanish speaking), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, white, and multiracial adults (n=5500). Distress measures included: anxiety-depression (Patient Health Questionnaire-4 [PHQ-4]), stress (modified Perceived Stress Scale), and loneliness-isolation (frequency felt lonely and isolated). Multinomial logistic regression models estimated associations between race-ethnicity and psychological distress, adjusting for demographic and health characteristics.

Results

Overall, 23.7% reported moderate/severe anxiety-depression symptoms, 34.3% reported moderate/severe stress, and 21.3% reported feeling lonely-isolated fairly/very often. Compared with white adults and adjusting for covariates, the prevalence of moderate/severe anxiety-depression was significantly lower among Asian (adjusted odds ratio [aOR]=0.44, 95% confidence interval [CI]=0.34-0.58), black (aOR=0.49, 95% CI=0.38-0.63), English-speaking Latino (aOR=0.62, 95% CI=0.45-0.85), Spanish-speaking Latino (aOR=0.31, 95% CI=0.22-0.44), and Native Hawaiian/Pacific Islander (aOR=0.66, 95% CI=0.49-0.90) adults. Similar trends were seen for moderate/severe stress and feeling lonely-isolated fairly/very often. Worse distress profiles of American Indian/Alaska Native and multiracial adults were attenuated after adjustment.

Conclusions

Minoritized groups tended to have less distress than white adults. Collective experiences of cumulative disadvantage could engender shared resiliency/normalization among these groups.

Food to Overcome Outcomes Disparities: A Randomized Controlled Trial of Food Insecurity Interventions to Improve Cancer Outcomes

PURPOSE

Food insecurity is prevalent among low-income immigrant and minority patients with cancer. To our knowledge, this randomized controlled trial is the first to prospectively examine the impact on cancer outcomes of food insecurity interventions, with the goal of informing evidence-based interventions to address food insecurity in patients with cancer.

METHODS

A three-arm randomized controlled trial was conducted among food-insecure (18-item US Department of Agriculture Household Food Security Survey Module score ≥ 3) patients with cancer (N = 117) at four New York City safety net cancer clinics. Arms included a hospital cancer clinic-based food pantry (arm 1), food voucher plus pantry (arm 2), and home grocery delivery plus pantry (arm 3). Treatment completion (primary outcome) and full appointment attendance were assessed at 6 months. Food security status, depression symptoms (Patient Health Questionnaire-9), and quality-of-life scores (Functional Assessment of Cancer Therapy-General) were assessed at baseline and at 6 months.

RESULTS

Voucher plus pantry had the highest treatment completion rate (94.6%), followed by grocery delivery plus pantry (82.5%) and pantry (77.5%; P = .046). Food security scores improved significantly in all arms, and Patient Health Questionnaire-9 and Functional Assessment of Cancer Therapy-General scores improved significantly in the pantry and delivery plus pantry arms.

CONCLUSION

Our findings in this preliminary study suggest that voucher plus pantry was the most effective intervention at improving treatment completion, and it met our a priori criterion for a promising intervention (≥ 90%). All interventions demonstrated the potential to improve food security among medically underserved, food-insecure patients with cancer at risk of impaired nutrition status, reduced quality of life, and poorer survival. All patients with cancer should be screened for food insecurity, with evidence-based food insecurity interventions made available.

Perceived Stress and Molecular Bacterial Vaginosis in the National Institutes of Health Longitudinal Study of Vaginal Flora

