Turning Up the Heat

Association between stress and catecholamines with painful TMD in children

BACKGROUND

Studying biomarkers in children with temporomandibular disorders (TMD) such as epinephrine, norepinephrine, and dopamine may reveal factors like screen time or sleep loss that affect these biomarkers and predict TMD-related pain, offering new research opportunities.

AIM

To determine the association between stress and catecholamines with myofascial pain and headache related to TMD in children.

DESIGN

Sixty-six 9- to 11-year-old children assisting at the clinics of Pediatric Dentistry of Universidad CES participated in the study. Myofascial pain and headache attributed to TMD were determined according to the Diagnostic Criteria for TMD (DC/TMD) Axis I. Stress was evaluated with the Perceived Stress Scale-Children (PSS-C), and a 24-h urine sample was analyzed using liquid chromatography to assay catecholamines. Single and multiple regression analyses were performed.

RESULTS

Children with a mean age of 10.3 years participated in the study. The mean score of stress was 29 ± 4. Perceived stress, dopamine, epinephrine, and norepinephrine were statistically significant predictors of myofascial pain and headache attributed to TMD in the single- and multiple variable logistic regression analyses.

CONCLUSION

Stressful states and its biological biomarkers increase the probability of developing myofascial pain and headache attributed to TMD in children.

The heart of Detroit study: a window into urban middle-aged and older African Americans' daily lives to understand psychosocial determinants of cardiovascular disease risk

BACKGROUND

Cardiovascular disease disproportionately affects African Americans. Psychosocial factors, including the experience of and emotional reactivity to racism and interpersonal stressors, contribute to the etiology and progression of cardiovascular disease through effects on health behaviors, stress-responsive neuroendocrine axes, and immune processes. The full pathway and complexities of these associations remain underexamined in African Americans. The Heart of Detroit Study aims to identify and model the biopsychosocial pathways that influence cardiovascular disease risk in a sample of urban middle-aged and older African American adults.

METHODS

The proposed sample will be composed of 500 African American adults between the ages of 55 and 75 from the Detroit urban area. This longitudinal study will consist of two waves of data collection, two years apart. Biomarkers of stress, inflammation, and cardiovascular surrogate endpoints (i.e., heart rate variability and blood pressure) will be collected at each wave. Ecological momentary assessments will characterize momentary and daily experiences of stress, affect, and health behaviors during the first wave. A proposed subsample of 60 individuals will also complete an in-depth qualitative interview to contextualize quantitative results. The central hypothesis of this project is that interpersonal stressors predict poor cardiovascular outcomes, cumulative physiological stress, poor sleep, and inflammation by altering daily affect, daily health behaviors, and daily physiological stress.

DISCUSSION

This study will provide insight into the biopsychosocial pathways through which experiences of stress and discrimination increase cardiovascular disease risk over micro and macro time scales among urban African American adults. Its discoveries will guide the design of future contextualized, time-sensitive, and culturally tailored behavioral interventions to reduce racial disparities in cardiovascular disease risk.

Positive and negative emotion are associated with generalized transcriptional activation in immune cells

Alterations in immune system gene expression have been implicated in psychopathology, but it remains unclear whether similar associations occur for intraindividual variations in emotion. The present study examined whether positive emotion and negative emotion were related to expression of pro-inflammatory and antiviral genes in circulating leukocytes from a community sample of 90 adolescents (M_age = 16.3 years, SD = 0.7; 51.1% female). Adolescents reported their positive emotion and negative emotion and provided blood samples twice, five weeks apart. Using a multilevel analytic framework, we found that within-individual increases in positive emotion were associated with reduced expression of both pro-inflammatory and Type I interferon (IFN) response genes, even after adjusting for demographic and biological covariates, and for leukocyte subset abundance. By contrast, increases in negative emotion were related to higher expression of pro-inflammatory and Type I IFN genes. When tested in the same model, only associations with positive emotion emerged as significant, and increases in overall emotional valence were associated with both lower pro-inflammatory and antiviral gene expression. These results are distinct from the previously observed Conserved Transcriptional Response to Adversity (CTRA) gene regulation pattern characterized by reciprocal changes in pro-inflammatory and antiviral gene expression and may reflect alterations in generalized immunologic activation. These findings highlight one biological pathway by which emotion may potentially impact health and physiological function in the context of the immune system, and future studies can investigate whether fostering positive emotion may promote adolescent health through changes in the immune system.

