Association of differential symptoms of stress to hair cortisol and cortisone concentrations among pregnant women in Kenya

Postpartum symptoms of anxiety, depression and stress: differential relationships to women's cortisol profiles

PURPOSE

Women are at high risk of stress, anxiety, and depression during the postpartum but the ways in which these different types of psychological distress are related to cortisol regulation is not clear. We examined the distinct association of each type of distress with women's average cortisol level, cortisol awakening response (CAR), cortisol decline across the day (diurnal slope), and overall amount of cortisol secretion across the day (AUCG).

METHODS

At 6 months postpartum, a diverse group of 58 women completed measures of depression, anxiety, perceived stress, and life stressors. Each woman provided 4 salivary samples for cortisol assay from waking to bedtime on each of 2 consecutive days. Linear regressions were used to examine associations of stress, anxiety and depression to each of the 4 cortisol measures, controlling for number of stressful life events.

RESULTS

Depressive symptoms were associated with less of a rise in the CAR (β = -.46, p = 0.01), steeper diurnal slope (β = .51, p = 0.006), and higher average cortisol level (β = .42, p = .01). Women who met the clinical cutoff for an anxiety disorder had lower overall cortisol output (β = -.29, p = 0.03). Stress was not related to any cortisol metric.

CONCLUSIONS

Findings suggest that stress is less associated with cortisol alterations in the postpartum than are more severe types of psychological distress. Anxiety and depression may have distinct and opposite profiles of cortisol dysregulation. Results indicate that mental health assessment is critical even in the later postpartum so that interventions can be initiated to reduce emotional suffering and the risk of impaired cortisol regulation.

Analysing and quantifying chronic stress-associated endogenous steroids in hair samples

In previous studies, various steroids have been associated with stress and have therefore been quantified to investigate stress-related questions. Since the main stress-related steroid cortisol follows a circadian rhythm, often hair is analysed to quantify this steroid. Further, hair analysis gives the unique possibility of long-time monitoring by analysing a certain segment of hair, since hair grows on average 1 cm per month. Hair is a difficult matrix due to the complex sample preparation with many steps including washing and grinding, followed by various extraction steps. Additionally, steroids are endogenous and are therefore present in the hair matrix. Hence, no analyte free matrix is available, which is needed for the quantification via external calibrators. To overcome this problem, the so-called surrogate methods can be used, for which a 13 C3 labelled or deuterated reference compound of the steroid of interest is used for quantification. In the present study, a surrogate method was developed and fully validated for the quantitative analysis of seven steroids in human hair. Validation experiments showed that the method is further suitable for semi-quantitative analysis of estradiol. However, it is not suitable for the analysis of androsterone and DHEAS. The method was successfully used to analyse steroids in a comprehensive study of 360 adolescent hair samples, enabling research into stress markers.

Relationships Among Number of Stressors, Perceived Stress, and Salivary Cortisol Levels During the Third Trimester of Pregnancy

OBJECTIVE

To examine relationships among the number of stressors, perceived stress, and salivary cortisol levels during the third trimester of pregnancy.

DESIGN

Secondary analysis of cross-sectional data.

SETTING

Participants' homes.

PARTICIPANTS

Women during the third trimester of pregnancy (N = 73).

METHODS

Participants provided saliva samples at four time points over 2 days for cortisol assay and completed questionnaires to assess stressors and perceived stress. We computed multiple linear regression models to examine the relationships among the number of stressors and perceived stress to cortisol awakening response, diurnal slope, and overall cortisol secretion. We also computed a multiple linear regression model to examine the relationship between perceived stress and the number of stressors.

RESULTS

Greater perceived stress was associated with reduced overall cortisol secretion across the day (β = -0.41, p = .01). The number of stressors was associated with perceived stress (β = 0.48, p = .002) but not salivary cortisol measures.

CONCLUSION

Elevated perceived stress and the related cortisol alterations that we identified could represent salient targets for enhancing hypothalamic-pituitary-adrenal axis function during the third trimester. Perceived stress may shape the relationship between exposure to stressors and cortisol response during pregnancy. Future research is warranted to confirm study results and to understand the implications for parturition and fetal development.