Vaginal microbiota provide the first line of defense against urogenital infections primarily through protective actions of Lactobacillus species Perceived stress increases susceptibility to infection through several mechanisms, including suppression of immune function. We investigated whether stress was associated with deleterious changes to vaginal bacterial composition in a subsample of 572 women in the Longitudinal Study of Vaginal Flora, sampled from 1999 through 2002. Using Cox proportional hazards models, both unadjusted and adjusted for sociodemographic factors and sexual behaviors, we found that participants who exhibited a 5-unit-increase in Cohen's Perceived Stress Scale had greater risk (adjusted hazard ratio (HR) = 1.40, 95% confidence interval (CI): 1.13, 1.74) of developing molecular bacterial vaginosis (BV), a state with low Lactobacillus abundance and diverse anaerobic bacteria. A 5-unit increase in stress score was also associated with greater risks of transitioning from the L. iners-dominated community state type (26% higher) to molecular-BV (adjusted HR = 1.26, 95% CI: 1.01, 1.56) or maintaining molecular-BV from baseline (adjusted HR = 1.23, 95% CI: 1.01, 1.47). Inversely, women with baseline molecular-BV reporting a 5-unit stress increase were less likely to transition to microbiota dominated by L. crispatus, L. gasseri, or L. jensenii (adjusted HR = 0.81, 95% CI: 0.68, 0.99). These findings suggest that psychosocial stress is associated with vaginal microbiota composition, inviting a more mechanistic exploration of the relationship between psychosocial stress and molecular-BV.

Perceived Stress and Perceived Lack of Control of Spanish Education-Degree University Students: Differences Dependent on Degree Year, Basis for Admission and Gender

Stress in higher education students is an issue of growing concern, as stress impacts quality of life and has been linked to drop-out from higher education. The aim was to investigate how stress was related to how far along students were in their degree program, using the Spanish Perceived Stress Scale (PSS10). We expected 1) first-year education students to experience more perceived lack of control than second-year students, 2) second-year students to experience more perceived stress than first-year students. Participants were students in three university education-degree programs (N = 399). The psychometric properties of the Perceived Stress (PS) and Perceived Lack of Control (PLC) subscales were investigated using Rasch models. One item was eliminated from each subscale. The estimated interval-level Rasch scores were utilized for testing hypotheses with general linear models. Results showed a somewhat more complex pattern than predicted as interaction effects between degree year and gender and between degree year and basis for admission were found.

Evaluation of the measurement properties of the Perceived Stress Scale (PSS) in Hispanic caregivers to patients with Alzheimer's disease and related disorders

OBJECTIVES

The Perceived Stress Scale (PSS) is the most widely used measure of perceived stress; however, minimal psychometric evaluation has been performed among Hispanic respondents, and even less among Hispanic caregivers to persons with Alzheimer's disease and related disorders (ADRDs).

DESIGN

Secondary data analysis.

SETTING

New York City, NY, USA.

PARTICIPANTS

A sample of 453 community dwelling Hispanic caregivers to patients with ADRD.

MEASUREMENTS

Latent variable models were used to evaluate the PSS. Exploratory and confirmatory factor analyses were used to examine unidimensionality. Differential item functioning (DIF) was examined for age, education, and language using the graded item response model.

RESULTS

The factor and bifactor analyses results supported essential unidimensionality of the item set; however, positively worded items were observed using response item theory to be less informative than the negatively worded items. Reliability estimates were high. Salient DIF was not observed for age, education, or language of interview using the primary DIF detection method. Sensitivity analyses using a second DIF detection method identified uniform language-DIF for the item, "In the last month, how often have you felt that you were on top of things?" However, the non-compensatory DIF value was below the threshold considered salient.

CONCLUSIONS

In summary, the 10-item PSS performed well in a sample of English- and Spanish-speaking Hispanic caregivers to patients with ADRD. Very little DIF, and none of high magnitude and impact, was observed. However, the negatively worded items, perhaps because they are more directly reflective of stress, were more informative. In the context of a short-form measure or computerized adaptive test, more informative items are those that would be selected for inclusion.

Measuring stress in Australia: validation of the perceived stress scale (PSS-14) in a national sample

Background

In Australia, the stress levels have increased over the years, impacting on the physical and mental health of the general population. The aim of the present study was to evaluate the validity and reliability of the PSS-14 in an Australian population.

Methods

The PSS-14 was applied to a large national sample comprising 3857 Australians in the population-based cross-sectional study Australia’s National Survey of Adult Oral Health 2004–2006. The psychometric properties analyzed with the Rasch model and Graphical Log-linear Rasch models were: model fit, item fit, local dependence, differential item functioning, unidimensionality, reliability, targeting and criterion validity.

