Childhood Trauma, Perceived Stress, and Hair Cortisol in Adults With and Without Cardiovascular Disease

Childhood Maltreatment and Body Mass Index in Older Adults With Chronic Illness

Background

Childhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing coronary artery disease (CAD). Emotional dysregulation and increased body mass index (BMI) may be involved. This study evaluated whether (1) childhood maltreatment is associated with a higher BMI at study onset and with greater increases in BMI 5 years later among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status moderate these results; and (3) baseline symptoms of anxiety, depression, and perceived stress (emotional dysregulation) mediate the association between childhood maltreatment and BMI at follow-up.

Methods

A total of 1232 men and women (aged 60.86 [6.95] years) completed validated questionnaires on childhood maltreatment and symptoms of psychological distress. The weight and height of the participant were measured, and the BMI was calculated using the weight (kg)/height (m2) ratio.

Results

Childhood maltreatment was not significantly associated with BMI at study onset nor at follow-up. This relation did not differ as a function of sex nor CAD status. Although childhood maltreatment was associated with significantly greater psychological distress at study onset (all P < 0.001), there latter was not found to mediate the relation between maltreatment and change in BMI at follow-up.

Conclusions

In contrast to previous literature, childhood maltreatment was not associated with BMI nor with the change in BMI over 5 years in men and women with chronic disease. However, as psychological distress increases risk for morbidity and mortality, it may represent an important target for prevention and intervention in survivors of childhood maltreatment.

Long-term glucocorticoids in relation to the metabolic syndrome and cardiovascular disease: A systematic review and meta-analysis

The striking link of Cushing's syndrome with the metabolic syndrome (MetS) and cardiovascular disease (CVD) suggests that long-term exposure to extremely high cortisol levels catalyzes cardiometabolic deterioration. However, it remained unclear whether the findings from the extreme glucocorticoid overabundance observed in Cushing's syndrome could be translated into more subtle variations in long-term glucocorticoid levels among the general population, for example, due to chronic stress. Here, we performed a systematic review (PROSPERO: CRD42023425541) of evidence regarding the role of subtle variations in long-term biological stress, measured as levels of scalp hair cortisol (HairF) and cortisone (HairE), in the context of MetS and CVD in adults. We also performed a meta-analysis on the cross-sectional difference in HairF levels between individuals with versus without CVD. Seven studies were included regarding MetS, sixteen regarding CVD, and one regarding both. Most articles indicated a strong, consistent cross-sectional association of higher HairF and HairE levels with CVD, which was confirmed by our meta-analysis for HairF (eight studies, SMD = 0.48, 95% confidence intervals [CIs]: 0.16-0.79, p = 0.0095). Moreover, these relationships appear largely independent of standard risk factors. Age seems relevant as the effect seems stronger in younger individuals. Results regarding the associations of HairF and HairE with MetS were inconsistent. Altogether, long-term biological stress, measured as HairF and HairE, is associated with the presence of CVD, and less consistently with MetS. Prospective studies need to evaluate the directionality of this relationship and determine whether HairF and HairE can be used in addition to standard risk factors in predicting future cardiometabolic deterioration.

Childhood maltreatment and leukocyte telomere length in men and women with chronic illness: an evaluation of moderating and mediating influences

BACKGROUND

Childhood maltreatment can result in lifelong psychological and physical sequelae, including coronary artery disease (CAD). Mechanisms leading to increased risk of illness may involve emotional dysregulation and shortened leukocyte telomere length (LTL).

METHODS

To evaluate whether (1) childhood maltreatment is associated with shorter LTL among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status influence these results; and (3) symptoms of anxiety, depression, and stress moderate or mediate the association between childhood maltreatment and LTL, men and women (N = 1247; aged 65 ± 7.2 years) with and without CAD completed validated questionnaires on childhood maltreatment, symptoms of depression, anxiety, and perceived stress. LTL was measured using quantitative polymerase chain reaction. Analyses included bivariate correlations, hierarchical regressions, and moderation/mediation analyses, controlling for sociodemographic and lifestyle variables.