"It has changed my life": unconditional cash transfers and personalized infant feeding support- a feasibility intervention trial among women living with HIV in western Kenya

BACKGROUND

The syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress.

METHODS

To address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20-35 weeks pregnant-20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health.

RESULTS

Analyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing.

CONCLUSIONS

The Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials.

TRIAL REGISTRATION

Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022.

CLINICALTRIALS

gov ID: NCT05219552 Protocol ID: K23MH116807.

Correlates of preconception and pregnancy hair cortisol concentrations

Assessing factors that influence chronic stress biomarkers like hair cortisol concentrations (HCCs) in pregnancy is critical to prevent adverse pregnancy outcomes. Thus, we aimed to identify correlates of HCC preconception and during pregnancy. 2,581 pregnant women participated in the study. HCC was available at four time periods: pre-pregnancy (0-3 months preconception, n = 1,023), and in the first (1-12 weeks, n = 1,734), second (13-24 weeks, n = 1,534), and third (25-36 weeks, n = 835) trimesters. HCC was assessed using liquid chromatography tandem mass spectrometry (LC-MS/MS). Sociodemographic, pregnancy- and hair-related characteristics, and measures of psychosocial stress, were interrogated as potential correlates of HCC. Spearman correlations, paired t-tests, and ANOVA were used to assess differences in log-transformed values of HCC (logHCC) across maternal characteristics. Multivariable linear regressions were used to identify the correlates of HCCs after adjusting for confounders. Mean logHCC values increased across the four prenatal periods (P < 0.001). In multivariable analyses, pre-pregnancy BMI was consistently associated with all HCCs, while gestational age, economic hardship, hair dyeing, and depression, showed time-specific associations with HCC. In conclusion, this study showed evidence of factors influencing HCC levels before and during pregnancy. The most consistent association was seen with pre-pregnancy BMI. Depression was also associated with HCC concentrations.

Effects of improved on-farm crop storage on perceived stress and perceived coping in pregnant women-Evidence from a cluster-randomized controlled trial in Kenya

BACKGROUND

Food insecurity can be harmful to pregnant women, as pregnancy is a challenging period with increased maternal nutritional requirements to ensure optimal fetal development and health of the mother. Whether food insecurity negatively affects maternal health may depend on how stressful pregnant women perceive this food insecurity to be and how strongly they believe they can cope with it. In Sub-Saharan Africa (SSA), pregnant women from smallholder households suffer from food insecurity due to post-harvest losses (PHL), i.e., loss of crops because of inadequate storage. An agricultural intervention that improves crop storage has been shown to reduce food insecurity. However, it remains to be determined whether this agricultural intervention (treatment) has an additional positive effect on pregnant women's perceived stress levels and coping abilities. This study examines whether pregnant women from treatment households experience lower perceived stress levels and higher perceived coping abilities compared to pregnant women from control housholds.

METHODS AND FINDINGS

In a randomized controlled trial (RCT), short message service (SMS)-based mobile phone surveys were conducted to assess the causal effect of a food security intervention (improved on-farm storage of maize) on perceived stress and coping in pregnant women from smallholder households. Pregnant women were identified through these monthly surveys by asking whether someone in their household was currently pregnant. The significant results revealed that pregnant women from treatment households experienced more perceived stress but better perceived coping abilities compared to pregnant women from control households. Uncertainty due to lack of experience, this might have contributed to the higher perceived stress, as the women could not easily judge the benefits and risks of the new storage technology. However, the technology itself is a tangible resource which might have empowered the pregnant women to counteract the effects of PHL and thus food insecurity.

CONCLUSION

Our findings indicate that pregnant women from treatment households had higher perceived coping abilities but experienced more perceived stress. More research is needed on how this technology impacts maternal mental health in a broader sense and whether biological mechanisms, such as epigenetics, may underlie this association.

Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review

BACKGROUND

Stress before conception and during pregnancy is associated with less favorable maternal and child health. Alterations in prenatal cortisol levels may serve as a central biological pathway linking stress to adverse maternal and child health. Research examining associations between maternal stress from childhood through pregnancy and prenatal cortisol has not been comprehensively reviewed.