Results

The PSS-14 did not fit the pure RM (χ2 (55) = 3828.3, p = < 0.001) and the unidimensionality of the whole scale was rejected (p = < 0.001). The Perceived Stress (χ2 (27) = 1409.7, p = < 0.001) and Perceived Control (χ2 (27) = 713.4, p = < 0.001) subscales did not fit the pure RM. After the deletion of two items, the Perceived Stress subscale (χ2 (96) = 94.4, p = 0.440) fitted a GLLRM, while the Perceived Control scale (χ2 (55) = 62.50, p = 0.224) fitted a GLLRM after the exclusion of four misfitting items.

Conclusions

The Perceived Stress subscale displayed adequate psychometric properties after the deletion of two items; however, the majority of problems centered around the Perceived Control subscale. The presence of differential item functioning among four items indicates that adjustment of total scores is required to avoid measurement bias. Recommendations for future applications in Australia are provided.

Medicine and Horsemanship: The Effects of Equine-assisted Activities and Therapies on Stress and Depression in Medical Students

This study examined the use of an equine-assisted brief course module on stress and depression among medical students (n = 28), a demographic known to experience high pressure. Evidence supports that animal-assisted therapies can lead to the improvement of health and quality of life, particularly in terms of cognitive, psychological, and physical benefits. This study used the seven-session Kane Medicine and Horsemanship program; students completed pre- and post-measures one week before and after the course. Participation in the course significantly reduced perceived stress (p: 0.001), depression (p: <0.001), stress severity (p: 0.014), and stress frequency (p: 0.001) among medical students. This approach should be further investigated as an option for improving well-being among medical students.

Psychometric properties of a Korean version of the Perceived Stress Scale (PSS) in a military sample

BACKGROUND

Perceived stress reflects a person's feeling of how much stress the individual is under at a given time. The Perceived Stress Scale (PSS) is a popular instrument measuring the extent to which individuals perceive situations in their life as excessive relative to the ability to cope. Based on a literature review, however, several issues related to the scale remain: (a) the dimensionality is not established, (b) little information about the individual items exists, and (c) much research is based on university student samples. To address these, this study evaluated the psychometric properties of the Korean version of the Perceived Stress Scale (KPSS) using a military sample.

METHODS

This study was conducted in South Korea with 373 military personnel, aged 19-30 years. Both classical test theory (CTT) and the Rasch rating scale model were used to examine the psychometric properties of the KPSS, including factor structure, concurrent validity, reliability, and item analyses.

RESULTS

Internal consistency reliability for the overall and negative/positive perception subscales was.85, .85 and .86, respectively. Based on Rasch reliability, person and item reliability were .82 and .98, respectively. Person and item separation were 2.13 and 7.19, respectively. Concurrent validity was established, with significantly positive association with the measures of depression and negative association with the measure of life satisfaction. Findings from the CFA suggested that a bifactor model with two group factors was the best fit to the observed data. The RSM showed that all but one item had acceptable infit and outfit statistics, and item difficulty ranged from -.73 to 1.22. Besides, the RSM showed positive and moderate inter-item correlations ranging from .42 to .75.

CONCLUSIONS

The results provided evidence that a 10-item Korean version of the Perceived Stress Scale was a reliable and valid scale to measure perceived stress in military samples.

Stress beyond coping? A Rasch analysis of the Perceived Stress Scale (PSS-14) in an Aboriginal population

