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Petrova D, Ubago-Guisado E, Garcia-Retamero R, Redondo-Sánchez D, Pérez-Gómez B, Catena A, Caparros-Gonzalez RA, Sánchez MJ. Allostatic Load and Depression Symptoms in Cancer Survivors: A National Health and Nutrition Examination Survey Study. Cancer Nurs 2024; 47:290-298. [PMID: 36920171 DOI: 10.1097/ncc.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Individuals with cancer often experience stress throughout the cancer trajectory and have a high risk of experiencing depression. OBJECTIVE The aim of this study was to examine the relationship between allostatic load (AL), a measure of cumulative stress-related physiologic dysregulation of different body systems, and symptoms of depression in cancer survivors. METHODS Participants were 294 adult cancer survivors from the US National Health and Nutrition Examination Survey (NHANES 2007-2018). Allostatic load was measured using 14 indicators representing cardiometabolic risk, glucose metabolism, cardiopulmonary functioning, parasympathetic functioning, and inflammation. Depressive symptoms were measured with the Patient Health Questionnaire-9. The relationship between AL and depressive symptoms was investigated using multiple regression adjusted for diverse sociodemographic and diagnosis variables. RESULTS Higher AL was associated with higher depressive symptom scores. The higher risk of depression was concentrated among those survivors in the highest AL quartile, with 21% (95% confidence interval, 11%-32%) of survivors presenting a high risk of depression compared with 8% to 11% of survivors in the lower quartiles. In exploratory analyses, the relationship between AL and depressive symptoms was only significant among survivors with a lower income. In contrast, in survivors in the highest income group, depressive symptoms were lower and unrelated to AL. CONCLUSION High AL is associated with more depressive symptoms among cancer survivors. IMPLICATIONS FOR PRACTICE Nurses have an important role in identifying psychological distress in cancer patients and survivors. Further research is needed to investigate the usefulness of AL as a marker in the context of cancer follow-up care and screening for psychological distress.
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Affiliation(s)
- Dafina Petrova
- Author Affiliations: Instituto de Investigación Biosanitaria, ibs.GRANADA (Drs Petrova, Ubago-Guisado, Caparros-Gonzalez, and Sánchez, and Mr Rendondo-Sánchez), Granada; Escuela Andaluza de Salud Pública (Drs Petrova, Ubago-Guisado, and Sánchez, and Mr Rendondo-Sánchez), Granada; CIBER of Epidemiology and Public Health (Drs Petrova, Ubago-Guisado, Pérez-Gómez, and Sánchez, and Mr Rendondo-Sánchez), Madrid; University of Granada (Drs Garcia-Retamero, Catena, and Caparros-Gonzalez); National Center for Epidemiology, Health Institute Carlos III (Dr Pérez-Gómez), Madrid; and Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada (Dr Sánchez), Spain
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Spiegler G, Su Y, Li M, Wolfson C, Meng X, Schmitz N. Characterization of depression subtypes and their relationships to stressor profiles among middle-aged and older adults: An analysis of the canadian longitudinal study on aging (CLSA). J Psychiatr Res 2024; 175:333-342. [PMID: 38761515 DOI: 10.1016/j.jpsychires.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
The current diagnostic criteria for depression do not sufficiently reflect its heterogeneous clinical presentations. Associations between adverse childhood experiences (ACEs), allostatic load (AL), and depression subtypes have not been extensively studied. Depression subtypes were determined based on clinical presentations, and their relationships to AL biomarkers and ACEs were elucidated in a sample of middle-aged and older adults. Participants from the Canadian Longitudinal Study on Aging who screened positive for depression were included (n = 3966). Depression subtypes, AL profiles and ACE profiles were determined with latent profile analyses, and associations between them were determined using multinomial logistic regression. Four depression subtypes were identified: positive affect, melancholic, typical, and atypical. Distinct associations between depression subtypes, stressor profiles and covariates were observed. Among the subtypes compared to positive affect, atypical subtype had the most numerous significant associations, and the subtypes had unique relationships to stressor profiles. Age, sex, smoking status, chronic conditions, marital status, and physical activity were significant covariates. The present study describes distinct associations between depression subtypes and measures of stress (objective and self-reported), as well as related factors that differentiate subtypes. The findings may inform more targeted and integrated clinical management strategies for depression in individuals exposed to multiple stressors.
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Affiliation(s)
- Gabriella Spiegler
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Yingying Su
- Douglas Research Centre, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montréal, QC, Canada; School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Muzi Li
- Douglas Research Centre, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Xiangfei Meng
- Douglas Research Centre, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montréal, QC, Canada.
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany.
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Carbone JT, Casement MD. Biomarker Profiles of Depression During Young Adulthood: Results From the National Health and Nutrition Examination Survey. J Adolesc Health 2024; 74:950-957. [PMID: 38340125 DOI: 10.1016/j.jadohealth.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/24/2023] [Accepted: 12/18/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE Cumulative "wear and tear" on physiological systems (allostatic load) may contribute to risk for depression, but there is limited research on allostatic load during young adulthood, which is a peak developmental period for depression onset. This study evaluates profiles of allostatic load and their association with depression in young adults. METHODS Biomarker and depression data were extracted for 18-24-year-olds (928 females, 932 males) in the National Health and Nutrition Examination Survey from 2015 to 2020. Latent class analysis was used to identify biomarker profiles. Multivariate logistic regression analyses were used to predict depression based on profile membership, controlling for sociodemographic characteristics. RESULTS Three allostatic load profiles were identified in both females and males-high inflammatory and moderate metabolic dysregulation (immunometabolic dysregulation), high metabolic and moderate inflammatory dysregulation (metaboimmune dysregulation), or low dysregulation. Metaboimmune or immunometabolic dysregulation profiles in females, and metaboimmune dysregulation in males, were associated with 3-3.5 times greater odds of depression compared to low dysregulation profiles. DISCUSSION Profiles of immune and metabolic dysregulation can be observed during young adulthood. Elevated immunometabolic and metaboimmune profiles were associated with depression risk in young adult females, while elevated metaboimmune profiles were associated with depression risk in young adult males. Detection of depression-related physiological dysregulation in young adults could be used to identify depression phenotypes and apply early interventions.
