Coping strategy and social support modify the association between perceived stress and C-reactive protein: a longitudinal study of healthy men and women

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Prospective network analysis of proinflammatory proteins, lipid markers, and depression components in midlife community women

BACKGROUND

Vulnerability theories propose that suboptimal levels of lipid markers and proinflammatory proteins predict future heightened depression. Scar models posit the reverse association. However, most studies that tested relationships between non-specific immune/endocrine markers and depression did not separate temporal inferences between people and within-person and how different immunometabolism markers related to unique depression symptoms. We thus used cross-lagged prospective network analyses (CLPN) to investigate this topic.

METHODS

Community midlife women (n = 2224) completed the Center for Epidemiologic Studies-Depression scale and provided biomarker samples across five time-points spanning 9 years. CLPN identified significant relations (edges) among components (nodes) of depression (depressed mood, somatic symptoms, interpersonal issues), lipid markers [insulin, fasting glucose, triglycerides, low-density lipoprotein-cholesterol (LDL), high-density lipoprotein-cholesterol (HDL)], and proinflammatory proteins [C-reactive protein (CRP), fibrinogen], within and across time-points. All models adjusted for age, estradiol, follicle-stimulating hormone, and menopausal status.

RESULTS

In within-person temporal networks, higher CRP and HDL predicted all three depression components (d = 0.131-2.112). Increased LDL preceded higher depressed mood and interpersonal issues (v. somatic symptoms) (d = 0.251-0.327). Elevated triglycerides predicted more somatic symptoms (v. depressed mood and interpersonal problems) (d = 0.131). More interpersonal problems forecasted elevated fibrinogen and LDL levels (d = 0.129-0.331), and stronger somatic symptoms preceded higher fibrinogen levels (d = 0.188).

CONCLUSIONS

Results supported both vulnerability and scar models. Long-term dysregulated immunometabolism systems, social disengagement, and related patterns are possible mechanistic accounts. Cognitive-behavioral therapies that optimize nutrition and physical activity may effectively target depression.

A systematic review of associations between emotion regulation characteristics and inflammation

Elevated inflammation is a risk factor for many psychiatric (e.g., depression) and somatic conditions (e.g., rheumatoid arthritis). Inflammation is influenced by psychosocial processes such as emotion regulation. Characterization of which emotion regulation characteristics impact inflammation could help refine psychosocial interventions aimed at normalizing health-harming inflammatory activity for individuals with psychiatric and somatic illnesses. To investigate this issue, we systematically reviewed the literature on associations between a variety of emotion regulation traits and inflammation. Out of 2816 articles identified, 38 were included in the final review. 28 (74%) found that (a) poor emotion regulation is associated with higher inflammation and/or (b) strong emotion regulation skills are associated with lower inflammation. Consistency of results differed as a function of the emotion regulation construct investigated and methodological characteristics. Results were most consistent for studies testing positive coping/social support seeking or broadly defined emotion regulation/dysregulation. Methodologically, studies testing reactivity to a stressor, adopting a vulnerability-stress framework, or using longitudinal data were most consistent. Implications for integrated, transdiagnostic psychoimmunological theories are discussed, as well as recommendations for clinical research.

The sex-dependent response to psychosocial stress and ischaemic heart disease

Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.

PTSD, Immune System, and Inflammation

Posttraumatic stress disorder (PTSD) is a severe trauma and stress-related disorder associated with different somatic comorbidities, especially cardiovascular and metabolic disorders, and with chronic low-grade inflammation. Altered balance of the hypothalamic-pituitary-adrenal (HPA) axis, cytokines and chemokines, C-reactive protein, oxidative stress markers, kynurenine pathways, and gut microbiota might be involved in the alterations of certain brain regions regulating fear conditioning and memory processes, that are all altered in PTSD. In addition to the HPA axis, the gut microbiota maintains the balance and interaction of the immune, CNS, and endocrine pathways forming the gut-brain axis. Disbalance in the HPA axis, gut-brain axis, oxidative stress pathways and kynurenine pathways, altered immune signaling and disrupted homeostasis, as well as the association of the PTSD with the inflammation and disrupted cognition support the search for novel strategies for treatment of PTSD. Besides potential anti-inflammatory treatment, dietary interventions or the use of beneficial bacteria, such as probiotics, can potentially improve the composition and the function of the bacterial community in the gut. Therefore, bacterial supplements and controlled dietary changes, with exercise, might have beneficial effects on the psychological and cognitive functions in patients with PTSD. These new treatments should be aimed to attenuate inflammatory processes and consequently to reduce PTSD symptoms but also to improve cognition and reduce cardio-metabolic disorders associated so frequently with PTSD.