The history of colonization contributed to Aboriginal and Torres Strait Islanders becoming one of the most disadvantaged groups in Australia. The multiple social inequalities, and therefore the constant insecurities for many about low income, poor living conditions, unemployment, and discrimination, generate chronic stress in this population. In the Baby Teeth Talk Study, an oral-health randomized controlled trial, the Perceived Stress Scale (PSS-14) was administered to 367 pregnant Aboriginal women at baseline. The aim of the present study was to evaluate the validity and reliability of the PSS-14 in an Aboriginal population. The study analysed: (a) model fit; (b) dimensionality; (c) local dependence; (d) differential item functioning; (e) threshold ordering and item fit; (f) targeting; (g) reliability; and (h) criterion validity. The dimensionality analysis indicated a two-factor structure, with negatively and positively worded items clustering together and 21.7% (95% Agresti-Coull C.I. [17.8%, 26.2%]) statistically significant t-tests between the persons' estimates. After the creation of composite items, the revised Perceived Distress (χ2 (21) = 11.74, p = 0.946) and Perceived Coping (χ2 (28) = 17.63, p = 0.935) subscales fitted the Rasch model. Reliability was modest (PersonSeparationIndexdistress = 0.72; PersonSeparationIndexcoping = 0.76). The latent correlation between the Perceived Distress and Perceived Coping subscales was r = 0.14. It is hypothesized that the social inequalities experienced by the Aboriginal population are so pronounced that even Aboriginal pregnant women that perceived themselves as coping well with life challenges ended up endorsing items regarding high levels of stress. The present research showed that a revised PSS-14 is a culturally valid and modestly reliable psychological instrument to measure stress in a population of pregnant Aboriginal women in Australia.

Perceived stress and incident sexually transmitted infections in a prospective cohort

PURPOSE

Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota.

METHODS

Using the 1999 Longitudinal Study of Vaginal Flora (n = 2439), a primarily African American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, and partner concurrence) as mediators using VanderWeele's difference method.

RESULTS

Baseline perceived stress was associated with incident STIs both before and after adjusting for confounders (adjusted hazard ratio = 1.015; 95% confidence interval, 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21% and 65% of this adjusted association, respectively, and 78% when included together in the adjusted model.

CONCLUSIONS

This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of bacterial vaginosis-both known risk factors for STIs-as mechanisms underlying this association.

Helplessness Mediates Racial Discrimination and Depression for African American Young Adults

Racial discrimination is associated with depressive symptoms for young African American adults. Yet few studies have examined the psychological mechanisms for this association. The purpose of this preliminary study was to examine the mediating effect of helplessness on the association between perceived racial discrimination and depressive symptoms in a sample of 172 African American young adults. Measures of perceived racial discrimination, depression, and helplessness were administered. Though the majority of the sample reported minimal or no symptoms of depression, approximately 37% of the sample reported dysphoric or more severe depression symptomatology. After controlling for age, perceived racial discrimination was directly and indirectly associated with depressive symptoms via helplessness. These findings provide some insight into the cognitive mechanisms through which depressive symptoms may emerge for African American young adults exposed to racial discrimination.

Emotion regulation moderates the association between chronic stress and cardiovascular disease risk in humans: a cross-sectional study

Chronic stress is a risk factor for incident cardiovascular (CV) disease. Emotion regulation is the ability to modulate one's state or behavior in response to a given situation or stressor, and may mitigate the effect of chronic stress on CV disease risk. Data from a cohort of 754 community-dwelling young to middle-aged adults who were assessed between 2007 and 2012 on stress, emotion regulation, and CV risk measures were used to test the hypothesis that emotion regulation mitigates the effect of chronic stress on CV risk. Emotion regulation was measured using the Difficulties in Emotion Regulation Scale (DERS). We created a composite stress score using data from the Cumulative Adversity Interview and the Perceived Stress Scale. Our outcomes included blood pressure, body mass index, and insulin resistance separately and combined into a composite CV risk score. Covariates included age, sex, race, years of education, and smoking status. We used multivariable logistic regression to evaluate associations between stress measures and CV risk among participants and the impact of emotion regulation (DERS scores) on this association. We found that composite stress interacted significantly with the DERS score to affect CV risk (p = .007). A median split of the DERS scores indicated that CV risk was associated with the composite stress score in the fully adjusted model (ß = 0.206; p = .005) among participants with low emotion regulation, but not among those with high emotion regulation (ß = 0.048; p = .59). Chronic stress was associated with CV risk only among participants with poor emotion regulation. Emotion regulation is a teachable skill, and may play a role in preventing CV disease.Lay summaryEmotion regulation is the ability to modify one's reaction to a negative or stressful event, and is a teachable skill. Effective emotion regulation dampens the negative effect of chronic stress on the body, which may reduce risk for cardiovascular disease.

