Sex and Gender Roles in Relation to Mental Health and Allostatic Load

Affect regulation and allostatic load over time

OBJECTIVE

Emerging work suggests that affect regulation strategies (e.g., active coping, anger expression) predict disease and mortality risk, with sometimes divergent estimates by sex or education levels. However, few studies have examined potential underlying biological mechanisms. This study assessed the longitudinal association of affect regulation with future allostatic load.

METHOD

In 2004-2006, 574 participants from the Midlife in the United States study completed validated scales assessing use of nine general and emotion-specific regulatory strategies (e.g., denial, anger expression). As a proxy for how flexibly participants regulate their affect, variability in the use of regulatory strategies was operationalized using a standard deviation-based algorithm and considered categorically (i.e., lower, moderate, greater variability) to assess non-linear effects. Participants also provided data on relevant covariates and 24 allostatic load biomarkers (e.g., cortisol, blood pressure). In 2017-2021, these biomarkers were again collected. Linear regressions modeled betas (β) and 95 % confidence intervals (CI) examining associations of affect regulatory constructs with future allostatic load.

RESULTS

In fully-adjusted models including initial allostatic load, general regulatory strategies were unrelated to future allostatic load. Yet, greater versus moderate affect regulation variability levels predicted lower allostatic load (β=-0.14; 95 %CI: -0.27, -0.01). Only among more educated participants, greater use of anger expression predicted lower allostatic load, while the reverse was noted with anger control (βexpression=-0.12; 95 %CI: -0.20, -0.05; βcontrol=0.14; 95 %CI: 0.05, 0.24).

CONCLUSIONS

While general regulatory strategies appeared unrelated to allostatic load, greater variability in their use and anger-related strategies showed predictive value. Subsequent studies should examine these associations in larger, more diverse samples.

Development of a multidomain gender norm attitude scale for youth in Bangladesh

Objective

Gender norms shape individuals' perceptions and behaviours, particularly concerning health outcomes. However, the lack of comprehensive gender norm attitude measures in low- and middle-income countries, including Bangladesh, impedes gender-transformative efforts. This study introduces the Multidomain Gender Norm Attitude Scale (M-GNAS) to evaluate gender norm attitudes among Bangladeshi youths.

Method

Three sequential studies were conducted in Bangladesh in 2022 to develop the M-GNAS. Study 1 engaged 124 participants in focus group discussions, generating a 40-item pool reflecting prevalent gender norms. Study 2 involved 1374 youths (mean age 26.82, SD 5.50) to finalise the M-GNAS items and explore its latent structure through exploratory factor analysis (EFA). Study 3, with 1416 participants of similar age, used confirmatory factor analysis (CFA) to assess structural validity and structural equation modelling to evaluate measurement invariance (MI) across genders.

Results

EFA identified a four-domain solution with 13 items: gender-appropriate behaviour, family financial decisions, family responsibility, and career choice. CFA supported this four-domain solution (CFI=0.96, TLI=0.95; RMSEA=0.07; SRMR=0.04). MI across gender was well established (CFI & TLI>0.95, RMSEA≤0.06, SRMR<0.6). Higher education was associated with more egalitarian attitudes (F (5, 1408) = 7.25, p < 0.001), supporting the scale's construct validity.

Conclusion

The M-GNAS is a psychometrically robust tool for assessing youths' attitudes toward prevalent gender norm domains in Bangladesh. It holds the potential for contributing to gender-transformative programmes and could be applied in similar initiatives across developing nations, contingent upon appropriate validation.

Gender roles and gender norms associated with psychological distress in women and men among the Dutch general population

Women report more psychological distress than men, which may be related to both biological sex and socio-cultural gender. We tested whether associations between gender and distress differ for women and men. The cross-sectional sample consisted of 678 Dutch people (54% women). Gender roles were assessed as masculinity and femininity. A composite gender norm score was calculated by summing gendered sociodemographics. Multivariate regressions examined sex, gender, and their interaction for depressive symptoms, anxiety, and perceived stress, additionally adjusted. Women reported more psychological distress. People scoring higher on masculine gender roles, but not feminine gender roles, reported lower psychological distress. A higher gender norm score was related to more depressive symptoms and perceived stress. This association was only present in men and was explained by health-related covariates. This research shows that there is a need to further elaborate on the discrepancies between sex and gender in health psychology research to better understand individual differences.

Correlation of allostatic load and perceived stress with clinical features in first-episode schizophrenia

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.

Associations of allostatic load with sociodemographic factors, depressive symptoms, lifestyle, and health characteristics in a large general population-based sample

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.

Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study

OBJECTIVE

Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations.

METHODS

Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors).

RESULTS

Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women.

CONCLUSIONS

By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.

The Intergenerational Transmission of Gender Roles: Evidence From Parents and Children in Single-Parent

Given the current increases in the divorce rate and the number of single-parent families, the development of gender roles among children from single-parent families has received more and more attention. This study investigated how single parents influenced the formation of their children's gender roles and family-related factors that benefited the development of gender roles in single-parent children. Through in-depth interviews with 24 pairs of parents and children from single-parent families, we investigated single parents' and their children's cognition on gender roles, parents' parenting attitudes and behaviors during their children's gender role development, and communication and interaction between parents and children. Results showed intergenerational consistency in the gender role concepts of parents and their children in single-parent families. However, the children's gender role concepts were not completely and directly inherited from their parents, and could be affected by their subjective initiative. Additionally, single parenting did not necessarily negatively impact children's gender role development, which depends on their parent's parenting style. The study's limitations are discussed, and future directions for in-depth research are suggested.

Spousal Synchrony in Allostatic Load Among Older Couples in the Health and Retirement Study

OBJECTIVE

Using national data from the Health and Retirement Study, this study examined interpartner associations of allostatic load (AL) among 2338 different-sex couples ( N = 4676 individuals) over a 4-year period among older American couples from a dyadic approach.

METHODS

AL was indexed by immune (C-reactive protein), metabolic (high-density lipoprotein cholesterol, total cholesterol, and glycosylated hemoglobin), renal (cystatin C), cardiovascular (systolic and diastolic blood pressures, pulse rate), and anthropometric (waist and body mass index) parameters using the traditional count-based formulation. Actor-partner interdependence models were used to assess interpartner concordance in AL.

RESULTS

Higher partners' baseline AL was significantly associated with higher own AL both at baseline and 4 years later. In addition, partners' baseline AL was significantly associated with own AL 4 years later only in women but not men. Lastly, we did not observe any significant moderating effect of relationship quality on interpartner AL concordance.