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Affiliation(s)
- Jason T Carbone
- School of Social Work, Wayne State University, Detroit, Michigan
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Zhou Y, Wang L, Yang K, Huang J, Li Y, Li W, Zhang P, Fan F, Yin Y, Yu T, Chen S, Luo X, Tan S, Wang Z, Feng W, Tian B, Tian L, Li CSR, Tan Y. Correlation of allostatic load and perceived stress with clinical features in first-episode schizophrenia. J Psychiatr Res 2024; 172:156-163. [PMID: 38382239 DOI: 10.1016/j.jpsychires.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Stress plays an important role in the etiology of schizophrenia. However, the mechanisms by which chronic physiological stress and perceived stress relate to the clinical features of schizophrenia may differ. We aimed to elucidate the relationships among chronic physiological stress indexed by allostatic load (AL), perceived stress, and clinical symptoms in individuals with first-episode schizophrenia (FES). METHODS Individuals with FES (n = 90, mean age = 28.26years old, 49%female) and healthy controls (111, 28.88, 51%) were recruited. We collected data of 13 biological indicators to calculate the AL index, assessed subjective stress with the Perceived Stress Scale-14 (PSS-14), and compared AL and perceived stress between groups. Patients with FES were also evaluated with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). RESULTS Individuals with FES had higher AL and PSS score than healthy controls. There were no significant correlations between AL and PSS score in either patients or controls. Among individuals with FES, the AL index was associated with the severity of positive symptoms, while the PSS score was positively associated with CDSS score. Both elevated AL and PSS were correlated with the occurrence of schizophrenia. CONCLUSIONS Physiological stress, as reflected by AL, may be more related to positive symptoms, while perceived stress appear to be associated with depressive symptoms in individuals with FES. Longitudinal studies are necessary to explore the relationships between interventions for different stressor types and specific clinical outcomes in FES.
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Affiliation(s)
- Yanfang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Leilei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Kebing Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China.
| | - Junchao Huang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yanli Li
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wei Li
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ping Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Fengmei Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yi Yin
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ting Yu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Song Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Shuping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wei Feng
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Baopeng Tian
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yunlong Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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Honkalampi K, Kraav SL, Kerr P, Juster RP, Virtanen M, Hintsa T, Partonen T, Lehto SM. Associations of allostatic load with sociodemographic factors, depressive symptoms, lifestyle, and health characteristics in a large general population-based sample. J Affect Disord 2024; 350:784-791. [PMID: 38266933 DOI: 10.1016/j.jad.2024.01.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We examined the associations between allostatic load (AL) and sociodemographic factors, depressive symptoms, lifestyle and health characteristics in a population-based sample of 4993 adults in Finland. METHODS Thirteen biomarkers were used to construct AL. High AL was defined as scoring highly in ≥4 items. RESULTS AL scores of 4 and above were exceeded in the age group of 45-54 years in men and 65-74 years in women. Age was the strongest predictor for belonging to the high AL score group. In addition, elevated depressive symptoms (BDI-6 ≥ 4), male sex, not engaging in physical exercise, high alcohol use and a low level of education were associated with an increased likelihood of belonging to the high AL group. CONCLUSION The older the participants were, the greater their AL burden was. However, AL burden increased more steeply as a function of age in men. In addition to lifestyle interventions, effective prevention strategies for depression at the population level could have a major public health impact in reducing the accumulation of AL burden.
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Affiliation(s)
- Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Siiri-Liisi Kraav
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Philippe Kerr
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Robert-Paul Juster
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Taina Hintsa
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; R&D Department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Handley ED, Duprey EB, Russotti J, Levin RY, Warmingham JM. Person-centered methods to advance developmental psychopathology. Dev Psychopathol 2024:1-9. [PMID: 38415403 PMCID: PMC11349932 DOI: 10.1017/s0954579424000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Dante Cicchetti's remarkable contributions to the field of developmental psychopathology include the advancement of key principles such as the interplay of typical and atypical development, multifinality and equifinality, the dynamic processes of resilience, and the integration of multiple levels of analysis into developmental theories. In this paper we assert that person-centered data analytic methods are particularly well-suited to advancing these tenets of developmental psychopathology. We illustrate their utility with a brief novel empirical study focused on underlying patterns of childhood neuroendocrine regulation and prospective links with emerging adult functioning. Results indicate that a childhood neuroendocrine profile marked by high diurnal cortisol paired with low diurnal DHEA was uniquely associated with more adaptive functioning in emerging adulthood. We discuss these findings, and person-centered methods more broadly, within the future of developmental psychopathology.