Is depression the missing link between inflammatory mediators and cancer?

Patients with cancer are at greater risk of developing depression in comparison to the general population and this is associated with serious adverse effects, such as poorer quality of life, worse prognosis and higher mortality. Although the relationship between depression and cancer is now well established, a common underlying pathophysiological mechanism between the two conditions is yet to be elucidated. Existing theories of depression, based on monoamine neurotransmitter system dysfunction, are insufficient as explanations of the disorder. Recent advances have implicated neuroinflammatory mechanisms in the etiology of depression and it has been demonstrated that inflammation at a peripheral level may be mirrored centrally in astrocytes and microglia serving to promote chronic levels of inflammation in the brain. Three major routes to depression in cancer in which proinflammatory mediators are implicated, seem likely. Activation of the kynurenine pathway involving cytokines, increases tryptophan catabolism, resulting in diminished levels of serotonin which is widely acknowledged as being the hallmark of depression. It also results in neurotoxic effects on brain regions thought to be involved in the evolution of major depression. Proinflammatory mediators also play a crucial role in impairing regulatory glucocorticoid mediated feedback of the hypothalamic-pituitary-adrenal axis, which is activated by stress and considered to be involved in both depression and cancer. The third route is via the glutamatergic pathway, whereby glutamate excitotoxicity may lead to depression associated with cancer. A better understanding of the mechanisms underlying these dysregulated and other newly emerging pathways may provide a rationale for therapeutic targeting, serving to improve the care of cancer patients.

Social Support Mediates the Association between Health Anxiety and Quality of Life: Findings from a Cross-Sectional Study

This study aimed to test if perceived social support and cyberchondria mediate the association between health anxiety and quality of life (QoL) in a nonclinical sample. Cross-sectional research involved adult internet users (n = 538) between 16 May 2020 and 29 December 2020 in Poland who completed self-report questionnaires, including the cyberchondria severity scale (CSS-PL), the short health anxiety inventory (SHAI), the multidimensional scale of perceived social support (MSPSS) and the quality of life scale (QOLS). A mediation analysis was performed to examine the direct effects of health anxiety on cyberchondria, perceived social support and quality of life. Likewise, the effects of cyberchondria and perceived social support on QoL were analyzed. Hence, indirect effects of health anxiety on QoL through cyberchondria and perceived social support were explored. Health anxiety significantly impaired QoL both directly and indirectly through low-perceived social support. Perceived social support partly mediated the association between health anxiety and QoL. Cyberchondria did not have a significant direct effect on the latter. Thus, cyberchondria did not mediate the relationship between health anxiety and QoL. Boosting-perceived social support may mitigate the detrimental effect of health anxiety on QoL. Cyberchondria was not found to have a significant effect on QoL in contrast to health anxiety alone.

The role of inflammatory markers and cortisol in the association between early social cognition abilities and later internalising or externalising problems: Evidence from a UK birth cohort

OBJECTIVE

Deficits in social cognition are associated with internalising (emotional and peer problems) and externalising (conduct problems and hyperactivity/inattention) symptoms in youth. It has been suggested that stress may be one of the mechanisms underlying these associations. However, no empirical studies have investigated if physiological stress can explain the prospective associations between social cognition deficits and internalising and externalising symptoms in the general youth population. This study addressed this question and focused on two indicators of physiological stress, dysregulated diurnal cortisol patterns and systemic inflammation.

METHOD

Participants were 714 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. Bayesian structural equation modelling was used to investigate a) the associations of social cognition abilities at ages 8, 11, and 14 years with internalising and externalising problems at age 17 years and b) the potential mediating effects of cortisol parameters at age 15 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at ages 9 and 16 years.

RESULTS

We found that social cognition difficulties were associated with later internalising and externalising problems. Flattened diurnal cortisol slope was associated with hyperactivity/inattention problems two years later. Lower morning cortisol partially mediated the direct association between social communication deficits at 8 years and hyperactivity/inattention and conduct problems at 17 years, even after adjustments for inflammation and confounders (for hyperactivity/inattention: indirect effect = 0.07, 95% CI [0.00, 0.18], p = .042; for conduct problems: indirect effect = 0.04, 95% CI [0.00, 0.11], p = .040). We did not find a significant association between systemic inflammation and social cognition difficulties, internalising problems, or externalising problems.