METHOD

The current scoping review of 48 papers synthesizes studies reporting on associations between stress before conception and during pregnancy with maternal cortisol in pregnancy. Eligible studies measured childhood, the proximal preconception period, pregnancy, or lifetime stress based on stress exposures or appraisals and measured cortisol in saliva or hair during pregnancy.

RESULTS

Higher maternal childhood stress was associated with higher cortisol awakening responses and alterations in typical pregnancy-specific changes in diurnal cortisol patterns across studies. In contrast, most studies of preconception and prenatal stress reported null associations with cortisol and those reporting significant effects were inconsistent in direction. A few studies found that the associations between stress and cortisol during pregnancy varied as a function of several moderators including social support and environmental pollution.

CONCLUSIONS

Although many studies have evaluated effects of maternal stress on prenatal cortisol, this scoping review is the first to synthesize existing literature on this topic. The association between stress before conception and during pregnancy and prenatal cortisol may depend on the developmental timing of stress and several moderators. Maternal childhood stress was more consistently associated with prenatal cortisol than proximal preconception or pregnancy stress. We discuss methodological and analytic factors that may contribute to mixed findings.

Individual and situational predictors of psychological and physiological stress and burnout among maternity providers in Northern Ghana

BACKGROUND

Maternity providers, including nurses, midwives, physicians, are at significant risk for stress and burnout due to the nature of care provision in maternal and child health settings. Yet, the empirical evidence on stress and burnout among maternity providers in sub-Saharan Africa is scarce. Therefore, the purpose of our study was to (1) assess levels of stress and burnout among maternity providers and support staff in Ghana, and (2) identify individual and situational factors associated with maternity provider stress, burnout, and physiology.

METHOD

Using a purposive sampling technique, we recruited 150 maternity providers from 19 high delivery health facilities within the 15 districts of the Upper East region (UER) of Ghana into a cross-sectional study. Participants completed Cohen's Perceived Stress Scale, the Shirom-Melamed Burnout scale, and sociodemographic, health-, and work-related items. Participants' heart rate variability (HRV) and hair cortisol levels were assessed for stress-related physiologic responses. We computed bivariate and multivariate linear regression models to examine factors associated with stress and burnout.

RESULT

Most participants were experiencing moderate to high stress (58.0%) and burnout (65.8%). Each unit increase in overcommitment to work was associated with 0.62 higher perceived stress scores (β = 0.62, 95% CI: 0.22, 1.02) and 0.15 higher burnout scores. On average, those who had experienced disrespect from colleagues in the last year had higher perceived stress scores compared to those who had not experienced disrespect (β = 1.77, 95% CI: 0.50, 3.04); and those who had experienced disrespect from patients in the last year had higher cortisol levels than those who had not (β = 0.52, 95% CI: 0.11, 0.93). Those who work for more than 5 days also had higher cortisol levels, on average, compared to those who worked fewer days a week.

CONCLUSION

We found high levels of stress and burnout among maternity providers in Northern Ghana, underscoring the need for interventions to manage the effects of stress and burnout on maternity providers' wellbeing, quality of care, and patient outcomes. Healthcare management teams should assist providers in reducing their overcommitment by hiring more staff, given its strong link to stress and burnout. Additionally, facilitating a respectful workplace culture could also help reduce stress and burnout among maternity providers.

Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity

Psychiatry and allied disciplines have recognized the potency of structural and social determinants of mental health, yet there has been scant attention given to the roles of neurobiology in the links between structural and social determinants and mental health. In this article, we make the case for why greater attention must be given to structural and social determinants of biological psychiatry by researchers, practitioners, and policy-makers. After defining these terms and theoretical frameworks for considering their relevance in biological psychiatry, we review empirical research with marginalized and minoritized racial, ethnic, gender, sexual, and economic communities that reveals the ways in which structural and social determinants affect neurobiological functioning with implications for mental health. We give particular emphasis to developmental science and developmentally informed research, because structural and social determinants influence neurobiological adaptation and maturation across the lifespan. We conclude with recommendations for advancing research, practice, and policy that connect biological psychiatry with structural and social determinants of health. Foremost among these is diversifying the ranks of biological psychiatry, from classrooms through laboratories, hospitals, and community health centers. Transforming and advancing the understanding of the structural and social determinants of neurobiology and mental health is most likely to come through transforming the discipline itself.