CONCLUSIONS

The findings suggest that older couples' physiological responses to environmental stress are not only linked concurrently, but the associations persist after 4 years, alluding to long-term impacts of couples' psychosocial context and physiology on each other.

The allostatic load model: a framework to understand the cumulative multi-system impact of work-related psychosocial stress exposure among firefighters

Firefighting is recognised as a profession where health and well-being can be affected by a variety of occupational factors, such as physical, thermal, and chemical stressors. Along with the risks intuitively associated with the fire service, however, psychosocial stress has begun to attract attention as another variable deserving of consideration. Indeed, long-term exposure to work-related psychosocial stress has been linked with poor health outcomes in many workers; however, despite this association, very little has been done to examine how such stressors become biologically embedded in firefighters. To help facilitate research into how psychosocial stress can affect health-related outcomes in the fire service, we propose a framework centered on the notion of allostatic load. First, we reviewed the occupational characteristics that may generate psychosocial stress within firefighters before introducing allostatic load (that is, dysregulation across various physiological systems caused by the need to manage ongoing stressors). Next, we provided a summary of how allostatic load can be measured and touched on the framework's utility for studying the cumulative effects of work-related stress on firefighter health. After this, factors that may influence the steps leading from stress exposure to health outcomes were discussed; in particular, we commented upon how research in this area should consider specific non-modifiable (age, sex, and ethnicity) and modifiable (psychosocial resources and behavioural habits) factors. Finally, we presented methodological barriers and opportunities that may arise when using the allostatic load framework with this professional group. By introducing the framework, we hope to provide a tool that may be used by those interested in stress-health research in firefighters to build the evidence needed to inform primary prevention measures.

Conformity to Masculinity Norms and Mental Health Outcomes Among Gay, Bisexual, Trans, Two-Spirit, and Queer Men and Non-Binary Individuals

Homophobia and biphobia negatively impact the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary individuals (GBT2Q) and sexual and gender minority men, but little is known about the impact of gender-related oppression. The current study examines the impact of pressure to conform to masculine norms in Canada-based GBT2Q individuals. Specifically, the associations between (a) gender expression and pressure to be masculine and (b) pressure to be masculine and depression, anxiety, and self-rated mental health were investigated. Drawing from an online national cross-sectional survey of 8,977 GBT2Q individuals and sexual and gender minority men living in Canada aged 15 years or older, 56.4% (n = 5,067) of respondents reported experiencing pressure to conform to masculine norms. Respondents were more likely to report masculine pressure if they were younger than 30 years, described their gender expression as fluid, identified their sexuality as queer, were an ethnoracial minority, and were trans. Pressure to be masculine was associated with increased odds of depression, anxiety, and reporting poor or fair mental health. The current study provides evidence of the detrimental impact of pressure to conform to masculine norms on the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary peoples.

The Association of Cytomegalovirus and Allostatic Load by Country of Birth and Length of Time in the United States

BACKGROUND

Cytomegalovirus (CMV) is a highly prevalent virus with a worldwide distribution. It typically remains dormant in most individuals until reactivation. Immunocompromised states are known to be potential causes for CMV reactivation. Current research has shown a link in the decline of immigrant health among those living in the US for an extended period, though the impact of CMV on this is not clear.

METHODS

This study investigated the association between country of birth, duration of US residency, allostatic load, and latent cytomegalovirus infection (CMV IgG) in a sample of US adults aged 20-49. The data utilized for our analysis was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Allostatic load, an index measuring the cumulative physiological strain on the body as it strives to regain stability in the presence of chronic stress, provided a valuable approach to assess stress within the context of CMV exposure. Logistic regression modeling was employed to estimate odds ratios and confidence intervals for the analysis. The chi-square test of association and Cramer's V statistic were used to assess the correlation among categorical variables, while Pearson's correlation coefficient was applied to evaluate the relationship between continuous variables. The results revealed that individuals born outside the US and those with less than 20 years of residency in the US exhibited significantly higher proportions of positive CMV IgG compared to individuals born in the US. Specifically, individuals born outside the US had more than triple the odds of CMV IgG when adjusting for the AL index (OR = 3.69, p-value = 0.0063). A similar trend was observed when examining AL risk based on the duration of US residency. Furthermore, age and sex were identified as significant predictors (p-value < 0.05) of AL risk, considering the individual's country of birth. In summary, the findings of this study significantly enhance our comprehension of the intricate interplay between cytomegalovirus (CMV) and allostatic load (AL). The investigation sheds light on how CMV and AL interact within specific demographic contexts, providing valuable insights into the underlying risk factors for CMV infection.

The roles of non-heterosexuality outside of identity and gender non-conformity in Allostatic Load among young adults

Using the National Longitudinal Study of Adolescent to Adult Health, this study contrasted levels of Allostatic Load at the baseline and change observed between the age 20s and 30s, among self-identified Lesbians/Gays/Bisexuals and heterosexuals with non-heterosexual attraction/behavior (discordant heterosexuals), against heterosexuals without (concordant heterosexuals). In addition, the study tested if Allostatic Load differs for each of the sexual orientation group differs jointly or independently of gender non-conformity. The study found no Allostatic Load elevation for self-identified non-heterosexual men and women. For women only, a significantly greater elevation of Allostatic Load is observed among discordant heterosexuals. Independently, Allostatic Load is found higher for females appearing more androgynous. The findings suggest expanding the current scope of sexual minority research to consider the relevance of minority stress to those without a LGB identity, who may be exposed to stress from disparate sources related to their gender identity.

On the Stress of Being a Woman: The synergistic contribution of sex as a biological variable and gender as a psychosocial one to risk of stress-related disorders

Stress-related disorders (SRD) disproportionately affect women. Cortisol blunting, a failure to demonstrate a typical rise and fall of cortisol in response to stress, is associated with SRDs and has been found to be more pronounced among women. Cortisol blunting relates to both sex as a biological variable (SABV; e.g., estrogens and their fluctuations, impact on neural circuits) and gender as a psychosocial variable (GAPSV; e.g., discrimination, harassment, gender roles). I suggest a theoretical model linking experience, sex- and gender-related factors, and neuroendocrine substrates of SRD to the heightened risk among women. The model thus bridges multiple gaps in the literature to create a synergistic conceptual framework with which to understand the stress of being a woman. Utilizing such a framework in research may allow identifying targeted, sex-and gender-dependent risk factors, informing psychological treatment, medical advice, educational and community programming, and policy. DATA AVAILABILITY: All references are cited as required, no other data is reported.