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Affiliation(s)
| | - Erinn B. Duprey
- Mt. Hope Family Center, University of Rochester
- Children’s Institute
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Liang Y, Booker C. Allostatic load and chronic pain: a prospective finding from the national survey of midlife development in the United States, 2004-2014. BMC Public Health 2024; 24:416. [PMID: 38336697 PMCID: PMC10854121 DOI: 10.1186/s12889-024-17888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Previous research has demonstrated a correlation between chronic stress and chronic pain (CP). However, there have been few studies examining the prospective association of allostatic load (AL)-the biological processes related to stress-with CP. METHODS We firstly conducted latent class analysis to identify phenotypes of AL using a community-dwelling sample, the Midlife in the United States. Multinomial logistic regression models were used to examine the prospective association between phenotypes of AL at MIDUS 2 biomarker project and the presence of CP, CP interference and the number of CP sites at MIDUS 3. RESULTS Three phenotypes of AL, low biological dysregulation, parasympathetic dysregulation and metabolic dysregulation, were identified. Compared to low biological dysregulation group, participants experiencing metabolic dysregulation phenotype of AL at MIDUS 2 had higher risks of having high-interference CP (RRR = 2.00, 95% CI: 1.06, 3.79, P < 0.05) and 3 or more CP sites (RRR = 2.03, 95% CI: 1.08, 3.83, P < 0.05) at MIDUS 3. CONCLUSION The findings indicate that focusing on mitigating the metabolic dysfunction phenotype of AL has the potential to be an efficacious strategy for alleviating future CP bodily widespreadness and high CP interference.
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Affiliation(s)
- Yunlong Liang
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK.
| | - Cara Booker
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK
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Mendis BILM, Palihaderu PADS, Karunanayake P, Satharasinghe DA, Premarathne JMKJK, Dias WKRR, Rajapakse IH, Hapugalle AS, Karunaratne WRSA, Binendra AGYN, Kumara KBPP, Prabhashwara GSD, Senarath U, Yeap SK, Ho WY, Dissanayake AS. Validity and reliability of the Sinhalese version of the perceived stress scale questionnaire among Sri Lankans. Front Psychol 2023; 14:1152002. [PMID: 37397314 PMCID: PMC10313401 DOI: 10.3389/fpsyg.2023.1152002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Despite the availability of validated psychometrics tools to assess depression, there has not been any validated and reliable tool established to test perceived stress among Sri Lankans. The objective of this study is to test the validity and reliability of the Sinhalese Version of the Sheldon Cohen Perceived Stress Scale. Materials and methods Standard and systematic procedures were adopted to translate the original English version of the Perceived Stress Scale-10 questionnaire into Sinhalese. Consecutive sampling was employed to recruit the Type 2 Diabetes mellitus (T2DM) sample (n = 321), and a convenient sampling was used to recruit the Age and Sex matched Healthy Controls (ASMHC) (n = 101) and the Healthy Community Controls (HCC) groups (n = 75). Cronbach alpha was used to assess internal consistency and reliability was determined using test-retest method utilizing Spearman's correlation coefficient. Sensitivity was evaluated by comparing the mean scores of the Sinhalese Perceived Stress Scale (S-PSS-10) and Sinhalese Patient Health Questionnaire (S-PHQ-9) scores. Post-hoc comparisons were done using Bonferroni's method. Mean scores were compared between the T2DM, ASMHC, and HCC groups using the independent t-test. Explanatory Factor Analysis (EFA) was conducted using the principal component and Varimax rotation while the Confirmatory Factor Analysis (CFA) was performed to assess the goodness-of-fit of the factor structure extracted from the EFA. Concurrent validity was assessed using the Pearson correlation between the S-PSS-10 and Patient Health Questionnaire measured by S-PHQ-9 (p < 0.05). Results Cronbach alpha values of the three groups T2DM, ASMHC and HCC were 0.85, 0.81, and 0.79, respectively. Results of the ANOVA test suggested that there was a significant difference in the mean scores between groups (p < 0.00). EFA analysis revealed the existence of two factors with eigenvalues greater than 1.0. The factor loadings for the items ranged from 0.71-0.83. The CFA analysis demonstrated a good model fit for the two-factor model S-PSS-10. The S-PSS-10 significantly correlated with S-PHQ-9, indicating an acceptable concurrent validity. Conclusion Findings revealed that the S-PSS-10 questionnaire can be used to screen perceived stress among the majority of the Sri Lankan Sinhalese-speaking population specially with chronic illnesses. Further studies with higher sample sizes across different populations would enhance the validity and reliability of S-PSS-10.