CONCLUSION

Our findings suggest that part of the effect of social communication difficulties in childhood on externalising problems in adolescence was mediated by lower morning cortisol. Hence, our study indicates that the hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis may be one of the physiological mechanisms linking some social cognition deficits to externalising problems.

Predicting cardiovascular risk using a novel risk score in young and middle-age adults with HIV: associations with biomarkers and carotid atherosclerotic plaque

BACKGROUND

Traditional risk factors associated with cardiovascular disease (CVD) include older age, smoking, poor diet, lack of exercise, obesity, high blood pressure, high cholesterol, and family history. Young-to-middle age adults (YMAA) are less often identified as being at risk of CVD, but traditional risk scores primarily target older adults and do not accurately estimate risk among YMAA.

METHODS

This study examined biomarkers associated with CVD risk in YMAA in the context of HIV and cocaine use; risk was assessed by two methods: (1) a relative cardiovascular (CV) risk score that includes several factors and (2) carotid atherosclerotic plaque. Associations between CVD risk (CV risk score and carotid atherosclerotic plaque) and proinflammatory cytokines, markers of immune activation, HIV status, and cocaine use were examined. Participants (N = 506) included people with and without HIV and people who use or do not use cocaine.

RESULTS

Participants' mean age was 36 (SD = 9.53); half (51%) were men. Cocaine use and C-reactive protein were associated with greater relative CV risk scores, but no associations between biomarkers and CV risk emerged. Age and CV risk scores were associated with carotid atherosclerotic plaque, but biomarkers were not. HIV was not associated with CV risk scores or carotid atherosclerotic plaque.

CONCLUSIONS

Among YMAA, CV risk scores may help providers identify lifestyle changes needed among those at risk for CVD before more advanced risk (e.g., atherosclerotic plaque) is identified. Implications are discussed.

Common humanity in the classroom: Increasing self-compassion and coping self-efficacy through a mindfulness-based intervention

Objective To examine the effectiveness of a classroom-based mindfulness-based intervention (MBI) in improving stress, coping, and psychological well-being in college students. Participants: Sixty-one students at a small liberal arts college. Methods: As part of a college course, students in the MBI condition (N = 33) completed mindfulness meditations, reflective journaling, and participated in group discussions over the course of eight weeks. A control group of students (N = 28) received traditional instruction about stress and coping as part of a concurrently taught college course. Perceived stress, mental health, mindfulness, self-compassion, and coping self-efficacy were measured before and after the intervention and instruction. Results: Significant improvements in self-compassion and coping self-efficacy emerged, particularly in the domains of common humanity, isolation, and emotion-focused coping self-efficacy. Conclusions: These findings suggest that incorporation of MBIs into the classroom can be an effective strategy to enhance the well-being of college students.

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.

Behavioural, physical, and psychological predictors of cortisol and C-reactive protein in breast cancer survivors: A longitudinal study

Background

Breast cancer survivors (BCS) can exhibit a dysregulation of cortisol and elevated C-reactive protein (CRP) levels post-treatment, which increase the risk of diverse health outcomes. Certain behavioural, physical, and psychological variables may help to predict cortisol and CRP levels post-treatment. The aims of this study were to: (1) describe naturally occurring changes in absolute diurnal cortisol and CRP levels over a period of 1.5 years post-treatment among BCS, (2) assess if absolute diurnal cortisol and CRP levels change in tandem, and (3) assess behavioural, physical, and psychological variables as predictors of absolute diurnal cortisol levels and CRP levels.

Methods

Capillary blood and saliva samples were collected from 201 BCS, on average, 3.5 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2−T5). At each time point, five saliva samples were collected on two nonconsecutive days: at awakening, 30 ​min after awakening, 2:00 p.m., 4:00 p.m., and at bedtime. At each time point, participants also completed self-report questionnaires and wore an accelerometer for seven consecutive days. Data were analyzed using multilevel modeling.