Symptoms of Depression and Anxiety Among Black Medical Students: the Role of Peer Connectedness and Perceived Discrimination

This study examined the association between discrimination, peer connectedness, and mental health symptoms among Black medical students. Data were collected from a convenience sample of Black medical students via an anonymous electronic questionnaire (n = 733) in year 2020. The Patient-Reported Outcomes Measurement Information System Depression and Anxiety forms were used to measure depression and anxiety symptoms. Structural equation modeling was used to examine the association between discrimination, peer connectedness, and mental health symptoms (Mplus 7.3). The majority of the participants were female (80%), approximately 40% were third or fourth year medical school students, and 13% had a clinical diagnosis of depression/anxiety before medical school. About half of the students reported being watched more closely than their classmates, and 66% reported feeling the need to work twice as hard as others to get the same treatment or evaluation. The majority of students reported that their peers were supportive of their academic success (60.7%), and 53% reported that students often or always invited them to social outings. The mean T-score for depressive symptoms was 53.6 (SD = 7.8), and the mean T-score for anxiety symptoms was 58.6 (SD = 8.4). Overall, findings indicated a high prevalence of anxiety and depression symptoms among Black medical students, and increased discrimination was associated with more mental health symptoms among males. Additionally, increased peer connectedness was associated with fewer symptoms of anxiety among males and females and fewer depressive symptoms among females. Addressing discrimination among medical students may improve mental health among Black medical students.

Presenteeism and Productivity: The Role of Biomarkers and Hormones

Purpose. This study aimed to assess whether self-reported productivity despite presenteeism may be affected by biomarkers and hormones and how these physiological indicators can interact with each other to explain the presenteeism dimensions. Methods. This pilot study included 180 healthy participants with a mean age of 41.22 years (SD = 13.58), 76.11% of whom were female. The dependent variable included a self-reported measure of productivity loss due to presenteeism: the Stanford Presenteeism Scale 6. This study also includes physiological indicators such as biomarkers (C-reactive protein (CRP) and blood glucose) and hormones (cortisol and TSH thyroid hormone). Results. Multiple linear regression analyses revealed that CRP moderated the relationship between cortisol levels and productivity despite presenteeism. Moreover, the increase of TSH moderated the relationship between cortisol, glycemia, and employees’ capacity to complete work tasks while sick. Conclusions. The results highlight TSH’s moderating role in decreasing employees’ capacity to fulfill tasks when these individuals have high levels of glycemia and cortisol in their blood. These findings have practical and theoretical implications based on a fuller understanding of how biomarkers and hormones explain productivity despite presenteeism.

Interplay between social isolation and loneliness and chronic systemic inflammation during the COVID-19 pandemic in Japan: Results from U-CORONA study

In the face of the global coronavirus disease 2019 (COVID-19) pandemic, billions of people were forced to stay at home due to the implementation of social distancing and lockdown policies. As a result, individuals lost their social relationships, leading to social isolation and loneliness. Both social isolation and loneliness are major risk factors for poor physical and mental health status through enhanced chronic inflammation; however, there might be an interplay between social isolation and loneliness on the association with chronic inflammation. We aimed to clarify the link between social relationships and inflammation in the context of the COVID-19 pandemic by distinguishing whether social isolation only, loneliness only, or both were associated with chronic inflammation markers among community-dwelling adults. The data of 624 people (aged 18-92 years, mean 51.4) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, which targeted randomly sampled households in Utsunomiya city, Japan, were analyzed. Social isolation was assessed as a structural social network by asking the number of social roles they have on a daily basis. Loneliness was measured with the UCLA loneliness scale. As chronic inflammation biomarkers, neutrophil-to-lymphocyte ratio (NLR) and the concentration of high-sensitivity C-reactive protein (CRP) were measured. Generalized estimating equations method was employed to take into account the correlations within households. Isolated-Lonely condition (i.e., being both socially isolated and feeling lonely) was associated with higher NLR among men (B = 0.141, 95%CI = -0.01 to 0.29). Interestingly, Nonisolated-Lonely condition (i.e., not socially isolated but feeling lonely) was associated with lower CRP among women (B = -0.462, 95%CI = -0.82 to -0.10) and among the working-age population (B = -0.495, 95%CI = -0.76 to -0.23). In conclusion, being both socially isolated and feeling lonely was associated with chronic inflammation. Assessing both social isolation and loneliness is critical for proper interventions to mitigate the impact of poor social relationships on health, especially in the context of the COVID-19 pandemic.