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Affiliation(s)
| | | | - Panduka Karunanayake
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Dilan Amila Satharasinghe
- Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | - Avanti Sulochana Hapugalle
- Department of North Indian Music, Faculty of Music, University of the Visual and Performing Arts, Colombo, Sri Lanka
| | | | | | | | | | - Upul Senarath
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Swee Keong Yeap
- China-ASEAN College of Marine Sciences, Xiamen University Malaysia, Sepang, Selangor, Malaysia
| | - Wan Yong Ho
- Division of Biomedical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Malaysia
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Hao B, Chen J, Cai Y, Li H, Zhu Z, Xu W, Liu H. Association between allostatic load and adverse outcomes among older patients with heart failure with preserved ejection fraction. BMC Geriatr 2023; 23:360. [PMID: 37296410 PMCID: PMC10257257 DOI: 10.1186/s12877-023-04091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The allostatic load (AL) refers to the cumulative weakening of multiple physiological systems caused by repeated adaptation of the body to stressors There are still no studies have focused on the association between AL and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). The present study aimed to investigate the association between AL and adverse outcomes, including mortality and HF admission, among elderly male patients with HFpEF. METHODS We conducted a prospective cohort study of 1111 elderly male patients with HFpEF, diagnosed between 2015 and 2019 and followed up through 2021. We constructed an AL measure using a combination of 12 biomarkers. The diagnosis of HFpEF was made according to the 2021 European Society of Cardiology guidelines. A Cox proportional hazards model was used to determine the associations between AL and adverse outcomes. RESULTS In multivariate analysis, AL was significantly associated with increased risk of all-cause mortality (medium AL: adjusted hazard ratio [HR] = 2.53; 95% confidence interval [CI] 1.37-4.68; high AL: HR = 4.21; 95% CI 2.27-7.83; per-score increase: HR = 1.31; 95% CI 1.18-1.46), cardiovascular mortality (medium AL: HR = 2.67; 95% CI 1.07-6.68; high AL: HR = 3.13; 95% CI 1.23-7.97; per-score increase: HR = 1.20; 95% CI 1.03-1.40), non-cardiovascular mortality (medium AL: HR = 2.45; 95% CI 1.06-5.63; high AL: HR = 5.81; 95% CI 2.55-10.28; per-score increase: HR = 1.46; 95% CI 1.26-1.69), and HF admission (medium AL: HR = 2.68; 95% CI 1.43-5.01; high AL: HR = 3.24; 95% CI 1.69-6.23; per-score increase: HR = 1.24; 95% CI 1.11-1.39). Consistent results were found in multiple subgroup analyses. CONCLUSIONS A higher AL was associated with poor prognosis in elderly men with HFpEF. AL relies on information that is easily obtained in physical examinations and laboratory parameters and can be assessed in various care and clinical settings to help risk stratification of HFpEF patients.
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Affiliation(s)
- Benchuan Hao
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Jianqiao Chen
- Department of Geriatrics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yulun Cai
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Huiying Li
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Zifan Zhu
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Weihao Xu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China.
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Birkenmaier J, Jung E, McMillin S, Qian Z. Are credit scores and financial well-being associated with physical health? SOCIAL WORK IN HEALTH CARE 2023; 62:162-178. [PMID: 37120849 DOI: 10.1080/00981389.2023.2207614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/03/2022] [Accepted: 04/21/2023] [Indexed: 05/30/2023]
Abstract
Consumer credit score has been used as an indicator of financial strain that could potentially impact health. Subjective financial well-being, or one's feelings about one's expectations, preferences, and satisfaction with their financial situation, is related to financial strain. This study examined whether subjective financial well-being mediates the association between credit score and self-reported physical health in a national representative sample. Using structural equation modeling (SEM), we test whether a mediating association exists between self-rated credit score and self-rated physical health. Results suggest that, after controlling for sociodemographic variables, those who reported higher credit scores have better health (β = 0.175, p < .001) and higher financial well-being (β = 0.469, p < .001), and those who reported higher financial well-being have better health (β = 0.265, p < .001). The mediation effect of financial well-being on the association between credit and physical health is also positive and statistically significant (β = 0.299, p < .001). Thus, subjective feelings about one's financial situation would enhance the observed positive association between credit and health. Practice and policy implications are included.
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Affiliation(s)
- Julie Birkenmaier
- School of Social Work, Saint Louis University, St Louis, Missouri, USA
| | - Euijin Jung
- Refugee Behavioral Health Postdoctoral Fellow, Research Program on Children and Adversity, Boston College School of Social Work, Chestnut Hill, Massachusetts, USA
| | - Stephen McMillin
- School of Social Work, Saint Louis University, St Louis, Missouri, USA
| | - Zhengmin Qian
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
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Beydoun HA, Beydoun MA, Kwon E, Hossain S, Fanelli-Kuczmarski MT, Maldonado A, Evans MK, Zonderman AB. Longitudinal association of allostatic load with depressive symptoms among urban adults: Healthy Aging in Neighborhoods of Diversity across the Life Span study. Psychoneuroendocrinology 2023; 149:106022. [PMID: 36640448 PMCID: PMC9931667 DOI: 10.1016/j.psyneuen.2022.106022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence suggests that lifetime exposure to stressful life events and chronic stressors may be linked to geriatric depression. Allostatic load (AL) is considered a mediator of the stress-health relationship and has been linked to psychosocial factors reflecting health disparities. The purpose of this study was to examine the longitudinal associations of AL with depressive symptoms scores among urban adults, before and after stratifying by sex and race. METHODS Secondary analyses were performed using Visit 1 (2004-2009), Visit 2 (2009-2013) and Visit 3 (2013-2017) data collected on 2298 Healthy Aging in Neighborhoods of Diversity across the Life Span study participants (baseline age: 30-64 y). AL at Visit 1 (ALv1) and z-transformed probability of higher AL trajectory (ALtraj) between Visits 1 and 3 were calculated using cardiovascular, metabolic and inflammatory risk indicators. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to calculate total and domain-specific depressive symptoms scores. Mixed-effects linear models controlled for socio-demographic, lifestyle and health characteristics. RESULTS In fully adjusted models, a positive cross-sectional relationship was observed between ALv1 and "somatic complaints" depressive symptoms (β = 0.21, P = 0.006) score at Visit 1, whereas ALtraj was associated with increasing depressive symptoms score (β = 0.086, P = 0.003) between Visits 1 and 3. An inverse relationship was observed between ALtraj and "positive affect" depressive symptoms score at Visit 1 among women (β = -0.31, P < 0.0001) and White adults (β = -0.32, P = 0.004). Among women, ALtraj was also positively related to change in "somatic complaints" depressive symptoms score between Visits 1 and 3 (β = 0.043, P = 0.020). CONCLUSIONS Among urban adults, AL may be associated with "somatic complaints" depressive symptoms at baseline. Higher AL trajectories may predict increasing depressive symptoms (overall) and increasing "somatic complaints" depressive symptoms (among women). A higher AL trajectory may be associated with lower "positive affect" depressive symptoms at baseline among women and White adults only.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Edward Kwon
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Marie T Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Ana Maldonado
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
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Carbone JT, Holzer KJ, Clift J, Fu Q. Latent profiles of biological dysregulation and risk of mortality: time-to-event analysis using the Midlife in the US longitudinal study. J Epidemiol Community Health 2023; 77:182-188. [PMID: 36627117 DOI: 10.1136/jech-2021-218073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is a well-established relationship between high allostatic load (AL) and increased risk of mortality. This study expands on the literature by combined latent profile analysis (LPA) with survival data analysis techniques to assess the degree to which AL status is associated with time to death. METHODS LPA was employed to identify underlying classes of biological dysregulation among a sample of 815 participants from the Midlife in the US study. Sex-stratified Cox proportional hazards regression models were used to estimate the association between class of biological dysregulation and time to death while controlling for sociodemographic covariates. RESULTS The LPA resulted in three classes: low dysregulation, immunometabolic dysregulation and parasympathetic reactivity. Women in the immunometabolic dysregulation group had more than three times the risk of death as compared with women in the low dysregulation group (HR=3.25, 95% CI: 1.47 to 7.07), but that there was not a statistically significant difference between the parasympathetic reactivity group and the low dysregulation group (HR=1.80, 95% CI: 0.62 to 5.23). For men, the risk of death for those in the immunometabolic dysregulation (HR=1.79, 95% CI: 0.88 to 3.65) and parasympathetic reactivity (HR=0.90, 95% CI: 0.34 to 3.65) groups did not differ from the low dysregulation group. CONCLUSION The findings are consistent with the previous research that demonstrates increased AL as a risk factor for mortality. Specifically, in women, that increased risk may be associated with immunometabolic dysregulation and not simply a generalised measure of cumulative risk as is typically employed in AL research.
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Affiliation(s)
- Jason T Carbone
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Katherine J Holzer
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
| | - Jennifer Clift
- School of Social Work, Wayne State University, Detroit, Michigan, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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13
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Twait EL, Basten M, Gerritsen L, Gudnason V, Launer LJ, Geerlings MI. Late-life depression, allostatic load, and risk of dementia: The AGES-Reykjavik study. Psychoneuroendocrinology 2023; 148:105975. [PMID: 36423561 PMCID: PMC11060697 DOI: 10.1016/j.psyneuen.2022.105975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The current study aimed to assess if the relation between depression and dementia could be explained by allostatic load (AL) profiles, as well as assessing their risk on incident all-cause dementia, Alzheimer's disease (AD), and non-AD dementias. METHODS The study included individuals without dementia at baseline from the population-based AGES-Reykjavik Study. Depressive symptoms assessed with the Geriatric Depression Scale-15 and AL markers were collected at baseline. Latent profile analysis (LPA) was performed on the AL markers. Incident dementia was measured during 12-years of follow-up. Cox regressions adjusted for AL profiles were performed to evaluate if AL could explain the relation between depressive symptoms and incident dementia. Additional Cox regressions exploring the interaction with depressive symptoms and AL profiles were also performed. RESULTS LPA revealed four profiles based on AL factors: 'Low cardiovascular dysregulation' (43 %), 'Average' (42 % prevalence), 'High cardiovascular dysregulation' (11 %), and 'Multisystem dysregulation' (4 %). Cox regression analyses found an increased risk for dementia in the 'Multisystem dysregulation' group (HR 1.72; 95 % CI 1.26-2.33), as well as for AD (HR 1.75; 95 % CI: 1.12-2.71) and non-AD dementias (HR 1.87; 95 % CI: 1.23-2.84). AL profiles did not mediate the risk of all-cause dementia with depressive symptoms; however, there was evidence of additive interaction with depressive symptoms and the 'Multisystem dysregulation' profile and all-cause dementia (RERI 0.15; 95 % CI 0.03-0.26). CONCLUSION AL profiles and depressive symptoms were independently related to dementia. Individuals with multisystem dysregulation could be more susceptible to the negative effects of depressive symptomology on incident dementia.
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Affiliation(s)
- Emma L Twait
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Maartje Basten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Lotte Gerritsen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Vilmundur Gudnason
- Department of Psychology, Utrecht University, Utrecht, the Netherlands; Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Lenore J Launer
- National Institute on Aging, Laboratory for Epidemiology and Population Sciences, Baltimore, MD, USA
| | - Mirjam I Geerlings
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands; National Institute on Aging, Laboratory for Epidemiology and Population Sciences, Baltimore, MD, USA; Amsterdam UMC, location University of Amsterdam, Department of General Practice, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later life, and Personalized Medicine, Amsterdam, the Netherlands; Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, the Netherlands.