Obstetric risk in pregnancy interacts with hair cortisone levels to reduce gestational length

Background

Maternal psychological stress has been linked to preterm birth. However, the differential contribution of psychological stress versus stress hormones is not clear. Studies focus primarily on perceived stress and cortisol, with few assessing its inter-convertible hormone cortisone. Furthermore, little is known about the potential moderating roles of obstetric risk and fetal sex in the relationship between maternal stress and gestational length. This gap in knowledge is particularly evident for rural women who typically experience chronic multiple stressors during pregnancy. We explored the relationship of hormonal and psychological stress to gestational length and the effects of obstetric risks and fetal sex on this relationship among Kenyan pregnant women.

Methods

The sample included 130 women recruited between 22 to 28 weeks gestation. They completed a clinical and sociodemographic questionnaire together with the Perceived Stress Scale and provided a hair sample for cortisol and cortisone assay. Women underwent an ultrasound to assess weeks of gestation. At delivery, their pregnancy-related health problems were identified using information extracted from medical records to compile each woman's number of pregnancy risks on the Obstetric Medical Risk Index (OMRI).

Results

Perceived stress and hair cortisol were not significant predictors of gestational length. However, a greater number of obstetric risks on the OMRI was associated with shorter gestational length. This effect was further explained by the interaction between obstetric risk and hair cortisone (B = 0.709, p = 0.02). Hair cortisone levels of mothers who had a shorter gestation were significantly higher in mothers with 2 or more risks on the OMRI but not among mothers with only one or no risks (t = 2.39, p = 0.02). Fetal sex had no relationship to gestational length and also had no moderating effect on the relationship between any stress-related metric and gestational length.

Conclusion

Cortisone levels may increase in anticipation of shorter gestation as a compensatory response to increased obstetric risk. Elevated cortisone may be a more sensitive marker of risk for early delivery than cortisol or psychological stress, with salience for both the male and female fetus.

First Look into the Use of Fish Scales as a Medium for Multi-Hormone Stress Analyses

Recent efforts have provided convincing evidence for the use of fish scale cortisol concentration in the assessment of long-term stress in fishes. However, cortisol alone is not sufficient to fully describe this state of long-term stress. Dehydroepiandrosterone (DHEA) is an androgen with actions that oppose those of cortisol. The means by which DHEA negates the effects of cortisol occurs in part via changes in the metabolism of cortisol to cortisone. The quantitation of cortisol, DHEA and cortisone could therefore provide a more comprehensive assessment of the overall status of physiological stress. As DHEA and cortisone have yet to be quantified within the fish scale, our first objective was to ensure our sample processing protocol for cortisol was applicable to cortisone and DHEA. Following this, we induced a state of long-term stress in goldfish (Carassius auratus). Some degree of elevation in all hormones was observed in the stressed fish scales. Additionally, cortisol and cortisone were significantly elevated in the stressed fish serum in comparison to controls while DHEA was undetectable in either group. Overall, these results suggest that fish scales provide an appropriate medium for the assessment of long-term stress in fishes via the quantitation of relevant steroid hormones.

Three-Faceted Approach to Perceived Stress: A Longitudinal Study of Stress Hormones, Personality, and Group Cohesion in the Real-Life Setting of Compulsory Basic Military Training

Compulsory basic military training is characterized not only by being challenging but also by being stressful. Assuming a high frequency of perceived stress events as a negative outcome of training, this article provides evidence on how the perceived frequency of stressful situations is affected by three types of factors: (i) biological stress response variables measured by hair steroid hormone levels, (ii) personality traits measured using the Big Five personality test, and (iii) group cohesion measures in military squads. A total of 112 conscripts in 11 squads participated in the research at the beginning (T1), in the middle (T2), and at the end (T3) of compulsory basic military training. Hair steroid hormone levels (cortisol, cortisone, and dehydroepiandrosterone (DHEA)) levels were measured by liquid mass spectrometry; other data were collected using self-report questionnaires. The results of the Poisson regression analysis indicated that hair steroid hormone cortisol had a statistically significantly impact and could increase the perceived frequency of stressful situations by up to 1.317 (e0.275, T2) times. The concentrations of other hormones (cortisone = 1.157, e0.146, T3 and DHEA = 1.020, e0.020, T3) also had a statistically significant effect. Other factors had a decreasing effect on the frequency. Extraversion was significant with an effect of 0.907 (e−0.098, T2) and 0.847 (e−0.166, T3), while task cohesion had an effect of 0.946 (e−0.056) and norm cohesion of 0.954 (e−0.047). The research indicates that the three groups of factors affect the perceived frequency of stressful situations during compulsory basic military training, but their impacts are considerably different.