Sex and gender in neurodevelopmental conditions

Health-related conditions often differ qualitatively or quantitatively between individuals of different birth-assigned sexes and gender identities, and/or with different gendered experiences, requiring tailored care. Studying the moderating and mediating effects of sex-related and gender-related factors on impairment, disability, wellbeing and health is of paramount importance especially for neurodivergent individuals, who are diagnosed with neurodevelopmental conditions with uneven sex/gender distributions. Researchers have become aware of the myriad influences that sex-related and gender-related variables have on the manifestations of neurodevelopmental conditions, and contemporary work has begun to investigate the mechanisms through which these effects are mediated. Here we describe topical concepts of sex and gender science, summarize current knowledge, and discuss research and clinical challenges related to autism, attention-deficit/hyperactivity disorder and other neurodevelopmental conditions. We consider sex and gender in the context of epidemiology, behavioural phenotypes, neurobiology, genetics, endocrinology and neighbouring disciplines. The available evidence supports the view that sex and gender are important contributors to the biological and behavioural variability in neurodevelopmental conditions. Methodological caveats such as frequent conflation of sex and gender constructs, inappropriate measurement of these constructs and under-representation of specific demographic groups (for example, female and gender minority individuals and people with intellectual disabilities) limit the translational potential of research so far. Future research and clinical implementation should integrate sex and gender into next-generation diagnostics, mechanistic investigations and support practices.

Longitudinal association of allostatic load with depressive symptoms among urban adults: Healthy Aging in Neighborhoods of Diversity across the Life Span study

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.

Gender and sex in eating disorders: A narrative review of the current state of knowledge, research gaps, and recommendations

INTRODUCTION

Eating disorders (EDs) have long been considered conditions exclusively affecting women, and studies in the ED field regularly exclude men. Research efforts are needed to better understand the role of gender and sex in EDs. This review describes the role of gender and sex in the development of EDs from a biopsychosocial perspective.

METHODS

The primary hypothesis of this narrative review is that gender and sex interact to influence ED risk. The literature review was conducted using the PubMed database.

RESULTS

This review first presents the general characteristics and prevalence of EDs according to gender and sex. Next, neurodevelopmental processes, neurobiology, gender roles, body image, and the minority stress model are addressed. Lastly, research perspectives to better include gender and sex in the field of EDs are discussed (e.g., representation of gender and sex diversities, development of appropriate assessment tools, and increasing awareness).

CONCLUSION

Although substantial knowledge gaps remain, there is a growing recognition of the importance of integrating gender and sex in ED research that holds promise for further development in the field.

Sex-dependent multimodal response profiles to psychosocial stress

INTRODUCTION

Sex differences in stress reactions are often reported in the literature. However, the sex-dependent interplay of different facets of stress is still not fully understood. Particularly in neuroimaging research, studies on large samples combining different indicators of stress remain scarce.

MATERIALS AND METHODS

In a functional magnetic resonance imaging study, a sample of 140 healthy participants (67 females using oral contraceptives) underwent a standardized stress induction protocol, the ScanSTRESS. During the experiment, salivary cortisol and subjective ratings were obtained at multiple time points and heart rate was recorded.

RESULTS

Sex differences emerged in different facets of the stress response:Women reacted with enhanced subjective feelings of stress and increases in heart rate, while men showed more pronounced neural activation in stress-related brain regions such as the inferior frontal gyrus and insula. Subjective feelings of stress and (para) hippocampal activity were negatively related in women,whereas a slightly positive association was observed in men.

DISCUSSION

These results provide further insight in the sex-specific stress response patterns. Moreover, they emphasize the role of the hippocampus in the regulation of the stress response. This paves the way for the identification of sex-dependent vulnerability factors that can, in the future, be implemented in the prevention and treatment of stress-related disorders.

Sex and gender role differences on stress, depression, and anxiety symptoms in response to the COVID-19 pandemic over time

Introduction

Stress, depression, and anxiety symptoms have been reported during the pandemic, with important inter-individual differences. Past cross-sectional studies have found that sex and gender roles may contribute to the modulation of one's vulnerability to develop such symptoms. This longitudinal study aimed to examine the interaction of sex and psychological gender roles on stress, depression, and anxiety symptoms in adults during the COVID-19 pandemic.

Methods

Following the confinement measures in March 2020 in Montreal, stress, depression, and anxiety symptoms were assessed every 3 months (from June 2020 to March 2021) with the Depression, Anxiety and Stress Scale among 103 females and 50 males. Femininity and masculinity scores were assessed with the Bem Sex Role Inventory before the pandemic and were added as predictors along with time, sex, and the interactions between these variables using linear mixed models.

Results

We observed similar levels of depressive symptoms between males and females, but higher levels of stress and anxious symptoms in females. No effects of sex and gender roles on depressive symptoms were found. For stress and anxiety, an interaction between time, femininity, and sex was found. At the beginning of the pandemic, females with high femininity had more stress symptoms than males with high femininity, whereas females with low femininity had more anxiety symptoms 1 year after the confinement measures compared to males with low femininity.

Discussion

These findings suggest that sex differences and psychological gender roles contribute to heterogeneous patterns of stress and anxiety symptoms over time in response to the COVID-19 pandemic.

Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research

BACKGROUND

Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods.

METHODS

This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews.

RESULTS

The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden.

CONCLUSIONS

The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

Sex and Gender and Allostatic Mechanisms of Cardiovascular Risk and Disease

Cardiovascular diseases are leading causes of mortality and morbidity in adults worldwide. Multiple studies suggest that there are clinically relevant sex differences in cardiovascular disease. Women and men differ substantially in terms of prevalence, presentation, management, and outcomes of cardiovascular disease. To date, however, little is known about why cardiovascular disease affects women and men differently. Because many studies do not differentiate the concept of sex and gender, it is sometimes difficult to discriminate sociocultural vs biological contributors that drive observed clinical differences. Female sex has some biological advantages in relation to cardiovascular disease, but many of these advantages seem to disappear as soon as women develop cardiovascular risk factors (eg, type 2 diabetes, hypertension, dyslipidemia). Furthermore, stress and allostatic load could play an important role in the relationship between sex/gender and cardiovascular diseases. In this narrative review, we argue that chronic stress and psychosocial factors might better encompass the patterns of allostatic load increases seen in women, while biological risk factors and unhealthy behaviours might be more important mechanisms that drive increased allostatic load in men. Indeed, men show allostatic load patterns that are more associated with impaired anthropometric, metabolic, and cardiovascular functioning and women have greater dysregulation in neuroendocrine and immune functioning. Thus gender-related factors might contribute to the pathogenesis of cardiovascular disease especially through stress mechanisms. It is important to continue to study the mechanisms by which gender influences chronic stress, because chronic stress could influence modifiable gendered factors to promote cardiovascular disease prevention.