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Measuring allostatic load: Approaches and limitations to algorithm creation. J Psychosom Res 2022; 163:111050. [PMID: 36228435 DOI: 10.1016/j.jpsychores.2022.111050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Allostatic load literature has proliferated over the past three decades, and a growing body of research demonstrates that higher levels of allostatic load are associated with a wide range of negative physical and mental health outcomes. However, there remain significant challenges with operationalization of the concept. A scoping review of the methods employed to create an allostatic load algorithm was conducted and recommendations for future research with an orientation towards advancing clinical application of the theory are discussed. METHODS A search of seven electronic databases (PubMed, PsycINFO, Social Work Abstracts, Social Service Abstracts, Social Sciences Citation Index (Web of Science), Sociological Abstracts, Scopus) was completed with the search term "allostatic load." Studies were reviewed, and if they met the inclusion criteria, data was extracted, complied, and presented in the narrative, table, and figures. RESULTS The initial searches yielded 5280 results with the final sample of 395 non-duplicate articles that met the inclusion criteria. More than half (52.5%) of all included publications employed biomarker cutoffs based on the high-risk quartiles of the sample distribution, 11.1% employed the sum of at-risk clinical scores, and the remainder of studies utilized a range of different algorithms. CONCLUSION Allostatic load literature has grown at an exponential rate in recent years, but researchers continue to operationalize the concept via algorithms that may have limited utility moving forward. More nuanced statistical approaches are emerging and should be considered, as should a shift towards an approach that can provide additional clinical utility.
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de la Fuente J, Pachón-Basallo M, Martínez-Vicente JM, Peralta-Sánchez FJ, Garzón-Umerenkova A, Sander P. Self- vs. External-Regulation Behavior Scale TM in different psychological contexts: A validation study. Front Psychol 2022; 13:922633. [PMID: 36389553 PMCID: PMC9644468 DOI: 10.3389/fpsyg.2022.922633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/26/2022] [Indexed: 09/08/2024] Open
Abstract
The self- vs. external-regulation behavior theory, SR-ER Theory (2021) model has postulated the Self-Regulation /Non or De-Regulation/Dys-regulation (SR-NR-DR) continuum in the person and in their context. The model also generates a behavioral heuristic that allows us to predict and explain the variability of other dependent behavioral variables in a range of scenarios (clinical, educational, health and technology contexts). Consequently, the objective of this study was to validate the different scales prepared on the basis of the theory presented. A total of 469 students voluntarily completed at different times the five questionnaires presented, to give a total of 1,385 completed questionnaires. Using an ex post facto design, descriptive, correlational, confirmatory factorial analysis (CFA), reliability, and concurrent validity analyses were carried out. The scales were analyzed individually and as a whole. The results showed the acceptable structure of scale and consistent levels of reliability. The five levels generated by the SR-NR-DR (personal and contextual) combinatory heuristic that arises from the theoretical model determined significant differences in the levels of the variables analyzed for each psychological context. We discuss the theoretical implications and the implications for the assessment and improvement of the behaviors analyzed in function of the personal and contextual regulation levels evaluated.
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Affiliation(s)
- Jesús de la Fuente
- School of Education and Psychology, University of Navarra, Pamplona, Spain
- School of Psychology, University of Almería, Almería, Spain
| | | | | | | | | | - Paul Sander
- Department of Psychology, Teesside University, Middlesbrough, United Kingdom
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Birkenmaier J, Rothwell D, Frey JJ, Coffey DS. Introduction to the Special Issue on "Financial Capability and Asset Building for Family Financial Wellbeing". JOURNAL OF FAMILY AND ECONOMIC ISSUES 2022; 43:647-653. [PMID: 36311286 PMCID: PMC9589663 DOI: 10.1007/s10834-022-09871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
The papers in this issue emerged from a 2020 social work academic conference focused on financial capability and asset building (FCAB) research. This introduction provides an overview of the challenging financial and economic realities for U.S. families that provide the context for these papers. An outline of social work?s unique role with these families precedes a brief introduction to each included paper. ?Building on these papers, the authors provide an overview of future directions for FCAB research in the areas of theory and methods. Regarding theory, the FCAB field will benefit from the further exploration of the role of access and context for financial capability, as well as the use of institutional theory in FCAB practice and research. The role of relationships on financial behavior is also under-researched along with the intersection of FCAB with clinical issues and other human needs. Regarding methods, future research that uses qualitative and longitudinal data is also needed to advance FCAB knowledge. Overall, interdisciplinary work across social work and consumer finance to build models that span professional boundaries and incorporate FCAB into consumer financial wellbeing models will advance theory and evidence.
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Affiliation(s)
- Julie Birkenmaier
- School of Social Work, Saint Louis University, 3550 Lindell Blvd, 63103 St Louis, MO USA
| | - David Rothwell
- Barbara E. Knudson Endowed Chair in Family Policy, College of Public Health and Human Sciences, Oregon State University, Waldo Hall 462 2250 SW Jefferson Way, 97331 Corvallis, OR USA
| | - Jodi Jacobson Frey
- The University of Maryland School of Social Work, 525 West Redwood Street, 21201 Baltimore, MD USA
| | - Darla Spence Coffey
- Council on Social Work Education, President and CEO, 333 John Carlyle Street, Suite 400, 22314 Alexandria, VA USA
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17
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Carbone JT, Dell NA, Issa M, Watkins MA. Associations between Allostatic Load and Posttraumatic Stress Disorder: A Scoping Review. HEALTH & SOCIAL WORK 2022; 47:132-142. [PMID: 35244700 DOI: 10.1093/hsw/hlac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/04/2021] [Accepted: 03/23/2021] [Indexed: 06/14/2023]
Abstract
Traumatic events may lead to the development of PTSD or PTSD symptomology that can negatively impact health outcomes. Allostatic load, which represents the cumulative biological wear and tear of exposure to stress, can be employed to better understand the physiological etiology of PTSD. A scoping review, informed by the PRISMA Extension for Scoping Reviews, was completed to identify published and unpublished empirical studies that explored the relationship of allostatic load and PTSD. Eight databases were searched yielding four studies, with the results summarized narratively and in tabular form. Findings were mixed as to the association between allostatic load and PTSD. Allostatic load was positively associated with PTSD diagnosis; however, studies measuring only PTSD symptomatology found no relationship. Few PTSD researchers have tested the relationship of a comprehensive measure of allostatic load to PTSD. Among those who have, studies show that allostatic load can be a beneficial tool and applicable theoretical framework for understanding the biological changes associated with PTSD. Future research should focus on standardizing measures of both allostatic load and PTSD and identifying potential confounders. A better understanding of the physiological changes associated with PTSD could lead to more effective prevention and treatment efforts.