Cortisol levels versus self-report stress measures during pregnancy as predictors of adverse infant outcomes: a systematic review

Systematically review existing evidence to (1) identify the association between self-report stress and cortisol levels measured during pregnancy; and, (2) assess their association with adverse infant outcomes to determine which is the better predictor. A systematic review was conducted in accordance with PRISMA guidelines. Search terms focused on pregnancy, psychological stress and cortisol. Nine electronic databases were searched, in addition to reference lists of relevant papers. Eligibility criteria consisted of studies that included measurement of self-reported psychological stress, cortisol and assessed their associations with any infant-related outcome. Further limits included studies published in English or Spanish with human female participants. A meta-regression was not feasible due to differences in study samples, measurement tools employed, types of cortisol assessed and outcomes reported. A narrative synthesis was provided. 28 studies were eligible for inclusion. Convergent validity between self-report measures and cortisol was reported by three studies (range r = 0.12-0.41). Higher levels of self-report stress were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low anthropometric measures (birth length, head circumference, length of the neonate), poor infant neurodevelopment (cognitive development) and potentially pathogenic gut microbiota (Clostridiaceae Clostridium, Haemophilus) in six studies. Higher cortisol levels were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low infant birth weight, poor infant neurodevelopment (attention scores on the Network Neurobehavioral Scale) and low levels of potentially protective gut microbiota (Lactobacillus, Slackia and Actinobaculum) in 13 studies. Of the studies that assessed which type of measure was a better predictor of infant outcomes (n = 6), there was agreement that cortisol levels were statistically better at predicting adverse outcomes than self-reported stress. Self-report stress measures appear to be modest predictors of adverse infant outcomes in comparison to cortisol. A number of methodological limitations need to be addressed in future studies to help understand the relationship between cortisol and self-reported stress and how they are related to adverse infant outcomes.

Scalp hair sweating as a predictor of hair cortisol level in human compared to obesity and other confounders

Inconsistent results were found throughout the literature regarding factors affecting hair cortisol levels. Hair cortisol level in humans was not studied for its associations to scalp hair sweating or hair wash frequency in a patient-based way. Factors affecting hair cortisol levels must be precisely known in order to interpret the results correctly. The aims of the study are to assess if BMI, Perceived Stress Scale (PSS), hair wash frequency, and sweating with scalp hair affect hair cortisol levels. It will assess which of these factors are more significant predictors of hair cortisol levels. In a study on healthy adults, information about history, socio-demographics, PSS, hair wash frequency, hair treatment, and scalp hair sweating were collected, and hair samples were taken and analyzed for their hair cortisol level. Associations of hair cortisol levels with each of the variables were investigated and significant predictors of hair cortisol levels among the variables were found. Mean hair cortisol level in the study participants was 16.84 pg/mg hair. Hair cortisol has a significant positive association with weight, BMI, PSS, and scalp hair sweating, p < 0.05. Scalp hair sweating significantly predicts hair cortisol levels by 12.3%, while other variables did not significantly predict hair cortisol levels, p < 0.05. Scalp hair sweating significantly predicts hair cortisol levels. Age, hair wash frequency, hair treatment, and stressful events have no associations with hair cortisol levels. Although BMI and PSS are associated with hair cortisol levels, they do not significantly predict it. Obesity is significantly associated with profuse sweating, thus the increase in hair cortisol levels in obese individuals could partly be the result of a higher incidence of sweating in these individuals. Thus, scalp hair sweating should be taken into consideration during the study and interpretation of hair cortisol levels.