The relationship between Chinese college students' mate preferences and their parents' education level

Parents have an influence on the formation of their children's mate preferences. This research conducted two studies to test the relationship between parents' education level and the gender role characteristics (masculinity and femininity) of ideal mate for college students, and the moderating role of urban-rural residence on this relationship. In study 1, 1,033 participants (627 females) reported their explicit attitude toward gender role characteristics for an ideal mate via the Chinese Sex Role Inventory-50. In study 2, we recruited 130 participants (66 females) and used an implicit association test to measure their implicit attitude. Regression-based analyses showed that the higher education level of parents was significantly associated with female students' mate preferences with high-femininity but low-masculinity traits. For male students, the higher education level of parents was associated with their explicit (not implicit) preferences of mates with high-masculinity but low-femininity traits. The significant moderating effect of urban-rural residence was observed in explicit preference, with the different patterns in gender groups. In conclusion, parents with higher educational attainment might bring up children who are more likely to embrace a partner with non-traditional gender roles (e.g., androgynous individuals, feminine men or masculine women).

Sex and Gender Multidimensionality in Epidemiologic Research

Along with age and race, sex has historically been a core stratification and control variable in epidemiologic research. While in recent decades research guidelines and institutionalized requirements have incorporated an approach differentiating biological sex from social gender, neither sex nor gender is itself a unidimensional construct. The conflation of dimensions within and between sex and gender presents a validity issue wherein proxy measures are used for dimensions of interest, often without explicit acknowledgement or evaluation. Here, individual-level dimensions of sex and gender are outlined as a guide for epidemiologists, and 2 case studies are presented. The first case study demonstrates how unacknowledged use of a sex/gender proxy for a sexed dimension of interest (uterine status) resulted in decades of cancer research misestimating risks, racial disparities, and age trends. The second illustrates how a multidimensional sex and gender framework may be applied to strengthen research on coronavirus disease 2019 incidence, diagnosis, morbidity, and mortality. Considerations are outlined, including: 1) addressing the match between measures and theory, and explicitly acknowledging and evaluating proxy use; 2) improving measurement across dimensions and social ecological levels; 3) incorporating multidimensionality into research objectives; and 4) interpreting sex, gender, and their effects as biopsychosocial.

Gendered work-family life courses and late-life physical functioning: A comparative analysis from 28 European countries

Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.

Lived experience and allostatic load among transmasculine people living in the United States

BACKGROUND

Transgender and gender diverse people face significant stigma that can adversely affect their physical and mental health. However, the psychobiological link between lived experience and health has been underexplored in this population. We thus examine perceived distress, mental health, and physiological 'wear and tear' by indexing allostatic load (AL) and assess associations with a range of contextual and experiential factors from transmasculine people living in the United States.

METHODS

Sixty-five people who identified as transgender men or along a transmasculine spectrum, living in Massachusetts, Vermont, and Rhode Island participated in The Transition Experience Study (age: M=31.8, range 18-55), which examines lived experience of social and medical transition and embodied gender minority/marginalization stress among a sample of transmasculine people. Based on in-depth in-person interview and survey data and inspired by an ecological systems model, we created indices representing (1) perceived progressive geopolitical climate; (2) socio-demographic advantage; (3) social support and resources; (4) gender minority and marginalization stressors; and (5) health behaviors. The Perceived Stress Scale and psychological symptoms (depression, anxiety, insomnia) were also assessed. AL indexed 10 neuroendocrine, immune, cardiovascular, and metabolic biomarkers.

RESULTS

Regressions revealed that perceived stress and psychological symptoms were negatively correlated with progressive geopolitical climate (respectively B=-1.47, p = 0.19; B=-.77, p < .001) and positively correlated with gender minority and marginalization stressors (respectively B=1.51, p < .001; B =.38, p = .005). AL was negatively associated with perceived progressive geopolitical climate (B=-.55, p = .007) and socio-demographic advantage (B=-3.2, p = .001).

DISCUSSIONS

These findings underline the importance of assessing geopolitical context and indexing lived experiences and life domains along with biomarker sampling. Together, these enable the identification of psychobiological pathways to better nuance multi-level contributors to health and well-being and understand embodied inequalities. These analyses of embodied stigma inclusive of AL biomarkers thus provide a model to further research centering transgender people's health from youth through old age.

Allostatic load and systemic comorbidities in psychiatric disorders

Psychiatric disorders are complex, disabling, and chronic conditions that are often accompanied by one or more systemic medical comorbidities. In this narrative review, we provide an overview of the allostatic load concept, which represents a multi-system dysregulation in response to chronic stress and link it to systemic comorbidities associated with psychiatric disorders. We synthesized published literature gathered using Medline (Ovid), Scopus, and PsychInfo and identified a high frequency of systemic comorbidities for both mood and psychotic disorders. The identified cardiovascular, metabolic, and immune comorbidities may represent the result of chronic wear and tear caused by a complex interaction between chronic psychosocial stress, health risk behaviors, pharmacological stressors, and the biological systems involved in the development of allostatic load. These findings support the notion that psychiatric disorders should be re-conceptualized as systemic disorders, affecting the brain and systemic biological pathways in an interconnected fashion to result in systemic comorbidities. We suggest that the multi-systemic and multi-dimensional approach that drives the allostatic load concept should be considered for understanding comorbidities in vulnerable psychiatric patients.

Allostatic load as a predictor of response to repetitive transcranial magnetic stimulation in treatment resistant depression: Research protocol and hypotheses

Treatment resistant depression is challenging because patients who fail their initial treatments often do not respond to subsequent trials and their course of illness is frequently marked by chronic depression. Repetitive transcranial magnetic stimulation (rTMS) is a well-established treatment alternative, but there are several limitations that decreases accessibility. Identifying biomarkers that can help clinicians to reliably predict response to rTMS is therefore necessary. Allostatic load (AL), which represents the 'wear and tear' on the body and brain which accumulates as an individual is exposed to chronic stress could be an interesting staging model for TRD and help predict rTMS treatment response. We propose an open study which aims to test whether patients with a lower pre-treatment AL will have a stronger antidepressant response to 4 week-rTMS treatment. We will also assess the relation between healthy lifestyle behaviors, AL, and rTMS treatment response. Blood samples for AL parameters will be collected before the treatment. The AL indices will summarize neuroendocrine (cortisol, Dehydroepiandrosterone), immune (CRP, fibrinogen, ferritin), metabolic (glycosylated hemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, uric acid, body mass index, waist circumference), and cardiovascular (heart rate, systolic and diastolic blood pressure) functioning. Mood assessment (Montgomery-Åsberg Depression Rating Scale and Inventory of Depressive symptomatology) will be measured before the treatment and at two-week intervals up to 4 weeks. With the help of different lifestyle questionnaires, a healthy lifestyle index (i.e., a single score based on lifestyle factors) will be created. We will use linear and logistic regressions to assess AL in relation to changes in mood score. Hierarchical regression will be done in order to assess the association between AL, healthy lifestyle index and mood score. Long-lasting and unsuccessful antidepressant trials may increase the chance of not responding to future trials of antidepressants and it can therefore increase treatment resistance. It is essential to identify reliable biomarkers that can predict treatment responses.