RESULTS

Childhood maltreatment was associated with significantly shorter LTL (r = -0.059, p = 0.038, b = -0.016, p = 0.005). This relation was not moderated by depression, anxiety, nor perceived stress, though there was mitigated evidence for absence of a maltreatment-LTL relation in men with CAD. Stress perception (but not anxiety or depression) partially mediated the relation between childhood maltreatment and LTL [Indirect effect, b = -0.0041, s.e. = 0.002, 95% CI (-0.0085 to -0.0002)].

CONCLUSIONS

Childhood maltreatment was associated with accelerated biological aging independently of patient characteristics. Emotional dysregulation resulting in chronic stress may contribute to this process. Whether stress management or other interventions may help prevent or slow premature aging in those who have suffered maltreatment requires study.

The impact of childhood trauma on perceived stress and personality in patients with obsessive-compulsive disorder: A cross-sectional network analysis

OBJECTIVE

Little is known about the role of childhood experiences in the development of obsessive-compulsive disorder (OCD). However, the influence of childhood experiences on personality, behavior, and perceived stress may vary between OCD patients and healthy individuals. The objective of this study was to use network analysis to explore the relationship between childhood trauma, personality, perceived stress, and symptom dimensions, thus finding the difference between patients' and healthy people's network.

METHODS

488 patients with OCD and 210 healthy volunteers were recruited. All of them were assessed with the Obsessive-Compulsive Inventory - Revised (OCI-R), the Perceived Stress Scale-10, the NEO Five-Factor Inventory and the Early Trauma Inventory Self-Report Short Form. Network analysis was conducted and the centrality indices were calculated. Network comparison test was performed.

RESULTS

In patients' network, the Obsession and the Ordering behavior were the most important nodes among the OCI-R. The perceived stress showed the strongest strength centrality of all nodes and positive correlation with the Obsession and Neuroticism. Network comparison test results indicated a statistically significant difference between network structure, and post-hoc analysis found five edges significantly differed between patients and healthy controls, mainly on Obsession and Washing behaviors.

CONCLUSIONS

Emotional abuse was considered significant in both networks due to its higher strength centrality. Meanwhile, perceived stress was found to be more significant in the patient network and exhibited stronger associations with obsession. The obsessive thoughts and washing behavior were different among patients and healthy controls, which brought new understanding to the pathopsychological mechanisms of OCD.

Impact of childhood trauma on the abnormal functional connectivity of brain regions in the fear network model of panic disorder

BACKGROUND

People who have suffered childhood trauma may be more susceptible to panic disorder (PD). Existing evidence indicates that childhood trauma can significantly impact brain function. Meanwhile, the brain regions involved in the fear network model (FNM) of PD highly overlap with the brain regions affected by childhood trauma. However, it remains unclear whether functional connections between brain regions associated with the FNM in patients with PD are affected by childhood trauma. This study aimed to investigate the effects of childhood trauma on the functional connectivity (FC) of brain regions associated with the FNM in patients with PD.

METHOD

This study recruited 62 patients with PD, including 21 with a high level of childhood trauma (PD_HCT), 41 with a low level of childhood trauma (PD_LCT), and 40 healthy controls (HCs). The patients underwent magnetic resonance imaging resting-state scanning. The amygdala, anterior cingulate, thalamus, and hippocampus were chosen as regions of interest (ROIs) to examine group differences in ROIs and whole-brain resting-state FC (rsFC).

RESULTS

Compared with PD_HCT patients, PD_LCT patients exhibited significantly increased rsFC in the right thalamus, right temporo-occipital middle temporal gyrus, left thalamus, and right temporo-occipital middle temporal gyrus. Compared with HCs, PD_LCT patients had increased rsFC between the right thalamus and the right temporo-occipital middle temporal gyrus.

CONCLUSION

Patients with PD who had suffered high and low levels of childhood trauma were found to exhibit different pathological rsFC alterations in the FNM, suggesting that childhood trauma may be an important risk factor for the development of PD symptoms.

Adverse childhood experiences and perceived stress in early adulthood in the context of disadvantage

BACKGROUND

Adverse childhood experiences (ACEs) may sensitize individuals to view situations in adulthood as more stressful, which may contribute to poor health outcomes. In populations facing disadvantage, ACEs may lead to the accumulation of stressors (stress proliferation or mediation hypothesis) throughout the life course. ACEs could also heighten perceived stress later in life due to its enduring impact (stress sensitization or effect modification hypothesis).