Dissecting the genetic association of C-reactive protein with PTSD, traumatic events, and social support

Inflammatory markers like C-reactive protein (CRP) have been associated with post-traumatic stress disorder (PTSD) and traumatic experiences, but the underlying mechanisms are unclear. We investigated the relationship among serum CRP, PTSD, and traits related to traumatic events and social support using genetic association data from the Psychiatric Genomics Consortium (23,185 PTSD cases and 151,309 controls), the UK Biobank (UKB; up to 117,900 individuals), and the CHARGE study (Cohorts for Heart and Aging Research in Genomic Epidemiology, 148,164 individual). Linkage disequilibrium score regression, polygenic risk scoring, and two-sample Mendelian randomization (MR) analyses were used to investigate genetic overlap and causal relationships. Genetic correlations of CRP were observed with PTSD (rg = 0.16, p = 0.026) and traits related to traumatic events, and the presence of social support (-0.28 < rg < 0.20; p < 0.008). We observed a bidirectional association between CRP and PTSD (CRP → PTSD: β = 0.065, p = 0.015; PTSD → CRP: β = 0.008, p = 0.009). CRP also showed a negative association with the "felt loved as a child" trait (UKB, β = -0.017, p = 0.008). Owing to the known association of socioeconomic status (SES) on PTSD, a multivariable MR was performed to investigate SES as potential mediator. We found that household income (univariate MR: β = -0.22, p = 1.57 × 10-7; multivariate MR: β = -0.17, p = 0.005) and deprivation index (univariate MR: β = 0.38, p = 1.63 × 10-9; multivariate MR: β = 0.27, p = 0.016) were driving the causal estimates of "felt loved as a child" and CRP on PTSD. The present findings highlight a bidirectional genetic association between PTSD and CRP, also suggesting a potential role of SES in the interplay between childhood support and inflammatory processes with respect to PTSD risk.

Preliminary evidence for a race-based stress reduction intervention for Black women at risk for cardiovascular disease

OBJECTIVE

Despite evidence that chronic stress, racism, and discrimination impact the well-being and the risk for cardiovascular disease (CVD) in Black women, there are few evidence-based interventions that improve well-being and reduce the risk for CVD in women of minority groups. The purpose of this pilot study was to evaluate the psychobehavioral and anti-inflammatory benefit of a race-based stress reduction program "Resilience, Stress, and Ethnicity (RiSE) for Black women at risk for CVD.

METHODS

Black women were recruited from the Chicagoland community and randomized to either the 8-week RiSE intervention (n = 40) or control group (n = 34). Participants were assessed for coping strategies, psychological distress, and blood levels of TNF-alpha and high sensitivity C-reactive protein (hsCRP) at baseline and at 4 and 8 weeks after baseline.

RESULTS

Participation in RiSE was associated with a more rapid decline in the use of avoidance coping (b = -0.3585, SE = 0.1705, p < .01). Reductions over time in TNF-alpha (b = -0.0163, SE = .0087, p = .08) and hsCRP (b= -0.4064, SE = 0.2270, p = .08) approached statistical significance.

CONCLUSIONS

Findings provide preliminary evidence in Black women at risk for CVD that RiSE contributes to decreases in avoidance coping. Although preliminary, these results suggest RiSE to be an effective intervention to promote improved coping associated with racism and discrimination in minorities.

Perceived stress, depressive symptoms, and cortisol-to-cortisone ratio in spot urine in 6878 older adults

BACKGROUND

Late life depression and perceived stress could influence disease pathways via reduced 11β-HSD2 activity, particularly given suggestions that reduced 11β-HSD2 activity, which is reflected in the cortisol-to-cortisone ratio, is a risk factor of disease. To date, however, examination of the relationship between the cortisol-to-cortisone ratio and perceived stress or depressive symptoms is insufficient.

METHODS

We examined the cross-sectional association of the cortisol-to-cortisone ratio with perceived stress and depressive symptoms, and analyzed whether cortisol levels modify this association, in 6878 participants aged 45-74 years. Cortisol and cortisone in spot urine were measured using liquid chromatography-mass spectrometry. Perceived stress during the past year was measured using a self-reported questionnaire. Depressive symptoms were evaluated using the Zung Self-Rating Depression Scale. Analyses were performed with adjustment for age, sex, lifestyle factors (smoking habit, alcohol consumption, physical activity, and sleeping hours), and physical health factors (body mass index [kg/m²] and medical history [diabetes, hypertension, and medication for hyperlipidemia or corticosteroids]).

RESULTS

Cortisol-to-cortisone ratio and cortisol were positively associated with perceived stress (% change: 2.33, P_trend = 0.003; and 4.74, P_trend = 0.001, respectively), but were not significantly associated with depressive symptoms. Further, the relationship between cortisol-to-cortisone ratio and perceived stress was modified by cortisol level and sex: the positive association between perceived stress and the cortisol-to-cortisone ratio was more evident in subjects with lower cortisol levels (P_interaction = 0.009) and in men (P_interaction = 0.026).

CONCLUSIONS

These findings suggest that the cortisol-to-cortisone ratio in spot urine may be a useful marker for non-acute perceived stress in daily life against a possible background of reduced 11β-HSD2 in older adults.