Results

Absolute diurnal cortisol levels did not change significantly over time. CRP levels decreased across time points (B_linear ​= ​−0.31, p ​= ​.01), though the rate of decrease slowed over time (B_quadratic ​= ​0.05, p ​= ​.03). Generally, greater sedentary time predicted higher overall absolute diurnal cortisol levels (B ​< ​0.01, p ​= ​.01); whereas higher physical activity (B ​= ​−0.004, p ​< ​.01), lower body mass index (B ​= ​0.10, p ​< ​.01), and lower health- and cancer-related stress (B ​= ​0.24, p ​= ​.04) predicted lower overall CRP levels. Also, lower absolute diurnal cortisol levels were evident when participants engaged in more sedentary time, as compared to their own average sedentary time (B ​= ​−0.01, p ​< ​.01).

Conclusions

Results offer insight into the nature of change in diurnal cortisol and CRP levels among BCS from treatment completion onwards and offer clinical implications. Helping BCS manage their weight, reduce stress, increase physical activity participation, and decrease sedentary time as soon as possible after treatment may help to reduce physiological dysregulations, thereby lowering the risk of adverse health outcomes in this population. Further research investigating specific intervention parameters such as type, context, frequency, and intensity are warranted for the development of the most optimal interventions.

Measuring salivary markers of inflammation in health research: A review of methodological considerations and best practices

There is an increasing interest in using saliva to measure inflammatory biomarkers. Compared to blood, saliva is non-invasive, requires a lower biosafety classification, and requires less specialized personnel to collect. As the assessment of inflammation in saliva becomes more popular in psychoneuroimmunology research, the development of gold-standard methodological practices is paramount. This paper reviews different considerations for designing studies to assess salivary measures of inflammation. We review saliva collection procedures, sample storage and processing considerations, assay techniques, flow rate, correspondence with blood-based markers, and potential demographic and health moderators of levels of salivary markers of inflammation. Together, this review highlights critical gaps for future research, including calls for standardization of study protocols, transparent reporting of results, assessing predictive validity of markers of salivary inflammation for disease, and the need for assessment of participants' oral and general health status. Although additional work is needed to elucidate gold standards for study design, measurement, and analysis, salivary markers of inflammation may be a useful tool for understanding oral and peripheral inflammation dynamics non-invasively.

Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

Declining life expectancy and increasing all-cause mortality in the United States have been associated with unhealthy behaviors, socioecological factors, and preventable disease. A growing body of basic science, clinical research, and population health evidence points to the benefits of healthy behaviors, environments and policies to maintain health and prevent, treat, and reverse the root causes of common chronic diseases. Similarly, innovations in research methodologies, standards of evidence, emergence of unique study cohorts, and breakthroughs in data analytics and modeling create new possibilities for producing biomedical knowledge and clinical translation. To understand these advances and inform future directions research, The Lifestyle Medicine Research Summit was convened at the University of Pittsburgh on December 4–5, 2019. The Summit's goal was to review current status and define research priorities in the six core areas of lifestyle medicine: plant-predominant nutrition, physical activity, sleep, stress, addictive behaviors, and positive psychology/social connection. Forty invited subject matter experts (1) reviewed existing knowledge and gaps relating lifestyle behaviors to common chronic diseases, such as cardiovascular disease, diabetes, many cancers, inflammatory- and immune-related disorders and other conditions; and (2) discussed the potential for applying cutting-edge molecular, cellular, epigenetic and emerging science knowledge and computational methodologies, research designs, and study cohorts to accelerate clinical applications across all six domains of lifestyle medicine. Notably, federal health agencies, such as the Department of Defense and Veterans Administration have begun to adopt “whole-person health and performance” models that address these lifestyle and environmental root causes of chronic disease and associated morbidity, mortality, and cost. Recommendations strongly support leveraging emerging research methodologies, systems biology, and computational modeling in order to accelerate effective clinical and population solutions to improve health and reduce societal costs. New and alternative hierarchies of evidence are also be needed in order to assess the quality of evidence and develop evidence-based guidelines on lifestyle medicine. Children and underserved populations were identified as prioritized groups to study. The COVID-19 pandemic, which disproportionately impacts people with chronic diseases that are amenable to effective lifestyle medicine interventions, makes the Summit's findings and recommendations for future research particularly timely and relevant.