OBJECTIVE

We examine the associations between ACEs and perceived stress in early adulthood, considering concurrent life stressors, in a longitudinal cohort of Puerto Rican youth exposed to a high degree of disadvantage.

PARTICIPANTS AND SETTING

A community-based sample of 1626 Puerto Rican children living in disadvantaged contexts was followed longitudinally in the Boricua Youth Study from 2000 to 2017.

METHODS

ACEs were measured prospectively during childhood (<18 yrs), and life stressors and past year perceived stress were measured in early adulthood (EA; mean age = 23.4, sd 2.22). Causal mediation analysis tested ACEs' effects on EA perceived stress indirectly through life stressors including potential effect modification.

RESULTS

ACEs influenced perceived stress in EA (standardized total effect = 0.13, p < .001) with 35% mediated by increased exposure to life stressors in EA due to ACEs. There was no evidence of increased sensitization to EA life stressors among those with higher ACEs exposure.

CONCLUSIONS

ACEs contribute to perceived stress in EA, albeit with small effect, partially through accumulating effects of ongoing stressors, supporting the stress proliferation hypothesis. Policies aimed at reducing exposure to adversity from childhood to EA are needed to reduce the experience of ACEs and negative sequelae.

Hair cortisol as a viable tool for the assessment of an association between environmental noise exposure and chronic stress

Entrenched in the well-established link between stress and health, noise exposure as a potential contributor to stress-related health effects receives tremendous attention. Indeed, exposure to noise can act as a stressor as evidenced through increased heart rate, blood pressure, adrenaline, epinephrine, and cortisol. Cortisol is secreted from the adrenal glands in response to stressor-induced activation of the hypothalamic-pituitary-adrenal axis. For assessment of environmental noise and stress, repeated sampling in blood, saliva, or urine is necessary to evaluate the association between environmental noise exposure and protracted changes in cortisol. Controlling for the many variables that influence the secretion of cortisol at discrete sampling intervals is challenging. Studies suggest that systemically produced cortisol integrates and remains in hair as it grows, providing a measure that integrates a cortisol response over a longer period, circumventing several limitations associated with multiple sampling. Robust evidence supports the integration of cortisol into hair, yet recent studies call into question the notion that cortisol is retained with growth. The current paper discusses the strengths and limitations of hair cortisol analysis with an emphasis on its utility as a measure of chronic stress in environmental noise studies.

Cross-sectional relation of long-term glucocorticoids in hair with anthropometric measurements and their possible determinants: A systematic review and meta-analysis

BACKGROUND

Long-term glucocorticoids (HairGC) measured in scalp hair have been associated with body mass index (BMI), waist circumference (WC), and waist-hip-ratio (WHR) in several cross-sectional studies. We aimed to investigate the magnitude, strength, and clinical relevance of these relations across all ages.

METHODS

We performed a systematic review and meta-analysis (PROSPERO registration CRD42020205187) searching for articles relating HairGC to measures of obesity. Main outcomes were bivariate correlation coefficients and unadjusted simple linear regression coefficients relating hair cortisol (HairF) and hair cortisone (HairE) to BMI, WC, and WHR.

RESULTS

We included k = 146 cohorts (n = 34,342 individuals). HairGC were positively related to all anthropometric measurements. The strongest correlation and largest effect size were seen for HairE-WC: pooled correlation 0.18 (95%CI 0.11-0.24; k = 7; n = 3,158; I²  = 45.7%) and pooled regression coefficient 11.0 cm increase in WC per point increase in 10-log-transformed HairE (pg/mg) on liquid-chromatography-(tandem) mass spectrometry (LC-MS) (95%CI 10.1-11.9 cm; k = 6; n = 3,102). Pooled correlation for HairF-BMI was 0.10 (95%CI 0.08-0.13; k = 122; n = 26,527; I²  = 51.2%) and pooled regression coefficient 0.049 kg/m² per point increase in 10-log-transformed HairF (pg/mg) on LC-MS (95%CI 0.045-0.054 kg/m² ; k = 26; n = 11,635).

DISCUSSION

There is a consistent positive association between HairGC and BMI, WC, and WHR, most prominently and clinically relevant for HairE-WC. These findings overall suggest an altered setpoint of the hypothalamic-pituitary-adrenal axis with increasing central adiposity.