Gender Differences Influence Gender Equality Awareness, Self-Esteem, and Subjective Well-Being Among School-Age Children in China

The objective of this study was to investigate and analyze the status and influential factors of gender equality awareness, self-esteem, and subjective well-being in school-age boys and girls. The results can help schools and teachers provide more effective gender equality and mental health education. In the study, 284 valid questionnaires were collected from a total of 323 school-age boys and girls in the Hunan Province, China (effective response rate of 87.93%). The questionnaire covered gender equality awareness, self-esteem, and subjective well-being, with the influencing factors analyzed through multiple linear regression. There was a significant correlation among children’s gender equality awareness in all areas examined (family, occupation, and school), with both boys and girls having the lowest awareness of gender equality in occupational fields. The children’s self-esteem and subjective well-being were significantly correlated as well. Gender equality awareness, self-esteem, and subjective well-being among boys and girls reflected different influential factors. Androgynous traits (neither feminine nor masculine) were conducive to the development of gender equality awareness and self-esteem among the children. Therefore, schools and teachers need to provide gender equality and mental health education according to the specific psychological characteristics of each boy and girl.

Exploring the sex and gender correlates of cognitive sex differences

The correlates of cognitive sex differences are yet to be fully understood. Many biological and psychosocial factors modulate these cognitive abilities leading to mixed results in the scientific literature. The current study aims to explore the different parameters potentially influencing cognitive abilities acting in synergy. Sex and gender correlates of cognitive functioning were assessed in a sample of individuals ages 18 to 45 years (N = 87) from diverse sexual orientations. Sex hormones were assessed via saliva samples at four timepoints throughout the testing. Gender roles, sexual orientation and socio-demographics were measured via self-report questionnaires. Participants completed mental rotation and verbal fluency tasks. Men performed better than women at mental rotation, while no significant difference was found for verbal fluency. Significant positive associations were observed between estradiol and word fluency for the naturally cycling women compared to the women using oral contraception. While controlling for sex hormones, a significant interaction effect of sex by gender roles was identified for mental rotation among masculine women. These exploratory results suggest an effect principally driven by sex and sex hormones on cognitive performance that will need to be furthered with larger studies.

Does gender role explain a high risk of depression? A meta-analytic review of 40 years of evidence

BACKGROUND

This meta-analytic review aimed to systematically evaluate associations of depression with multiple gender role dimensions (masculinity, femininity, androgyny, and undifferentiated traits) and to determine potential moderators (participant characteristics, study instruments and sociocultural factors) of the relationship.

METHODS

Of 4481 initially identified records in three electronic databases, 58 studies published 1978 to 2021 were included for meta-analysis.

RESULTS

(1) Association of depression and gender role is moderated by study year and human development indices. (2) Masculinity is a protective factor for depression, while this dominance has declined as life expectancy increases. (3) A negative, weak but significant association between depression and femininity is observed in women, and college students, which starts to emerge with the gradual increase in the national education and income index from 1990 to 2019. (4) Androgynous individuals reported the lowest level of depression as compared with other gender role orientations (masculine, feminine, and undifferentiated trait group). This disparity is becoming more extreme with life expectancy and per capita income index increases.

LIMITATIONS

English-language studies were only included in this review.

CONCLUSIONS

Androgyny might be the most ideal gender role protecting both women and men from depression.

Does allostatic load predict incidental coronary events differently among sexes?

Background

One measure to quantify the degree of dysregulation is allostatic load (AL). Typically, AL incorporates information on diverse biomarkers and is associated with health outcomes such as cardiovascular diseases or the incidence of coronary events (C-E).

Aims

This study investigates the predictive performance of different AL scoring methods on the incidence of coronary events (C-E). This study also elaborates sex differences in the baseline risks of C-E and the AL associated risks of C-E.

Design

Longitudinal data analysis of the Heinz Nixdorf Recall Study (Risk Factors, Evaluation of Coronary Calcification, and Lifestyle) of 4327 participants free of C-E at study baseline aged 45-75. The data contains over 13 biomarkers measuring AL.

Methods

After conducting multiple imputations on missing values on AL for 826 participants, the analysis sample consisted of N = 4327 participants. We applied the two most commonly used methods of AL scoring AL (count-based and Z-score) and a recently developed logistic regression weighting method (LRM) approach. Cox regression was used to predict the incidence of C-E for each AL score. Results were estimated without (M0) and with (M1) covariate adjustment, and in a final model (M2), with an interaction between AL and sex.

Results

We found no violation of the proportional hazard assumption and significant differences in the survival curves between the sexes for C-E (Log-rank test: prob. > Chi2 = 0.000). In M0, all AL-scoring methods predicted C-E significantly, with the LRM based AL-score having the best performance (hazard ratio = 3.133; CI: [2.630, 3.732]; Somer's D = 0.717). After covariate inclusion, differences between the scoring methods levelled, though the count-based method and LRM performed better than the Z-scoring method. The interaction analysis in M2 showed a significant multiplicative interaction for the count-based method (1.254; [1.066, 1.475]) and for the LRM (1.746; [1.132, 2.692]). The additive relative excess risk due to interaction (RERI) measure was negative for the count-based method (RERI = -1.967; [-3.778; -0.156]) and the LRM (RERI = -1.909 [-3.910; 0.091]), indicating subadditivity.

Conclusion

AL scores are suitable for predicting C-E. Differences between the AL-scoring algorithms were only present after including interactions. We value the count-based method as suitable for clinical practice since its calculation is relatively simple, and performance was among the best. Interaction analysis revealed that despite strong sex differences in baseline C-E, the effect of AL is more pronounced for females at high levels of AL; thus, females could benefit more from a potential intervention on AL. We suggest further investigation of sex differences concerning the mediation by physiological and psychological intermediates.