Associations Between Race, Perceived Psychological Stress, and the Gut Microbiota in a Sample of Generally Healthy Black and White Women: A Pilot Study on the Role of Race and Perceived Psychological Stress

OBJECTIVE

Racial health disparities persist among black and white women for colorectal cancer. Understanding racial differences in the gut microbiota and related covariates (e.g., stress) may yield new insight into unexplained colorectal cancer disparities.

METHODS

Healthy non-Hispanic black or white women (age ≥19 years) provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. Polymerase chain reaction was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using QIIME. Operational taxonomic unit data were log transformed and normalized. Analyses were conducted using linear models in R Package "limma."

RESULTS

Fecal samples were analyzed for 80 women (M (SD) age = 39.9 (14.0) years, 47 black, 33 white). Blacks had greater average body mass index (33.3 versus 27.5 kg/m, p < .01) and waist circumference (98.3 versus 86.6 cm, p = .003) than whites. Whites reported more stressful life events (p = .026) and greater distress (p = .052) than blacks. Final models accounted for these differences. There were no significant differences in dietary variables. Unadjusted comparisons revealed no racial differences in alpha diversity. Racial differences were observed in beta diversity and abundance of top 10 operational taxonomic units. Blacks had higher abundances than whites of Faecalibacterium (p = .034) and Bacteroides (p = .038). Stress was associated with abundances of Bifidobacterium. The association between race and Bacteroides (logFC = 1.72, 0 = 0.020) persisted in fully adjusted models.

CONCLUSIONS

Racial differences in the gut microbiota were observed including higher Bacteroides among blacks. Efforts to cultivate an "ideal" gut microbiota may help reduce colorectal cancer risk.

Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program

Depression and stress have been associated with less weight loss among some participants in behavioral weight loss (BWL) programs. The purpose of this study was to (1) measure the levels of depression and stress among a sample of black women living in rural Alabama and Mississippi who were participating in a BWL program and (2) examine the association between these psychosocial variables and weight loss outcomes of participants at 6 months. Overweight and obese black women in a BWL program (n = 409) completed validated surveys to measure depression and stress at baseline and 6 months. Weight and height were also measured at baseline and 6 months. Statistical tests were conducted to examine associations between depression, stress, and weight loss. Mean BMI at baseline was 38.68 kg/m². Participants achieved a 1.17 kg/m² reduction in BMI at 6 months. When comparing by baseline depression or stress categories, no significant differences in weight loss outcomes were observed. Analysis of continuous data revealed a significant correlation between baseline depression score and change in BMI. In adjusted models, change in depression score over time was significantly associated with change in weight. No differences in weight loss outcomes at 6 months were observed when comparing participants with and without elevated depressive symptoms or elevated stress at baseline. This suggests that potential participants may not need to be excluded from BWL programs based on pre-specified cut points for these psychological conditions. Greater improvements in depression were associated with better weight loss outcomes suggesting that more emphasis on reducing depression may lead to greater weight losses for black women in BWL programs.

Validity and reliability of the Cohen 10-item Perceived Stress Scale in patients with chronic headache: Persian version

BACKGROUND

The Cohen Perceived Stress Scale is being used widely in various countries. The present study evaluated the validity and reliability of the Cohen 10-item Perceived Stress Scale (PSS-10) in assessing tension headache, migraine, and stress-related diseases in Iran.

METHODS

This study is a methodological and cross-sectional descriptive investigation of 100 patients with chronic headache admitted to the pain clinic of Baqiyatallah Educational and Therapeutic Center. Convenience sampling was used for subject selection. PSS psychometric properties were evaluated in two stages. First, the standard scale was translated. Then, the face validity, content, and construct of the translated version were determined.

RESULTS

The average age of participants was 38 years with a standard deviation (SD) of 13.2. As for stress levels, 12% were within the normal range, 36% had an intermediate level, and 52% had a high level of stress. The face validity and scale content were remarkable, and the KMO coefficient was 0.82. Bartlett's test yielded 0.327 which was statistically significant (p<0.0001) representing the quality of the sample. In factor analysis of the scale, the two elements of "coping" and "distress" were determined. A Cronbach's Alpha coefficient of 0.72 was obtained. This confirmed the remarkable internal consistency and stability of the scale through repeated measure tests (0.93).