Higher Levels of Stress-Related Hair Steroid Hormones Are Associated with the Increased SCORE2 Risk Prediction Algorithm in Apparently Healthy Women

Cardiovascular diseases (CVDs) are the major cause of death worldwide. Although the importance of conventional CVD risk factors, including older age, male gender, hypertension, obesity, dyslipidemia and hyperglycemia, is well-studied, psychosocial stress, which is considered an independent CVD risk factor, requires further investigation. Thus, we aimed to investigate the association between long-term secretion of stress-related steroid hormones, including cortisol, cortisone and dehydroepiandrosterone, and the 10-year fatal and non-fatal CVD risk estimated by the SCORE2 risk prediction algorithm, as well as traditional CVD risk factors in a group of apparently healthy women. A total of 145 women (aged 50–64 years) participating in the national CVD prevention program were enrolled in the study. Sociodemographic, lifestyle, health-related characteristics, stress, anxiety and sleep quality indicators were evaluated using specific questionnaires. Anthropometric and arterial blood pressure measures were assessed by trained personnel, lipid and glucose metabolism biomarkers were measured using routine methods, and hair steroid hormone levels were determined by ultra-high-performance liquid chromatography-tandem mass spectrometry. The results showed that higher levels of hair cortisol and cortisone are associated with increased SCORE2 values. Moreover, significant associations between hair glucocorticoids and individual cardiovascular risk factors, including obesity, hypertension, dyslipidemia and hyperglycemia, were found. These findings indicate that stress-related hair steroid hormones might be valuable biomarkers for CVD prediction and prevention.

Prevalence and types of childhood trauma in first episode psychosis patients. Relation with clinical onset variables

OBJECTIVE

To study the prevalence and the type of childhood trauma (CT) in a first-episode psychosis (FEP) cohort and in a healthy control (HC) sample. To study which clinical and sociodemographic variables in the onset of the FEP are related to having suffered some traumatic experience in childhood.

METHOD

100 FEP patients and 94 HC participated in the study. The Childhood Traumatic Questionnaire (CTQ) was used to evaluate CT. The Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance (PSP), the Suicide Risk Scale of Plutchik (SRSP), and the Perceived Stress Scale (PSS) were also administered.

RESULTS

61% of FEP patients and 17% of HC reported having experienced some kind of CT. FEP showed more CT than controls in all subscales, except in sexual abuse. The most frequent CT was emotional abuse. For the FEP group, younger age, more years of education, have a first-degree family history, more positive and negative symptoms, more perceived stress and more personal and social functioning were the variables more influenced by having suffered some kind of CT.

CONCLUSIONS

There is a high prevalence of CT in FEP patients. Having a first-degree family history of mental illness, more positive symptoms, and more perception of stress at the time of hospital admission were related to having suffered CT. More research is needed to find out the best way to detect CT and its role in psychosis to be able to implement interventions to improve the evolution of these patients.

Determinants of Chronic Biological Stress, Measured as Hair Cortisol Concentration, in a General Population of Adolescents: From Individual and Household Characteristics to Neighborhood Urbanicity

Chronic biological stress may adversely affect adolescents' physical and mental health, but insight in the personal and environmental factors that determine chronic stress is limited. We measured 3-month cumulative hair cortisol concentration (HCC) in 419 adolescents, participating in the Flemish Environment and Health Study. Adolescents' health and lifestyle characteristics, household and neighborhood socio-economic status as well as neighborhood urbanicity were assessed as potential determinants of HCC, using multiple linear regression models. We additionally explored heterogeneity of our results by sex. HCC were significantly higher in boys from densely populated neighborhoods, the association was not significant in girls. Accordingly, boys living outside cities had significantly lower HCC than boys, living in cities. HCC was significantly lower in adolescents with an optimal vitality, a measure of a positive mental health status. In adolescent girls, menarcheal status (pre-/postmenarche) was a significant determinant of HCC. Our findings are the first to suggest that residential urbanicity may have an impact on chronic biological stress in a general population of adolescent boys.