Gender roles are related to cortisol habituation to repeated social evaluative stressors in adults: secondary analyses from a randomized controlled trial

Masculine and feminine gender roles influence stressor appraisals and coping in everyday life, but their effect on stress response systems like the hypothalamic-pituitary-adrenocortical axis is unclear. Accordingly, the present study tested the association between gender roles and cortisol responses to repeated stress as part of secondary analyses of data from a randomized controlled trial examining the effects of stress management interventions on cortisol habituation. Participants (N_final = 86; 72% female) completed a baseline survey assessing gender role endorsement using the Bem Sex Role Inventory, from which 4 groups were derived: masculine (n = 20), feminine (n = 20), androgynous (high masculinity, high femininity; n = 22), and undifferentiated (low masculinity, low femininity; n = 24). Following the stress management intervention (mindfulness-based stress reduction or cognitive-behavioral skills training) or waitlist period control, participants completed the Trier Social Stress Test on two laboratory visits (48 h apart). Salivary cortisol was assessed 0, 25, 35, and 60 min post-stressor during both laboratory visits. Androgynous and undifferentiated individuals both exhibited a significant decrease in total cortisol from visit 1 to visit 2 (i.e. habituation) whereas feminine and masculine individuals did not. Undifferentiated individuals exhibited greater habituation than feminine and masculine individuals, whereas androgynous individuals only exhibited greater habituation than the feminine group. Controlling for study condition assignment did not alter these results. Results imply that gender roles may be implicated in stress-related disease because of their association with HPA axis functioning during episodes of acute stress.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Allostatic Load Among Black Sexual Minority Women

Background: Allostatic load is the physiological deterioration that accumulates as the body responds to stress, resulting in disparities in chronic disease. Although perceptions of stress vary, marginalization and social disadvantage are associated with elevated allostatic load. Allostatic load is understudied in the multiply marginalized populations of sexual minority Black women. Methods: We used data from six waves of the National Health and Nutrition Examination Survey (2001-2010, 2015-2016) to identify heterosexual (n = 78), lesbian (n = 21), and bisexual (n = 57) Black women. We quantified allostatic load using nine biomarkers, and compared mean allostatic load across the three groups, adjusting for age, educational attainment, income, and country of birth to account for possible confounding. Results: We found no significant differences in allostatic load among heterosexual, lesbian, and bisexual Black women. Conclusions: These findings suggest that sexual orientation may not contribute to within-group differences in allostatic load among Black women, a group previously noted to have elevated allostatic load.

Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018

The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. We performed modified Poisson regression to estimate the adjusted Relative Risks (aRRs) of allostatic load, and generalized linear models to determine adjusted mean differences accounting for NHANES sampling weights. Among US adults aged 18 or older, the prevalence of high AL increased by more than 45% from 1988 to 1991 to 2015-2018, from 33.5% to 48.6%. By the latest period, 2015-2018, Non-Hispanic Black women (aRR: 1.292; 95% CI: 1.290-1.293) and Latina women (aRR: 1.266; 95% CI: 1.265-1.267) had higher risks of AL than non-Hispanic White women. Similar trends were observed among men. Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.

Effect of Gender Roles and Workplace Violence on the Professional Quality of Life and Wellbeing at Work Among Child Protection Workers

Exposure to workplace violence puts child protection workers at risk for adverse occupational outcomes. While previous studies have identified protective and risk factors, individual differences in gender roles have yet to be explored. Moving beyond sex, the present study aims to examine the ways in which gender roles influence exposure to workplace violence, professional quality of life, and wellbeing at work among child protection workers. A randomized sample stratified by sex of 301 Canadian child protection workers (male: 15.6%, female: 84.4%) completed validated questionnaires of gender roles, professional quality of life, and wellbeing at work. We assessed mean differences using analyses of covariances controlling for clinical experience and type of work. We then assessed the moderating effect of gender roles on other variables through hierarchical multiple linear regressions. Androgyny (high masculinity and high femininity) was associated with higher scores on positive indicators of professional quality of life and wellbeing at work. However, gender roles showed no significant moderating effect on the relationship between exposure to violence, professional quality of life, and wellbeing at work. Results suggest that androgyny could be related to potential psychosocial benefits for child protection workers.

Sex-Specific Interaction Between Cortisol and Striato-Limbic Responses to Psychosocial Stress

Although women and men differ in psychological and endocrine stress responses as well as in the prevalence rates of stress-related disorders, knowledge on sex differences regarding stress regulation in the brain is scarce. Therefore, we performed an in-depth analysis of data from 67 healthy participants (31 women, taking oral contraceptives), who were exposed to the ScanSTRESS paradigm in a functional magnetic resonance imaging study. Changes in cortisol, affect, heart rate and neural activation in response to psychosocial stress were examined in women and men as well as potential sex-specific interactions between stress response domains. Stress exposure led to significant cortisol increases, with men exhibiting higher levels than women. Depending on sex, cortisol elevations were differently associated with stress-related responses in striato-limbic structures: higher increases were associated with activations in men but with deactivations in women. Regarding affect or heart rate responses, no sex differences emerged. Although women and men differ in their overall stress reactivity, our findings do not support the idea of distinct neural networks as the base of this difference. Instead, we found differential stress reactions for women and men in identical structures. We propose considering quantitative predictors such as sex-specific cortisol increases when exploring neural response differences of women and men.

Depressive symptoms, childhood maltreatment, and allostatic load: The importance of sex differences

OBJECTIVE

Roughly half the individuals who experience childhood maltreatment also experience depressive symptoms in adulthood; however, many current treatments are ineffective. Allostatic load (AL) offers a method of exploring this relationship through the lens of biometric dysregulation that may explain these increased odds for depressive symptoms in adulthood. We attempted to expand the limited research base on AL, depressive symptoms, and childhood maltreatment by examining how these variables are associated in a U.S. community sample.

METHOD

Data were acquired through secondary analysis of the Midlife in the United States Refresher biomarker survey (n = 691). Depression severity, measured by the Center for Epidemiologic Studies Depression Scale, served as the dependent variable, while summed scores for the Childhood Trauma Questionnaire, and a 16 measure AL index served as independent variables. All analyses were stratified by sex (n male = 347, n female = 344). The Perceived Stress Scale was included to control for recent stress. An OLS regression was used to understand the relationship between depression and predictor variables before then being tested for the possible mediating role of AL.

RESULTS

Comparison of OLS models yielded notable differences in predicting depressive symptoms between males and females, namely that while maltreatment was significant for both groups, AL was only significant for females. Mediation by allostatic load was not significant for males or females.