Examining the Relationship Between Hair Cortisol With Stress-Related and Transdiagnostic Subclinical Measures

Background: Hair cortisol concentrations (HCC) provide a retrospective examination of long-term cortisol production as a measure of the hypothalamic-pituitary-adrenal (HPA) axis functioning, one of the major neural systems implicated in mediating the effects of stress on mental illness. However, evidence about the relationship between HCC with stressors and symptoms is scattered. In the present study, we aimed to examine the association between HCC and a wide range of stress-related and transdiagnostic subclinical measures in a sample of non-clinical young adults with a wide distribution of schizotypy. Methods: A total sample of 132 non-clinical young adults recruited at college and technical schools oversampled for schizotypy scores were assessed on distal and proximal stressful experiences, appraisals of stress, traits and symptoms of the affective, psychosis and dissociation spectrums, as well as stress-buffering measures, and provided 3 cm-hair samples. Results: No significant associations were found between HCC and any of the stress-related and subclinical measures. Only suspiciousness and disorganization showed a trend for a positive association with HCC but the magnitude was small. Conclusions: The present findings support previous studies indicating an overall lack of concordance between a broad range of stress-related and (sub)clinical phenotypic measures with hair cortisol. This study examined for the first time the relationship of HCC with the non-clinical expression of the psychosis spectrum, that is, schizotypy, which complements previous studies on clinical high risk and established psychosis and offers a promising strategy for studying possible HPA dysfunctions characterizing the subclinical psychosis continuum without the confounds associated to clinical psychosis.

Association between hair cortisol, hair cortisone, and fatigue in people living with HIV

Cumulative evidence to date largely supports an association between dysregulation of the activity of the hypothalamic-pituitary-adrenal (HPA) axis and fatigue. People living with HIV (PLHIV), in particular, are vulnerable to both HPA axis dysregulation and fatigue. Few investigations have examined the possible role of HPA-axis dysfunction in the occurrence of fatigue in PLHIV. This cross-sectional study aimed to investigate the association between glucocorticoids in hair, retrospective indicators of long-term HPA axis activity and biomarkers of chronic stress, and fatigue in PLHIV. A total of 446 PLHIV from Guangxi China provided hair samples for cortisol and cortisone assay and provided information on fatigue levels, sociodemographic, lifestyle, and HIV-related characteristics. Results showed that before and after controlling sociodemographic, lifestyle, and HIV-related characteristics, hair cortisone levels, but not hair cortisol levels, were associated with fatigue levels in PLHIV. In conclusion, we found that higher cortisone levels are associated with greater fatigue levels in a large cohort of Chinese PLHIV.LAY SUMMARYWe found that hair cortisone levels were significantly associated with fatigue levels in a large cohort of Chinese PLHIV. Hair cortisol levels were, however, not associated with fatigue levels in the PLHIV studied. We thus show that Chinese PLHIV who have higher cortisone levels are associated with higher fatigue levels.

Maternal Sociodemographic Factors and Antenatal Stress

Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, parity, marital status, maternal education, household income, polygyny, and intimate partner violence) and outcomes (hair cortisol, hair cortisone, and PSS score) was examined using univariate, bivariate and multivariate models. We found a negative association between PSS scores and household income (β = −2.40, p = 0.016, 95% CI = −4.36, −0.45). There was a positive association of the ratio of hair cortisone to cortisol with Adolescent age group (β = 0.64, p = 0.031, 95% CI = 0.06, 1.22), and a negative association with Cohabitation (β = −1.21, p = 0.009, 95% CI = −2.11, −0.31). We conclude that household income influenced psychological stress in pregnancy. Adolescence and cohabitation may have an influence on biological stress, but the nature of this effect is unclear.

Greater Pain Severity is Associated with Higher Glucocorticoid Levels in Hair Among a Cohort of People Living with HIV

Background

Pain is a common occurrence and persistent symptom, which has an adverse impact on individual well-being and quality of life among people living with HIV (PLHIV). Alteration in the activity of the Hypothalamic-Pituitary-Adrenal (HPA) axis resulting in abnormal glucocorticoid levels had been proposed to play important roles in those associations.

Purpose

This study aimed to investigate whether pain severity was associated with hair glucocorticoid levels, a novel method of measuring long-term glucocorticoid exposure, among a large cohort of Chinese PLHIV.