The association between chronic stress, hair cortisol, and angiographically documented coronary atherosclerosis, a case-control study

Cardiovascular diseases remain the principal contributor to global mortality and morbidity. Chronic stress has emerged as a strong prognostic factor for cardiovascular diseases. We aimed to measure hair cortisol concentration (HCC) in patients with angiographically confirmed coronary atherosclerosis and find the association between HCC and classic cardiovascular risk factors in a case-control study. The study included 500 angiographically confirmed coronary atherosclerosis patients and 500 age and sex-matched controls having no coronary stenosis. Hair cortisol concentration was assessed from a single sample of scalp hair by ELISA. Perceived stress scale 10 was used to evaluate the stress level of the participants. Spearman rank correlation was applied to find the association between hair cortisol level and classic cardiovascular risk factors. Multivariate regression was executed to assess the independent contribution of hair cortisol concentration as a coronary atherosclerosis risk factor. Median hair cortisol concentration was significantly high in patients with angiographically documented coronary atherosclerosis compared to controls (158(17.6-1331.3) pg/mg versus 73 (13.4-889) pg/mg. Hair cortisol concentration showed a significant positive correlation with BMI r = 525 and Hb1Ac r = 665 (both, p = ≤0.0001). In multivariate logistic regression analysis after adjusting for all the confounding variables, HCC, matched odds ratio (MOR), 10.73;95%CI (1.60,42.09) p-value = 0.001 remained the most significant predictor of coronary atherosclerosis.LAY SUMMARYHair cortisol concentrations (HCC) were significantly high in patients with angiographically confirmed coronary atherosclerosis compared to controls. HCC showed a significant positive correlation with diabetes and obesity and remained a major predictor of coronary atherosclerosis in the final analysis.

Long-term residential exposure to air pollution is associated with hair cortisol concentration and differential leucocyte count in Flemish adolescent boys

BACKGROUND

Exposure to air pollution and traffic noise are associated with adverse health outcomes in adolescents. Chronic endocrine stress and systemic inflammation have been hypothesized to underlie the adverse health effects. Simultaneous assessment of inflammation and chronic endocrine stress in epidemiological studies is lacking. The aim of the study was to investigate biomarkers of chronic endocrine stress and inflammation in relation to long-term residential exposure to air pollution and traffic noise in adolescents.

METHODS

In Flemish adolescents (14-15 years), we determined hair cortisol concentration (HCC) as a chronic stress biomarker in 3-cm scalp-near hair sections (n = 395), and leucocyte and leucocyte subtype counts (neutrophils, monocytes, lymphocytes) as inflammatory biomarkers in peripheral blood (n = 385). Daily particulate matter (PM_2.5, PM₁₀), nitrogen dioxide (NO₂) and black carbon (BC) concentrations were modelled at the residential address and averaged over 3-month and 1-year periods prior to sampling. Residential traffic noise level was estimated and classified in 5 dB intervals. Sex-specific associations between residential exposures and effect biomarkers were studied using linear regression models, adjusted for a priori selected covariates.

RESULTS

In boys, HCC increased with a factor 1.30 (95% CI: 1.10, 1.54) for an increase in 1-year mean NO₂ from the 25th to 75th percentile (p75/p25), after adjustment for age, BMI, personal and neighborhood socioeconomic status. The corresponding estimate for PM₁₀ was 1.24 (95% CI: 1.02, 1.51). Total leucocyte count in boys, adjusted for the aforementioned covariates and recent health complaints, was positively associated with PM_2.5, PM₁₀, NO₂ and BC. In particular, the neutrophil count increased with a factor 1.11 (95% CI: 1.03, 1.19) for a (p75/p25)-factor increase in 1-year mean BC, corresponding estimates for PM_2.5, PM₁₀ and NO₂ were 1.10 (95% CI: 1.01, 1.19), 1.10 (95% CI: 1.01, 1.20) and 1.08 (95% CI: 1.00, 1.16). Lymphocyte count increased with a factor 1.05 (95% CI: 1.01, 1.10) for a (p75/p25)-factor increase in 1-year mean NO₂. Similar results were observed for 3-month mean exposures. Results were robust to adjustment for recent air pollution exposure. In girls, air pollutants were not associated with HCC or differential leucocyte count. Residential traffic noise level was not associated with HCC or leucocyte counts in boys nor girls.