Depression and inflammation among children and adolescents: A meta-analysis

BACKGROUND

Increasing evidence suggests that youth with Major Depressive Disorder (MDD) exhibit early indicators of cardiovascular disease. A leading hypothesized mechanism of this association is via inflammatory pathways, however, results examining this direct association are mixed. Our objective was to synthesize and quantify observational studies examining the association of depression and inflammation among children and adolescents.

METHODS

Electronic searches were conducted in MEDLINE, Embase, PsycINFO, and Scopus, yielding 2,757 non-duplicate records from 1946 to 2019. The included studies measured depression or depressive symptoms and examined its association with inflammation in participants younger than 18 years. All relevant articles were reviewed and data extracted by two independent coders. Estimates were examined by using random-effects meta-analysis.

RESULTS

Twenty-two studies (20,791 participants) were included. Significant associations were observed between concurrent depression and CRP (n = 7; r = 0.12; 95% confidence interval [CI] = 0.04 to 0.19), and IL-6 (n = 7; r = 0.17; 95% CI= 0.10 to 0.24). Longitudinal analyses revealed that depression is a significant predictor of IL-6 (n = 3; r = 0.29; 95% CI= 0.04 to 0.50) and conversely, that inflammation (measured by CRP or IL-6) predicts future depression (n = 4; r = 0.04; 95% CI= 0.00 to 0.08).

LIMITATIONS

Results are limited by the small number of studies preventing examination of some moderator variables. Findings are correlational, not causal.

CONCLUSION

Depression is positively associated with concurrent and future inflammation among children and adolescents. Results suggest that bidirectional associations may exist between depression and a pro-inflammatory state.

Syndemic burden and systemic inflammation, HIV health status, and blood pressure among women with unsuppressed HIV viral loads among women living with HIV

INTRODUCTION

Smoking, low education, obesity, and depressive symptoms are all associated with HIV health status, increased blood pressure, and inflammation, and constitute a syndemic burden that may contribute to poor health outcomes. The current study examined syndemic burden and health outcomes among women living with HIV.

METHODS

Women were participants enrolled in the Women's Interagency HIV Study. Outcomes included blood pressure, HIV health status (HIV-1 RNA viral load and CD4 T-cell counts), and IL-6. Syndemic burden was defined as a count variable of low education, obesity, cigarette use, and depressive symptoms.

RESULTS

Women (N = 131) were an average of 60.54 years of age (SD = 8.86), and 49% were non-Hispanic Black. In multivariable analyses, syndemic burden was not significantly associated with SBP (P = 0.342) or DBP (P = 0.763), IL-6 (P = 0.168), or CD4 cell count (P = 0.846). However, syndemic burden was associated with increased viral load (age adjusted β = 0.35, P < 0.001). Comparing women with high versus low syndemic burden, also controlling for women's age, women with high syndemic burden had higher DBP and HIV viral load.

DISCUSSION

Syndemic burden appeared to play an important role in HIV health status and could potentially increase the risk of HIV transmission. High syndemic burden, defined as at least two syndemic conditions, had the greatest effects of HIV viral load and DBP. Targeted interventions to address syndemic burden may help improve health outcomes in women living with HIV as well as reduce the risk of hypertension and HIV transmission.

Short-Term Mental Health Sequelae of Bereavement Predict Long-Term Physical Health Decline in Older Adults: U.S. Health and Retirement Study Analysis

OBJECTIVES

Spousal death is a common late-life event with health-related sequelae. Evidence linking poor mental health to disease suggests the hypothesis that poor mental health following death of a spouse could be a harbinger of physical health decline. Thus, identification of bereavement-related mental health symptoms could provide an opportunity for prevention.

METHODS

We analyzed data from N = 39,162 individuals followed from 1994 to 2016 in the U.S. Health and Retirement Study; N = 5,061 were widowed during follow-up. We tested change in mental and physical health from prebereavement through the 5 years following spousal death.