CONCLUSION

We explored the possible mediation of childhood maltreatment and adulthood depressive symptoms by AL. While our study did not confirm mediation, this was the first known study to explore these relationships in a U.S., community sample. Sex stratification reveals a clear need for accounting for sex differences in predictor variables for future studies.

Gender role moderates correlation between learning needs and behavioural intention of sexual health care in female nurses

Aim

This study evaluated the correlation between learning needs and behavioural intention of sexual health care in female Registered Nurses and to assess the moderating effect of gender role on this relationship.

Design

In this cross‐sectional questionnaire‐based survey, a convenience sampling of female Registered Nurses was included from Chung Shan Medical University Hospital, Taiwan.

Methods

Three questionnaires were used to obtain self‐reported data on learning needs, behavioural intention and gender role.

Results

Based on gender role scores, 11.8% of participants were feminine, 10.0% were masculine, 31.0% were androgynous and 47.2% were undifferentiated. Significant positive correlations between learning needs and behaviour intention were observed in the total population as well as in undifferentiated, feminine and androgynous nurses (all p < .05). Learning needs were positively associated with the behavioural intention of sexual health care in female nurses, which was moderated by gender role (F = 2.868, p = .036).

Occupational gender roles in relation to workplace stress, allostatic load, and mental health of psychiatric hospital workers

OBJECTIVES

Gendered inequalities in workplace stress are linked to sex-specific health trajectories that are poorly understood. Measuring gendered inequalities is challenging but necessary to better explain individual differences in occupational health. The aim of this exploratory, retrospective study was to create a measure of occupational gender-roles and use structural equation models to investigate pathways linking layers of gendered factors to workplace stress, allostatic load, and mental health in a sample of psychiatric hospital workers (N = 192).

METHODS

Individual-level gender-roles were measured with the Bem Sex-Role Inventory Short-Form. Occupational gender-roles were measured using a novel web-based survey approach. Sex-specific allostatic load indices were constructed using 23 biomarkers (e.g., neuroendocrine, immune, cardiovascular, and metabolic). Workplace stress was assessed using the Job Content Questionnaire and the Effort-Reward at Work Questionnaire. Depressive symptoms were assessed with the Beck Depression Inventory-II, burnout symptoms with the Maslach Burnout Inventory - General Survey, and trauma symptoms with the PTSD Civilian Checklist.

RESULTS

Individual-level masculine gender-roles were positively associated with psychological demands (R² = 0.103) and social support (R² = 0.078). Masculine and feminine occupational gender-roles were positively associated with decisional latitude (R² = 0.157) and effort-reward ratio (R² = 0.058). Both individual masculine and feminine gender-roles had protective effects on depressive symptoms (R² = 0.289) and burnout symptoms (R² = 0.306) but only individual masculine gender-roles had protective effects on trauma symptoms (R² = 0.198). We found no association between occupational gender-roles and mental health and allostatic load.

CONCLUSION

Beyond individual gender-roles, our study shows the utility of measuring occupational gender-roles to delineate associations between workplace stressors and mental health that should be applied in future studies of sex differences in occupational health.

The Human Brain Is Best Described as Being on a Female/Male Continuum: Evidence from a Neuroimaging Connectivity Study

Psychological androgyny has long been associated with greater cognitive flexibility, adaptive behavior, and better mental health, but whether a similar concept can be defined using neural features remains unknown. Using the neuroimaging data from 9620 participants, we found that global functional connectivity was stronger in the male brain before middle age but became weaker after that, when compared with the female brain, after systematic testing of potentially confounding effects. We defined a brain gender continuum by estimating the likelihood of an observed functional connectivity matrix to represent a male brain. We found that participants mapped at the center of this continuum had fewer internalizing symptoms compared with those at the 2 extreme ends. These findings suggest a novel hypothesis proposing that there exists a neuroimaging concept of androgyny using the brain gender continuum, which may be associated with better mental health in a similar way to psychological androgyny.

Biocultural approaches to transgender and gender diverse experience and health: Integrating biomarkers and advancing gender/sex research

Transgender and gender diverse (TGD) people are increasingly visible in U.S. communities and in national media. With this increased visibility, access to gender affirming healthcare is also on the rise, particularly for urban youth. Political backlash and entrenchment in a gender binary, however, continue to marginalize TGD people, increasing risk for health disparities. The 2016 National Institute of Health recognition of sexual and gender minority people as a health disparities population increases available funding for much-needed research. In this article, we speak to the need for a biocultural human biology of gender/sex diversity by delineating factors that influence physiological functioning, mental health, and physical health of TGD people. We propose that many of these factors can best be investigated with minimally invasively collected biomarker samples (MICBS) and discuss how to integrate MICBS into research inclusive of TGD people. Research use of MICBS among TGD people remains limited, and wider use could enable essential biological and health data to be collected from a population often excluded from research. We provide a broad overview of terminology and current literature, point to key research questions, and address potential challenges researchers might face when aiming to integrate MCIBS in research inclusive of transgender and gender diverse people. We argue that, when used effectively, MICBS can enhance human biologists' ability to empirically measure physiology and health-related outcomes and enable more accurate identification of pathways linking human experience, embodiment, and health.

Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study

BACKGROUND

In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated.

OBJECTIVE

This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting.

METHODS

PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups-patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)-compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test.

RESULTS

This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020.

CONCLUSIONS

Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/22500.

Depression is Associated with Moderate-Intensity Physical Activity Among College Students During the COVID-19 Pandemic: Differs by Activity Level, Gender and Gender Role

PURPOSE

The novel coronavirus disease (COVID-19) pandemic and associated restrictive measures have implications for depressive symptoms (henceforth depression) of young people and risk may be associated with their reduced physical activity (PA) level. Therefore, we aimed to examine the association between depressive symptoms and PA among college students with different gender and gender role (masculinity traits and femininity traits) during the COVID-19 pandemic.

PARTICIPANTS AND METHODS

Cross-sectional study included 628 healthy college students from nineteen different locations. The Center for Epidemiological Studies Depression Scales (CES-D), the International Physical Activity Questionnaire - Short Form (IPAQ-SF), and the 50-item Chinese Sex-Role Inventory (CSRI-50) were used to measure depressive symptoms, PA continuous (weekly metabolic equivalent minutes, MET-minutes/week) and categorical indicators (activity level category) and gender role, respectively. The statistical analyses were used in partial correlation analysis, t-test, one-way ANOVA, moderation model tests, and linear regression model tests.