CONCLUSIONS

Long-term residential exposure to air pollutants was positively associated with chronic endocrine stress and inflammation in adolescent boys, not in girls. This study may contribute to a better understanding of the early pathophysiological changes that may underlie adverse health effects of air pollution exposure in adolescents.

Loneliness Mediates the Relationship Between Early Life Stress and Perceived Stress but not Hypothalamic-Pituitary-Adrenal Axis Functioning

Many authors have proposed that early life stress (ELS) provokes a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and contributes negatively to the management of stress in adulthood. However, these associations have not always been observed, making it necessary to include new factors that could explain the different results found. In this regard, people with ELS experiences report less social support during adulthood, suggesting that loneliness could be a mediating factor. Thus, our aims were to investigate whether ELS was related to both perceived stress and diurnal HPA axis activity, and whether loneliness mediates these relationships, in a community sample (N=187, 18-55years old). Fourteen cortisol samples were collected on two non-consecutive days to obtain the overall diurnal cortisol, diurnal cortisol slope, and bedtime levels. Additionally, ELS was assessed with the Risky Families Questionnaire (RFQ) and the Recalled Childhood and Adolescence Perceived Stress (ReCAPS) measure. Results revealed that ELS was associated with perceived stress, but not HPA axis functioning, and loneliness mediated the relationship between ELS and perceived stress, but not between ELS and HPA axis functioning. Similar results were found for both ELS questionnaires, suggesting that the ReCAPS is an adequate tool. These results highlight the importance of loneliness in understanding the long-term effects of ELS, and they indicate different effects of ELS on subjective and physiological stress indicators.

Maternal separation in childhood and hair cortisol concentrations in late adulthood

BACKGROUND

Parent-child separation has been shown to increase the risk of a range of mental and physical health conditions later in life. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation may help to explain this association. However, few studies have examined the effect of maternal separation on cortisol in late adulthood.

METHODS

We examined the relationship between maternal separation in childhood and hair cortisol concentrations in late adulthood, using data from the Whitehall II study (n = 3969, mean age: 70 y, range: 60-83 y). Additionally, the role of childhood (adverse childhood experiences (ACEs), material disadvantage, and parenting), adult (marital status and social position), and health (health behaviors, cardiovascular health and medication, and depression) measures in this association were examined. Finally, we examined age of separation and reason for separation. Analysis was carried out using linear regression.

RESULTS

Hair cortisol concentrations (pg/mg) among participants who reported maternal separation during childhood were higher (B=0.179, 95% CI 0.041-0.317, p = 0.01) compared to their non-separated counterparts. This effect was robust to adjustment by childhood, adult, and health measures. Among participants who reported separation, age at onset and reason for separation were not significantly associated with hair cortisol concentrations.

CONCLUSION

In older age individuals, hair cortisol concentrations were higher in those who reported maternal separation during childhood. This effect was independent of a wide variety of factors suggesting that there are lifelong pathways between early life separation and HPA functioning in old age.

Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial

OBJECTIVE

Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb.

METHOD

Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC).

RESULTS

The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb.

CONCLUSIONS

Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://clinicaltrials.gov/ct2/show/NCT01995916.

Intermediation of perceived stress between early trauma and plasma M/P ratio levels in obsessive-compulsive disorder patients

OBJECTIVES

This study is to find the correlation among BDNF metabolism, early trauma, and current stress status of OCD patients. As well as to study the BDNF metabolism-stress related pathological mechanism in OCD development.

METHODS

A total of 140 participants were recruited in this study, including 64 drug-naïve OCD patients (OCDs) and 76 healthy controls (HCs). The clinical data of the subjects were measured using YBOCS, CTQ, and PSS. The plasma mBDNF and proBDNF values were measured by ELISA while the M/P ratio was calculated.

RESULTS

The mBDNF, proBDNF plasma levels, and M/P ratio of unmedicated OCD individuals decreased evidently comparing with HCs. Also, positive associations were found between PSS and CTQ and between CTQ and M/P ratio. The negative correlation included proBDNF and PSS as well as proBDNF and CTQ. Intermediary analysis generated by SPSS has showed that the perceived stress played a complete mediating role between early trauma and plasma M/P ratio levels, and the mediating effect was 0.043 in non-medication OCD patients.

CONCLUSIONS

Findings from this study suggested that early trauma experience and stress state work together in regulating BDNF metabolism level in OCD patients. The nucleus accumbens and reward loop are also pivotal in the pathogenesis of OCD.