RESULTS

Bereaved spouses experienced an increase in depressive symptoms following their spouses' deaths but the depressive shock attenuated within 1 year. Bereaved spouses experienced increases in disability, chronic-disease morbidity, and hospitalization, which grew in magnitude over time, especially among older respondents. Bereaved spouses were at increased risk of death compared to nonbereaved respondents. The magnitude of depressive symptoms in the immediate aftermath of spousal death predicted physical-health decline and mortality risk over 5 years of follow-up.

DISCUSSION

Bereavement-related depressive symptoms indicate a risk for physical health decline and death in older adults. Screening for depressive symptoms in bereaved older adults may represent an opportunity for intervention to preserve healthy life span.

Symptoms of anxiety and depression and risk of atrial fibrillation-The HUNT study

BACKGROUND

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Anxiety and depression may activate the autonomic nervous system which is likely to play an important role in the etiology of AF. However, little is known about the association between symptoms of anxiety and depression and risk of AF.

OBJECTIVE

This study aimed to assess the association between symptoms of anxiety and depression and risk of AF.

METHODS

In a population-based study, 37,402 adult residents were followed for incident AF from 2006 to 2008 until 2015. Participants were classified according to data on anxiety and depression symptoms. Cox proportional regression models were used to adjust for common AF risk factors.

RESULTS

During a median follow-up of 8.1 years, 1433 (3.8%) participants developed AF. In comparisons with no anxiety symptoms, the multivariable-adjusted hazard ratios (HRs) were 1.1 (95% CI: 0.9-1.5) for mild to moderate anxiety symptoms and 1.0 (95% CI: 0.8-1.4) for severe anxiety symptoms. In comparisons with no depression symptoms, the multivariable-adjusted HRs were 1.5 (95% CI: 1.2-1.8) for mild to moderate depression symptoms and 0.9 (95% CI: 0.6-1.3) for severe depression symptoms. Recurrent anxiety/depression symptoms were not associated with increased AF risk.

CONCLUSIONS

In this large, population-based study, we found no evidence of an association between symptoms of anxiety or severe depression and AF risk, even for recurrent anxiety or depression symptoms. An unexpected association of symptoms of mild to moderate depression with increased AF risk requires confirmation in other studies. Our findings add to the sparse literature on symptoms of anxiety and depression and risk of AF.

HIV and carotid atherosclerosis: a mediational model

Cardiovascular disease (CVD) is the leading cause of death in the US and is a significant contributor to morbidity and mortality for people living with HIV (PLWH). This study examined the association between HIV infection, cocaine usage, and inflammatory markers, and their combined association with carotid atherosclerosis among young and middle-aged adults with HIV. Participants (N = 494) were enrolled based on HIV status and cocaine use. Blood pressure, body mass index (BMI), and cocaine use were assessed. Cytokines and growth factors, IL-1a, IL-6, TNFα and VEGF, and immune activation markers, sCD14 and sCD163 were measured. Participant age was 36.2 years (SD = 9.5); 50% were male, 49% female and 1% transgender; 39% were HIV-positive, 50% were current or past smokers, and 39% endorsed cocaine use. A path analysis showed an indirect effect of HIV serostatus on the presence of carotid atherosclerotic plaques (Indirect Effect = 0.048, SE = 0.024, p = .043), when controlling age, BMI, smoking, and cocaine use. This effect was mediated by inflammatory markers and changes in blood pressure. Findings point to putative underlying mechanisms leading to atherosclerosis among PLWH.

Grief, depressive symptoms, and inflammation in the spousally bereaved

Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.

Couple identity and well-being in Chinese HIV serodiscordant couples: resilience under the risk of stigma

Resilience literature has suggested the context-specific nature of resilience while such framework has yet to be expanded to health psychology research among HIV serodiscordant couples. Conceptualizing a couple affected by chronic diseases using a "we-ness" framework rather than two separate individuals is important for stress coping of the couple. Considering this social-cognitive context of couple coping would be helpful to facilitate resilience of both the patient and the spouse. It is not clear whether couple identity serves as a protective factor for HIV serodiscordant couples and whether stigma, a prevalent contextual risk in this population, will alter the strength of such a protective effect on well-being. This longitudinal study examined the protective effect of couple identity in predicting the psychological and physical well-being of HIV discordant couples and the moderating role of stigma in such associations. A total of 160 Chinese HIV serodiscordant couples completed the baseline survey and follow-up one year later. Results showed that couple identity predicted fewer depressive symptoms at both the within- and between-couple level and better self-rated physical health at the between-couple level one year later. These protective effects were diminished when HIV stigma was high. This study highlights the importance of examining resources with consideration of contextual factors. It also calls for the sensitivity of stigma in developing a couple-based intervention for HIV serodiscordant couples.