CONCLUSION

The Persian PSS-10 has good internal consistency and reliability. The availability of a validated Persian PSS-10 would indicate a link between stress and chronic headache.

Recruitment and Baseline Characteristics of Participants in the Lifestyle Improvement Through Food and Exercise (LIFE) Study

African Americans experience poorer diabetes outcomes than non-Hispanic Whites. Few clinical trials of diabetes self-management interventions specifically target African Americans, perhaps due to well-documented barriers to recruitment in this population. This paper describes strategies used to successfully recruit 211 low-income African Americans from community clinics of a large, urban public hospital system to a randomized clinical trial of an 18-month diabetes self-management intervention. Diabetes-related physiological, psychosocial, and behavioral characteristics of the sample are reported. The sample was 77% female, mean age = 55, mean A1C = 8.5%, 39% low health literacy, 28.4% moderate/severe depression, and 48.3% low adherence. Participants ate a high-fat diet with low vegetable consumption. Relative to males, females had higher BMI, depression, and stress, and better glycemic control, less physical activity, and less alcohol consumption. Males consumed more daily calories, but females consumed a greater proportion of carbohydrates. Gender-specific diabetes self-management strategies may be warranted in this population.

The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health

BACKGROUND

Objective, subjective, and neighborhood socioeconomic status (SES) are associated with perceived health, morbidity, and mortality.

PURPOSE

We investigated whether perceived stress and health behaviors mediated the relation between the three types of SES and perceived health.

METHODS

Participants (N = 508) attending a public clinic completed a computerized survey assessing objective SES (income, education, employment); health behaviors; perceived stress; and perceived health. They also indicated their social standing relative to others (subjective SES) and provided their current address to determine neighborhood SES.

RESULTS

In a structural equation model including all three SES types, lower objective and subjective SES were related to poorer perceived health. When mediators were included in the model, there were significant indirect effects of (a) SES on health through stress and (b) SES on health through stress and health-compromising behaviors.

CONCLUSIONS

Interventions to reduce the impact of stressors could improve the health of socioeconomically disadvantaged individuals.

Validation of the Perceived Stress Scale in a community sample of older adults

BACKGROUND

Three versions of Perceived Stress Scale (PSS-14, PSS-10, and PSS-4) are among the most widely used measures of stress. The aim of the current study was to validate this instrument in a sample of nondemented older adults to facilitate studies of the impact of stress on health.

METHODS

Seven hundred sixty-eight nondemented adults over the age of 70 years completed the PSS-14 questionnaire and other neuropsychological tests. Exploratory factor analysis was used to determine the underlying factor structure of all PSS versions, and confirmatory factor analysis was used to test the construct validity of factors. The internal consistency reliability of the scales was assessed using Cronbach's alpha, and concurrent validity was evaluated by examining PSS relation with age, gender, depression, anxiety, and Positive Affect and Negative Affect Schedule.

RESULTS

A two-factor model was the optimal fit for the 14-item and 10-item versions of PSS. For PSS-14, all items' loadings exceeded 0.4 for one of the two factors except item 12. Therefore, we studied a 13-item version of PSS and 10-item and 4-item subsets representing PSS-10 and PSS-4. Internal consistency coefficients were satisfactory for the full scale of PSS-13 and PSS-10 but not for PSS-4. Women reported higher levels of stress than men. Higher levels of total PSS scores showed association with higher levels of depression, anxiety, and negative affect, and lower level of positive affect.

CONCLUSIONS

The 13-item and 10-item versions of PSS may be used to understand the experience of stress among older adults.