Relationship of childhood trauma, psychological resilience, and family resilience among undergraduate nursing students: A cross-sectional study

PURPOSE

To analyze how family resilience mediates the relationship between childhood trauma and psychological resilience in undergraduate nursing students.

DESIGN AND METHODS

A cross-sectional survey design was used to investigate 698 nursing undergraduate students (mean age: 18.77 ± 0.86 years) using the Childhood Trauma Questionnaire, Family Resilience Assessment Scale, and Connor-Davidson Resilience Scale. The mediating effect of family resilience was estimated using structural equation modeling and the bootstrap method.

FINDINGS

Both childhood trauma and family resilience were associated with psychological resilience. Family resilience showed a partial mediating effect between childhood trauma and psychological resilience, accounting for 21.5% of the total effect.

PRACTICE IMPLICATION

Our findings may help inform family interventions to improve the psychological resilience of nursing students, especially for those with childhood trauma experience.

Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review

BACKGROUND

Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations.

OBJECTIVE

To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress.

DESIGN, DATA SOURCES, AND METHODS

The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded.

RESULTS

Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors.

CONCLUSIONS

Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.

Cardiovascular Disease and Hair Cortisol: a Novel Biomarker of Chronic Stress

PURPOSE OF REVIEW

This review focuses on the concentration of cortisol in human hair as a biomarker of chronic stress in cardiovascular disease (CVD). We outline the cardiovascular consequences of cortisol excess and provide a comprehensive overview of recent studies investigating the relationship of hair cortisol with CVD. In addition, clinical implications and limitations of the evidence are discussed, together with directions for future research.

RECENT FINDINGS

Hair cortisol may be a reliable biomarker of chronic stress since it provides quantification of total cortisol secreted into hair over several weeks. A growing body of evidence suggests that elevated hair cortisol levels are associated with both the incidence of CVD and poorer recovery and treatment outcomes. Moreover, increased hair cortisol concentration has been linked with established cardiometabolic risk factors for CVD including high blood pressure, diabetes, and adiposity. Hair cortisol is a promising biomarker of chronic cortisol excess which may contribute to both the pathogenesis and prognosis of CVD. However, the current evidence relies on small-scale cross-sectional studies. Further research adopting longitudinal designs across larger samples of CVD patients and healthy participants is required to inform the development of novel evidence-based interventions.

The association of potential stressors with hair steroids in parents with small children: The Ulm SPATZ health study

Previous studies have reported weak associations between questionnaire-based stress measurements and hair steroids. A stronger relationship may exist in highly stressed subpopulations or with stress brought up by novel or unpredictable situations. In the Ulm SPATZ Health Study, conducted in Ulm, Germany, baseline recruitment 04/2012 to 05/2013, we analyzed data of families enrolled shortly after childbirth. Mothers completed standardized questionnaires assessing sociodemographic, health- and family-life-related factors, and the Screening Scale of the Trier Inventory of Chronic Stress (TICS) at 6 months (T2) and 12 months postpartum (T3). Their current partners completed SSCS-TICS and an Effort-Reward Imbalance (ERI) Questionnaire obtained at 6 weeks postpartum (T1). Partners (n = 375 at T1) and mothers (n = 654 at T2 or T3) provided a 2 to 3-cm hair segment for hair analysis. Adjusted linear and cubic spline regressions were used to analyze (non-)linear relationships between potential stressors and hair cortisol (hairF) and hair cortisone (hairE) concentrations as well as the respective change scores between 12 months and 6 months. Lacking social recognition and high paternal work overload were significantly associated with paternal hairF in cubic spline models (test for overall association, chi² = 8.24, p = 0.041, chi² = 8.41, p = 0.038) but not in linear models. However, the association between ERI and hairF (chi² = 7.54, p = 0.059) was marginally significant. Maternal education was related to maternal hairF and hairE at T2. No association was observed between maternal postpartum employment and hair steroids at T2 or T3. Conversely, we could show a relationship between some change scores of stress and hairE in mothers. Considering non-linearity and family-related stressors, there are few associations between questionnaire-based stress measurements and hairF or hairE. Novelty of stressors was not shown to be a relevant factor.