Methods

A measure of pain severity and hair samples were collected from 431 adults PLHIV in Guangxi, China. Glucocorticoid (cortisol and cortisone) in hair were quantified by liquid chromatography-tandem mass spectrometry. The general linear model was used to test the associations of pain severity with hair glucocorticoid levels after adjusting for potential confounding factors.

Results

Of the 431 PLHIV, 273 reported none pain, 87 reported mild pain, and 71 reported moderate-severe pain. Hair cortisone, but not hair cortisol, was found to differ significantly among the three pain severity groups (F=3.90, p=0.021). PLHIV reported moderate-severe pain had higher hair cortisone than those reported mild (p=0.070) or none pain (p=0.014), with no differences between the latter two pain severity groups.

Conclusion

Greater pain severity is associated with higher hair cortisone levels among Chinese PLHIV. In order to reduce the long-term glucocorticoid levels, interventions managing pain should be considered for PLHIV with moderate-severe pain.

Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors

Background

Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors.

Methods

Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level.

Results

85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = − 2.83; CI = -5.47; − 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout.

Conclusions

Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10453-0.

Human Placenta Buffers the Fetus from Adverse Effects of Perceived Maternal Stress

Maternal stress during pregnancy is linked to several negative birth outcomes. The placenta, a unique pregnancy-specific organ, not only nourishes and protects the fetus but is also the major source of progesterone and estrogens. As the placenta becomes the primary source of maternal progesterone (P4) and estradiol between 6-9 weeks of gestation, and these hormones are critical for maintaining pregnancy, maternal stress may modulate levels of these steroids to impact birth outcomes. The objective was to test whether maternal perceived stress crosses the placental barrier to modulate fetal steroids, including cortisol, which is a downstream indicator of maternal hypothalamic-pituitary-adrenal (HPA) axis regulation and is associated with negative fetal outcomes. Nulliparous women, 18 years or older, with no known history of adrenal or endocrine illness were recruited during their third trimester of pregnancy at the University of California San Francisco (UCSF) Mission Bay hospital obstetrics clinics. Simultaneous measurement of 10 steroid metabolites in maternal (plasma and hair) and fetal (cord blood and placenta) samples was performed using tandem mass spectrometry along with assessment of the perceived stress score and sociodemographic status. While the maternal perceived stress score (PSS) and sociodemographic status were positively associated with each other and each with the body mass index (BMI) (r = 0.73, p = 0.0008; r = 0.48, p = 0.05; r = 0.59, p = 0.014, respectively), PSS did not correlate with maternal or fetal cortisol, cortisone levels, or fetal birth weight. Regardless of maternal PSS or BMI, fetal steroid levels remained stable and unaffected. Progesterone was the only steroid analyte quantifiable in maternal hair and correlated positively with PSS (r = 0.964, p = 0.003), whereas cord estradiol was negatively associated with PSS (r = -0.94, p = 0.017). In conclusion, hair progesterone might serve as a better marker of maternal stress than cortisol or cortisone and maternal PSS negatively impacts fetal estradiol levels. Findings have implications for improved biomarkers of stress and targets for future research to identify factors that buffer the fetus from adverse effects of maternal stress.

Social and Psychophysiological Consequences of the COVID-19 Pandemic: An Extensive Literature Review

The Coronavirus Disease 2019 (COVID-19) pandemic, now a global health crisis, has surprised health authorities around the world. Recent studies suggest that the measures taken to curb the spread of the COVID-19 outbreak have generated issues throughout the population. Thus, it is necessary to establish and identify the possible risk factors related to the psychosocial and psychophysiological strain during the COVID-19 outbreak. The present extensive literature review assesses the social, psychological, and physiological consequences of COVID-19, reviewing the impact of quarantine measures, isolation, vast human loss, social and financial consequences in the family's economies, and its impact on the psychological health of the population. We also discussed the effect of psychophysiological factors, considering the impact of physical inactivity and modifications in nutritional habits, at psychological and physiological levels. The present review includes an actualized to date bibliography, articles for which were methodologically analyzed to verify they met the standards of quality and scientific accuracy. Authors understand the pandemic as a multifactorial event for which only a profound and extensive analysis would lead to better compression and efficient intervention in the near future.