RESULTS

Total of 34.72% participants had clinically relevant depression (16, CES-D scale). Total of 58.6% participants were classified as a "low" activity level for spending less time on PA. Depression significantly negatively correlated with MET-minutes/week in moderate-intensity PA but not vigorous and walking scores. Of note, the depression-PA association was only moderated by the "low" activity level group in terms of categorical scores across gender groups. Participants with higher masculinity traits were less likely to have depression among all participants. Moreover, more recovered cases and fewer deaths could also predict the lower depression risk in the "high" activity level group.

CONCLUSION

Moderate-intensity PA is beneficial for reducing depression risk among college students at a low activity level. College students with fewer masculinity traits (regardless of gender) are highly vulnerable to depression during the outbreak of COVID-19. Effective control of the COVID-19 pandemic seems critical to alleviating the burden of mental disorders of the public including depression.

Relationship between allostatic load and clinical outcomes in youth at ultra-high risk for psychosis in the NEURAPRO study

Individuals at ultra-high risk (UHR) for psychosis have an elevated risk of developing psychosis and other psychiatric outcomes. Risk biomarkers can assist in delineating individual risk and allow better prediction of longer-term outcomes. The aim of the present study was to examine if allostatic load (AL), a multisystem index of neuroendocrine, cardiovascular, immune and metabolic dysregulation, is associated with clinical outcomes in youth at UHR for psychosis. AL was measured in 106 participants of the NEURAPRO study (n = 70 female, n = 36 male; mean age 17.21, SD 2.37), a multicentre randomized-controlled trial of long-chain omega-3 polyunsaturated fatty acids versus placebo in people at UHR for psychosis. Psychiatric symptoms and social and occupational functioning were assessed at baseline and 6 and 12 months after study intake. Multivariate linear and logistic regression models were used to test the relationship between AL and clinical outcomes. High AL at baseline was associated with poor social and occupational functioning at 6 months (β = -0.224, p = 0.025) and with more severe manic symptoms at 6 months (β = 0.207, p = 0.026), taking into account relevant covariates including age and smoking status. No significant associations were observed at the 12-month follow-up assessment or with any other clinical outcome measures. Our data provide initial evidence for a link between AL and impaired functioning in individuals at UHR for psychosis. Further studies are needed to evaluate AL as a potential predictor of early treatment response.

Does the choice of Allostatic Load scoring algorithm matter for predicting age-related health outcomes?

Allostatic Load (AL) is posited to provide a measure of cumulative physiological dysregulation across multiple biological systems and demonstrates promise as a sub-clinical marker of overall health. Despite the large heterogeneity of measures employed in the literature to represent AL, few studies have investigated the impact of different AL scoring systems in predicting health. This study uses data for 4477 participants aged 50+ years participating in the Irish Longitudinal Study on Ageing (TILDA) to compare the utility of 14 different scoring algorithms that have been used to operationalise AL (i.e. count-based high-risk quartiles, deciles, two-tailed cut-points, z-scores, system-weighted indices, clinical cut-points, sex-specific scores, and incorporating medication usage). Model fit was assessed using R², Bayesian Information Criterion (BIC), and the area under the Receiver Operating Characteristic curve (AUC). The measure incorporating medications predicted walking speed and SRH marginally better than others. In general, AL was not predictive of grip strength. Overall, the results suggest that the choice of AL scoring algorithm exerts a relatively modest influence in predicting a number of important health outcomes.

Allostatic load and women's brain health: A systematic review

Allostatic load represents the 'wear and tear' of chronic stress on the brain and body that may differ between men and women. A small but growing number of studies are assessing allostatic load in relation to mental health. The objective of this systematic review was to (1) assess sex differences in allostatic load and (2) identify allostatic load associations that are specific to women. We systematically searched for allostatic load studies that included psychosocial causes and/or psychiatric consequences. Our search focused on allostatic load studies that disaggregated by sex and that include women. Sixty-two studies were included in this systematic review. First, men appear to have higher allostatic load than women. Second, women show gender-specific variation for numerous factors such as age, race/ethnicity, adversities, social support, and health behaviors that influence associations between allostatic load and mental health. Recommendations are made to guide researchers advance sex and gender approaches.

Sex Differences in Work-Stress Memory Bias and Stress Hormones

Mental health problems related to chronic stress in workers appear to be sex-specific. Psychosocial factors related to work-life balance partly explain these sex differences. In addition, physiological markers of stress can provide critical information on the mechanisms explaining how chronic stress gets "under the skull" to increase vulnerability to mental health disorders in working men and women. Stress hormones access the brain and modulate attentional and memory process in favor of threatening information. In the present study, we tested whether male and female workers present a memory bias towards work-stress related information, and whether this bias is associated with concentrations of stress hormones in reactivity to a laboratory stressor (reactive levels) and samples taken in participants' workday (diurnal levels). In total, 201 participants (144 women) aged between 18 and 72 years underwent immediate and delayed recall tasks with a 24-word list, split as a function of valence (work-stress, positive, neutral). Participants were exposed to a psychosocial stressor in between recalls. Reactivity to stress was measured with saliva samples before and after the stressor. Diurnal cortisol was also measured with five saliva samples a day, during 2 workdays. Our exploratory results showed that men presented greater cortisol reactivity to stress than women, while women recalled more positive and neutral words than men. No sex difference was detected on the recall of work-stress words, before or after exposure to stress. These results do not support the hypothesis of a sex-specific cognitive bias as an explanatory factor for sex differences in stress-related mental health disorders in healthy male and female workers. However, it is possible that such a work-stress bias is present in individuals who have developed a mental-health disorder related to workplace stress or who have had one in the recent past. Consequently, future studies could use our stress memory bias task to assess this and other hypotheses in diverse working populations.

Reducing Allostatic Load in Depression and Anxiety Disorders: Physical Activity and Yoga Practice as Add-On Therapies

The allostatic load (AL) index constitutes a useful tool to objectively assess the biological aspects of chronic stress in clinical practice. AL index has been positively correlated with cumulative chronic stress (physical and psychosocial stressors) and with a high risk to develop pathological conditions (e.g., metabolic syndrome, cardiovascular pathology, inflammatory disorders) and the so-called stress-related psychiatric disorders, including anxiety and depressive disorders. Chronic stress has negative effects on brain neuroplasticity, especially on hippocampal neurogenesis and these effects may be reversed by antidepressant treatments. Several evidences indicate that non-pharmacological interventions based on physical activity and yoga practice may add synergizing benefits to classical treatments (antidepressant and benzodiazepines) for depression and anxiety, reducing the negative effects of chronic stress. The aim of this review is to provide a general overview of current knowledge on AL and chronic stress in relation to depression and anxiety, physical activity and yoga practice.