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18
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Lawrence JA, Kawachi I, White K, Bassett MT, Williams DR. Associations between multiple indicators of discrimination and allostatic load among middle-aged adults. Soc Sci Med 2022; 298:114866. [PMID: 35278977 PMCID: PMC9214633 DOI: 10.1016/j.socscimed.2022.114866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 01/03/2023]
Abstract
The objective of this paper is to examine associations between multiple measures of discrimination (i.e., everyday, lifetime, and appraised burden) and components of allostatic load (AL). We drew on pooled cross-sectional data from the Biomarker Project of the Midlife in the United States study (n = 2118). Ages ranged from 25 to 84 years and included mostly Black (n = 389) and white (n = 1598) adults. Quasi-Poisson models were fit to estimate prevalence ratios for each discrimination measure and high-risk quartiles across seven physiological systems (i.e., sympathetic and parasympathetic nervous system; HPA axis; inflammation; cardiovascular; metabolic glucose; and metabolic lipids) and overall AL scores. In fully adjusted models, everyday discrimination was associated with elevated lipids (aPR: 1.07; 95% CI 1.01, 1.13). Lifetime experiences of discrimination were associated with lower sympathetic nervous system (aPR: 0.82; 95% CI: 0.69, 0.98) and greater cardiovascular risk scores (aPR: 1.17; 95% CI: 1.02, 1.34) among those reporting three or more experiences, as well as increased inflammation (aPR: 1.13; 95% CI: 1.02, 1.25; aPR: 1.28; 95% CI: 1.14, 1.43), metabolic glucose (aPR: 1.35; 95% CI: 1.19, 1.54; aPR: 1.45; 95% CI: 1.24, 1.68), and metabolic lipids (aPR: 1.13; 95% CI: 1.03, 1.24; aPR: 1.28; 95% CI: 1.15, 1.43) scores for those reporting one to two and three or more experiences. Appraised burden yielded nuanced associations with metabolic glucose and parasympathetic nervous system scores. Everyday and lifetime measures were also associated with higher overall AL, though burden of discrimination was only associated with AL among those reporting "a little" burden. While AL summary scores provide insight into the cumulative impacts of discrimination on health, there appear to be distinct physiologic pathways through which varying forms of discrimination contribute to AL and, ultimately, to poorer health. These unique pathways may be useful in identifying potential points of intervention to mitigate the impacts of discrimination on health inequities.
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Affiliation(s)
- Jourdyn A Lawrence
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Population Health Sciences, Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA; François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kellee White
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA
| | - Mary T Bassett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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Ding R, Ye X, Chen S, Wang Y, Zhu D, He P. Does self-perceived income priority matter? The association between income inequality and allostatic load in China. Stress 2022; 25:1-8. [PMID: 34882049 DOI: 10.1080/10253890.2021.1999407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
There is a scarcity of evidence about the association between income inequality and allostatic load (AL) across diverse population, which is critical to identify the downstream biological pathway of the inequality-health linkage. This study aimed to determine the association of income inequality with AL, and assess whether there are differences in such association between people with different perception of income priority. We utilized data from the 2006 and 2009 wave of China Health and Nutrition Survey (CHNS). Multilevel linear regression analyses were conducted to examine the association between AL score and community Gini coefficient. Additionally, to investigate whether the association of income inequality and AL score would vary among individuals with different perception of income priority, a cross-level interaction term for Gini coefficient and self-perceived income priority was applied. Both the cross-sectional analysis in 2009 (coefficient = 0.081, p = .016) and the time-lagged analysis (0.106, 0.008) suggested that community-level Gini coefficient was positively associated with AL. Similar result was only found among individuals from low median income communities in subsample analysis. Additionally, the cross-level interaction between Gini coefficient and self-perceived income priority was significantly associated with AL among respondents from low-median income communities. There is a positive association between income inequality and AL among Chinese adults, with individual who perceived income as a higher priority in their life suffering more from income inequality. This study contributes to the increasing efforts and new perspective to understand the inner mechanism of both the detrimental effect of income inequality and the accumulation of AL.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, PR China
| | - Xin Ye
- China Center for Health Development Studies, Peking University, Beijing, PR China
| | - Siyuan Chen
- China Center for Health Development Studies, Peking University, Beijing, PR China
| | - Yanshang Wang
- China Center for Health Development Studies, Peking University, Beijing, PR China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Beijing, PR China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, PR China
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20
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Bohlen L, Shaw R, Cerritelli F, Esteves JE. Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework. Front Psychol 2021; 12:767005. [PMID: 34777176 PMCID: PMC8578726 DOI: 10.3389/fpsyg.2021.767005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.