Stressors in multiple life-domains and the risk for externalizing and internalizing behaviors among African Americans during emerging adulthood

Behavioral and mental health outcomes have been associated with experiencing high levels of stress. Yet, little is known about the link between the nature of stressors, their accumulation over time, and the risk for externalizing and internalizing outcomes. Compared to the general population, African Americans are exposed to a disproportionate number of stressors beginning earlier in life. Incorporating Agnew's General Strain Theory into the study of stress, this study examined whether different kinds of stressors are equally salient in the risk for violent behaviors and depressive symptoms among African Americans transitioning into young adulthood. It further examined the effects of the accumulation of stressors in different life domains and their effect on risks. This study utilized data from an African American subsample of an ongoing longitudinal study that followed 604 adolescents (53 % females) from 9th grade into adulthood. Multilevel growth curve models were used to examine how changes in stressors across multiple life domains related to violent behaviors and depressive symptoms. We found that continued exposure to perceived daily stress and racial discrimination stress increased the risk for violent behaviors during young adulthood, and exhibited a nonlinear relationship between the accumulation of stressors and risk for violence. Moreover, we found that exposure to perceived daily stress, financial stress, neighborhood stress, and racial discrimination stress increased the risk of depressive symptoms and led to a linear relationship between the accumulation of stressors and risk for depressive symptoms. Findings suggest identifiable stressors that can persist over time to influence risks at young adulthood.

Stress management-augmented behavioral weight loss intervention for African American women: a pilot, randomized controlled trial

The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week adaptation of the Diabetes Prevention Program Lifestyle Balance intervention augmented with stress management strategies (Lifestyle + Stress) or Lifestyle Alone. A trend toward greater percentage of baseline weight loss at 3-month data collection was observed in Lifestyle + Stress (-2.7 ± 3.6%) compared with Lifestyle Alone (-1.4 ± 2.3%; p = .17) and a greater reduction in salivary cortisol (Lifestyle + Stress: -0.2461 ± 0.3985 ng/mL; Lifestyle Alone: -0.0002 ± 0.6275 ng/mL; p = .20). These promising results suggest that augmenting a behavioral weight control intervention with stress management components may be beneficial for overweight/obese AA women with moderate to high stress levels and merit further investigation with an adequately powered trial.

Development of the brief inventory of perceived stress

OBJECTIVES

To provide a measure of perceived stress that is psychometrically superior to existing instruments and novel in dimensionality.

DESIGN

At 4-week intervals over 48 weeks, patients with multiple sclerosis (N = 138) completed 26 items from the Perceived Stress Scale (PSS) and the Perceived Stress Questionnaire (PSQ).

RESULTS

Extant factor analytic models of the PSS fit poorly. A new measure using nine PSS and PSQ items, the Brief Inventory of Perceived Stress (BIPS), demonstrated good fit, construct validity, and stability with 3 factors: Lack of Control, Pushed, and Conflict and Imposition.

CONCLUSIONS

Items commonly used to measure perceived stress may have a more sophisticated underlying structure than previously thought. The BIPS's multidimensionality and longitudinal stability offer potential benefits in conceptualization and outcome prediction.

Psychometric properties of the Chinese version of the Perceived Stress Scale in policewomen

Background

The 10-item Perceived Stress Scale (PSS-10) is one of most widely used instruments to measure a global level of perceived stress in a range of clinical and research settings. This study was conducted to examine the psychometric properties of the Simplified Chinese version of the PSS-10 in policewomen.

Methodology

A total of 240 policewomen were recruited in this study. The Simplified Chinese versions of the PSS-10, the Beck Depression Inventory Revised (BDI-II), and the Beck Anxiety Inventory (BAI) were administered to all participants, and 36 of the participants were re-tested two weeks after the initial testing.

Principal Findings

The overall Cronbach's alpha was 0.86, and the test–retest reliability coefficient was 0.68. Exploratory Factor Analysis (EFA) yielded 2 factors with eigenvalues of 4.76 and 1.48, accounting for 62.41% of variance. Factor 1 consisted of 6 items representing “negative feelings”; whereas Factor 2 consisted of 4 items representing “positive feelings”. The item loadings ranged from 0.72 to 0.83. The Confirmatory factor analysis (CFA) indicated a very good fit of this two-factor model to this sample. The PSS-10 significantly correlated with both BDI-II and BAI, indicating an acceptable concurrent validity.

Conclusions

The Simplified Chinese version of the PSS-10 demonstrated adequate psychometric properties for evaluating stress levels. The results support its use among the Chinese population.