The moderating role of job resources in the relationship between job demands and interleukin-6 in an Italian healthcare organization

In this study we examined the association between job demands (JD), job resources (JR), and serum levels of a possible biomarker of stress, the pro-inflammatory cytokine interleukin-6 (IL-6). According to the buffer hypothesis of the Job Demands-Resources (JD-R) model, we expected that job resources-defined as job autonomy and social support from supervisor-might buffer the relationship between job demands, defined as emotional demands and interpersonal conflict with colleagues, and IL-6. Data from 119 employees in an Italian public healthcare organization (acute care hospital) were analyzed using multiple regression. In predicting IL-6, the interactions between emotional demands and JR and between interpersonal conflict with colleagues and job autonomy (but not social support) were significant, after controlling for the effect of age and gender. The association between JD and IL-6 was stronger for individuals with low levels of JR, so that levels of IL-6 were highest when JD were high and JR were low. Overall, these results are consistent with the buffer hypothesis of the JD-R model and also extend previous research, showing that the exposure to stressful situations at work, measured as high JD and low JR, is associated with higher levels of IL-6 in hospital employees.

Translating biobehavioral research advances into improvements in health care-a "network of networks" approach to multimorbidity

Biobehavioral research has made great advances in past decades, allowing researchers to paint an ever-improving picture of interactions between the central nervous system and the systems in the periphery of the body. This knowledge allows us, from a researcher's perspective, to better understand diseases and disease symptoms that are not explainable with a narrow view on organ-specific biomedical processes. However, what is lacking is the translation of this knowledge into clinical practice. In their commentary, Sturmberg et al pointed out these shortcomings and proposed a model connecting the different networks in the human body, and the importance of their connectedness, and drew conclusions for necessary changes in patient care. While doing so, Sturmberg et al also created the basis of what could be considered a new and all-encompassing stress model. This work therefore not only calls for changes in clinical practice but also provides a basis for further steps in biobehavioral research.

Sweetened beverage consumption is a risk factor for depressive symptoms among adolescents living in Boston, Massachusetts, USA

OBJECTIVE

To investigate the relationship between sweetened beverage consumption and depressive symptoms among adolescents.

DESIGN

In a cross-sectional study, adolescents were asked how often they drank soda and fruit drinks in the past 7 d. Depressive symptoms were measured using a brief adapted version of the Modified Depression Scale. Summation scores were standardized using the Z-transformation. We used multilevel multiple linear regression models to estimate the association between soda and fruit drink consumption and depressive symptoms.

SETTING

The 2008 Boston Youth Survey.

SUBJECTS

Adolescents (n 1878), high-school students in grades 9-12 of Boston public schools, Massachusetts, USA.

RESULTS

Compared with those who never drank soda in the past 7 d, those who consumed soda 2-6 times/week (β=0·18; 95 % CI 0·04, 0·32) or ≥1 times/d (β=0·29; 95 % CI 0·13, 0·45) had higher depressive symptoms. Similarly, those who consumed fruit drinks 2-6 times/week (β=0·14; 95 % CI 0·00, 0·28) and those who consumed ≥1 times/d (β=0·22; 95 % CI 0·04, 0·40) had higher depressive symptoms.

CONCLUSIONS

Frequent consumption of both soda and fruit drinks is associated with greater depressive symptoms among adolescents.

Positive Affect and Inflammatory Activity in Breast Cancer Survivors: Examining the Role of Affective Arousal

OBJECTIVE

Given the importance of positive affect and inflammation for well-being in cancer survivors, the current study examined the relationship between high- and low-arousal positive affect and inflammation in 186 women who completed treatment of early-stage breast cancer.

METHODS

Measures of high- and low-arousal positive affect were completed within 3 months after treatment completion (baseline). Plasma markers of inflammation, including soluble tumor necrosis factor receptor type II (sTNF-RII), C-reactive protein (CRP), and interleukin-1 receptor antagonist, were assessed at baseline and 6- and 12-month follow-up assessments.