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Affiliation(s)
- Lucas Bohlen
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Robert Shaw
- Scandinavian College of Osteopathy, Gothenburg, Sweden
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
| | - Francesco Cerritelli
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Jorge E. Esteves
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, University College of Osteopathy, London, United Kingdom
- International College of Osteopathic Medicine, Malta, Italy
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21
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Spooner RK, Taylor BK, L'Heureux E, Schantell M, Arif Y, May PE, Morsey B, Wang T, Ideker T, Fox HS, Wilson TW. Stress-induced aberrations in sensory processing predict worse cognitive outcomes in healthy aging adults. Aging (Albany NY) 2021; 13:19996-20015. [PMID: 34410999 PMCID: PMC8436901 DOI: 10.18632/aging.203433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 01/06/2023]
Abstract
It is well recognized that not all individuals age equivalently, with functional dependence attributable, at least in part, to stress accumulated across the lifespan. Amongst these dependencies are age-related declines in cognitive function, which may be the result of impaired inhibitory processing (e.g., sensory gating). Herein, we examined the unique roles of life and biological stress on somatosensory gating dynamics in 74 adults (22-72 years old). Participants completed a sensory gating paired-pulse electrical stimulation paradigm of the right median nerve during magnetoencephalography (MEG) and data were subjected to advanced oscillatory and time-domain analysis methods. We observed separable mechanisms by which increasing levels of life and biological stress predicted higher oscillatory gating ratios, indicative of age-related impairments in inhibitory function. Specifically, elevations in life stress significantly modulated the neural response to the first stimulation in the pair, while elevations in biological stress significantly modulated the neural response to the second stimulation in the pair. In contrast, neither elevations in life nor biological stress significantly predicted the gating of time-domain neural activity in the somatosensory cortex. Finally, our study is the first to link stress-induced decline in sensory gating to cognitive dysfunction, suggesting that gating paradigms may hold promise for detecting discrepant functional trajectories in age-related pathologies in the future.
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Affiliation(s)
- Rachel K Spooner
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA.,College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Emma L'Heureux
- College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA.,College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Yasra Arif
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA.,College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Pamela E May
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Brenda Morsey
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tina Wang
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA
| | - Trey Ideker
- Department of Medicine, University of California San Diego, La Jolla, CA 92161, USA
| | - Howard S Fox
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA.,College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Regulation/Non-Regulation/Dys-Regulation of Health Behavior, Psychological Reactance, and Health of University Undergraduate Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073793. [PMID: 33916478 PMCID: PMC8038604 DOI: 10.3390/ijerph18073793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 02/08/2023]
Abstract
The Self-Regulation vs. External-Regulation Theory (2017) has postulated a continuum of regulation/non-regulation/dys-regulation that is present both in the individual and in the individual’s context. This gives rise to a behavioral heuristic that can predict and explain other health-related variables, such as psychological reactance and student health. On a voluntary basis, 269 university students completed validated questionnaires on variables of regulation, reactance and health. Using an ex post facto design, we performed correlational analysis and structural linear regression to build a structural equations model (SEM) with acceptable statistical values. The results showed various predicted relationships: self-regulation was associated with and positively predicted self-regulated health behavior; external health-regulating contexts were associated with and positively predicted self-regulated health behavior; non-regulatory and dysregulatory contexts negatively predicted self-regulated health behavior and students’ health itself, as well as positively predicting psychological reactance behavior. Implications are established for explaining variability in general and health-related self-regulation, as well as for intervening in these variables in health programs.
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Honkalampi K, Virtanen M, Hintsa T, Ruusunen A, Mäntyselkä P, Ali-Sisto T, Kärkkäinen O, Koivumaa-Honkanen H, Valkonen-Korhonen M, Panayiotou G, Lehto SM. Comparison of the level of allostatic load between patients with major depression and the general population. J Psychosom Res 2021; 143:110389. [PMID: 33609985 DOI: 10.1016/j.jpsychores.2021.110389] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We compared the level of allostatic load (AL) between patients with major depressive disorder (MDD) and non-depressed controls using two definitions of AL: continuous AL scores (AL index) and clinically significant high AL (≥4). We examined whether MDD was associated with AL independent of basic socioeconomic (age, sex, cohabiting status and level of education) and lifestyle factors (smoking and alcohol use). METHODS The MDD patient sample consisted of 177 psychiatric outpatients (mean age 33.7, SD 10.7 years), who were recruited from the Department of Psychiatry at Kuopio University Hospital, Finland, in 2016-19. The non-depressed controls (n = 228, mean age 49.8, SD 10.1 years) lived in the municipality of Lapinlahti, Finland. Ten biomarkers were used to construct the two AL variables. These indicators were systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine, waist circumference, body mass index (BMI) and C-reactive protein (CRP). RESULTS The mean AL scores did not significantly differ between MDD patients (2.97) and non-depressed controls (3.12), thus it was not associated with MDD in univariate analysis. In multivariate models a higher AL index was associated with a 1.42 to 1.82 times higher likelihood of belonging to the MDD group. Furthermore, we found that high AL (i.e. AL ≥ 4) was associated with MDD, with the likelihood ranging between 2.27 and 2.96 compared with the non-depressed controls in multivariate models. CONCLUSIONS Even young adult patients with MDD appear to display clinically significant, high AL compared with non-depressed controls. Thus, it is important to pay attention to the somatic health of depressed patients in addition to their mental health.
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Affiliation(s)
- Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Taina Hintsa
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Anu Ruusunen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Deakin University, iMPACT Institute/Food and Mood Centre, School of Medicine, Geelong, Australia
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Toni Ali-Sisto
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Olli Kärkkäinen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Minna Valkonen-Korhonen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Georgia Panayiotou
- Clinical Psychology and Psychophysiology lab, University of Cyprus, Nicosia, Cyprus
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Department of Psychiatry, University of Helsinki, Helsinki, Finland
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