Gender Effect According to Item Directionality on the Perceived Stress Scale for Adults With Multiple Sclerosis

Assessment is critical to rehabilitation practice and research, and self-reports are a commonly used form of assessment. This study examines a gender effect according to item wording on the Perceived Stress Scale for adults with multiple sclerosis. Past studies have demonstrated two-factor solutions on this scale and other scales measuring stress-related constructs with factor loadings being determined by item wording. Moreover, women have typically scored higher on these measured constructs. However, a literature review reveals that this gender difference often manifests only on the factor composed of negatively worded items. This study extends this line of research by examining gender differences on the Perceived Stress Scale on the negatively worded items at both the item and bundle levels after controlling for responses on the positively worded items. Implications of this study on the field of rehabilitation are discussed.

Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke

Background

Smoking causes heart disease, the major cause of death in China and Hong Kong. Stress is one major trigger of smoking and relapse, and understanding stress among smoking cardiac patients can therefore help in designing effective interventions to motivate them to quit. The objective of this study was to examine the psychometric properties of the Perceived Stress Scale (PSS), and to compare the appropriateness of the three versions of the scale (PSS-14, PSS-10, and PSS-4) among Chinese cardiac patients who were also smokers.

Methods

From March 2002 to December 2004, 1860 cardiac patients who smoked were recruited at the cardiac outpatient clinics of ten acute hospitals in Hong Kong, and 1800 questionnaires were analysed. Participants completed a questionnaire including the PSS, nicotine dependence and certain demographic variables. The psychometric properties of the PSS were investigated: construct validity using confirmatory factor analysis, reliability using Cronbach's alpha and concurrent validity by examining the relationship with smoking- and health-related variables.

Results

For all the three versions of the PSS, confirmatory factor analyses corroborated the 2-factor structure of the scale, with the positive and negative factors correlating significantly and negatively to a moderate extent (r < -0.5), and high Cronbach's alpha values for the two subscales (alpha > 0.5). All the correlations of the two subscales and the smoking- and health-related variables were statistically significant and in the expected directions although of small magnitudes, except daily cigarette consumption.

Conclusions

The findings confirmed the satisfactory psychometric properties of all three Chinese versions of PSS. We recommend the use of PSS-10 for research which focuses on the two components of perceived stress, as it shows a higher reliability; and the use of PSS-4 if such partition is not essential and space for multiple measures is limited.

Do US Black Women Experience Stress-Related Accelerated Biological Aging?: A Novel Theory and First Population-Based Test of Black-White Differences in Telomere Length

We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women's Health Across the Nation (SWAN), we estimate that at ages 49-55, black women are 7.5 years biologically "older" than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited.

Do US Black Women Experience Stress-Related Accelerated Biological Aging?: A Novel Theory and First Population-Based Test of Black-White Differences in Telomere Length

We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women's Health Across the Nation (SWAN), we estimate that at ages 49-55, black women are 7.5 years biologically "older" than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited.

Workplace Discrimination and Depressive Symptoms: A Study of Multi-Ethnic Hospital Employees

Workplace discrimination reports have recently increased in the U.S. Few studies have examined racial/ethnic differences and the mental health consequences of this exposure. We examined the association between self-reported workplace discrimination and depressive symptoms among a multi-ethnic sample of hospital employees. Data came from the prospective case-control Gradients of Occupational Health in Hospital Workers (GROW) study (N = 664). We used the Center for Epidemiological Studies Depression Scale (CES-D) to assess depressive symptoms and measured the occurrence, types, and frequency of workplace discrimination. African Americans were more likely than other racial/ethnic employees to report frequent and multiple types of discrimination exposure. Multivariate relationships were examined while controlling for socio-demographic factors, job strain, and general social stressors. After adjustment, workplace discrimination occurrence and frequency were positively associated with depressive symptoms. The positive association between workplace discrimination and depressive symptoms was similar across racial and ethnic groups. Reducing workplace discrimination may improve psychosocial functioning among racial/ethnic minority hospital employees at greatest risk of exposure.