RESULTS

Multilevel modeling analyses showed that high-arousal positive affect was associated with lower levels of sTNF-RII, a marker of TNF activity, at treatment completion and prospectively predicted maintenance of these differences through the 6- and 12-month follow-ups adjusting for biobehavioral confounds (b = -0.055, t(156) = -2.40, p = .018). However, this association was no longer significant when adjusting for fatigue. Exploratory analyses showed that low-arousal positive affect was associated with lower levels of CRP at treatment completion and through the 6- and 12-month follow-ups; this association remained significant after adjusting for fatigue and other confounds (b = -0.217, t(152) = -2.04, p = .043).

CONCLUSIONS

The relationship of high-arousal positive affect (e.g., "active") with sTNF-RII seems to be driven by the overlap of high-arousal positive affect with fatigue, whereas the relationship of low-arousal positive affect (e.g., "calm") with CRP was independent of fatigue. Future research should consider affective arousal when examining the association of positive affect with inflammation as this facet of positive affect may have important implications for interpretation of results.

Trans fatty acid intake is related to emotional affect in the Adventist Health Study-2

Trans fatty acids in Western diets increase health risks, and have been associated with the risk of depression. We hypothesized that intakes of trans fatty acids (primarily from margarines and baked goods) were inversely associated with positive affect and positively associated with negative affect in a longitudinal study. Church attendees residing in North America completed a food frequency questionnaire in 2002-6 as part of the Adventist Health Study-2. A subset in which we excluded participants with established cardiovascular disease (n=8,771) completed the Positive and Negative Affect Schedule (PANAS) in 2006-7. The associations between dietary intakes of fatty acids to positive and negative affect were tested with linear regression analysis controlling for age, gender, ethnicity, education, body mass index, exercise, sleep, sleep squared, Mediterranean diet, total energy intake and alcohol. Intakes of trans fatty acids were inversely associated with positive affect (β=-0.06, B=-0.27 [95% CI -0.37, -0.17], p<.001) and positively associated with negative affect (β=0.05, B=0.21 [95% CI 0.11, 0.31], p<.001). In comparison, we found no association between n-3 polyunsatured fatty acids (PUFA) intakes with affect. The n-6:n-3 PUFA ratio was inversely associated with positive affect (β=-0.03, B=-0.34 [95% CI -0.58, -0.10], p=0.006). The findings suggest that a lower dietary trans fatty acid intake has beneficial effects on emotional affect while the n-6: n-3 ratio is detrimental to positive affect.

Association of Psychosocial Work Hazards With Depression and Suboptimal Health in Executive Employees

OBJECTIVES

This study aims to investigate whether psychosocial work-related hazards, measured by workplace justice and employment insecurity, are associated with depression and suboptimal health status in Taiwan's executive-level employees.

METHODS

There were 365 executives who have received a series of cardiovascular health examinations, blood sampling, and self-reported questionnaires, which included the psychosocial work-related hazards and the CES-D scale. Suboptimal health status was defined as the presence of dyslipidemia or prediabetes.

RESULTS

Executive-level employees perceived lower workplace justice and higher employment insecurity and had a significantly higher risk of depression (CES-D scores ≥16 or ≥23). However, workplace justice was identified as a significant determinant factor that was negative for dyslipidemia but protective for prediabetes.

CONCLUSION

This study supports the fact that psychosocial work-related hazards can independently contribute to the risk of developing depression, prediabetes, and dyslipemia in executives.

You've Gotta Know When to Fold 'Em

The notion that persistence is essential for success and happiness is deeply embedded in popular and scientific writings. However, when people are faced with situations in which they cannot realize a key life goal, the most adaptive response for mental and physical health may be to disengage from that goal. This project followed 90 adolescents over the course of 1 year. Capacities for managing unattainable goals were assessed at baseline, and concentrations of the inflammatory molecule C-reactive protein (CRP) were quantified at that time, as well as 6 and 12 months later. To the extent that subjects had difficulties disengaging from unattainable goals, they displayed increasing concentrations of CRP over the follow-up. This association was independent of potential confounds, including adiposity, smoking, and depression. Because excessive inflammation contributes to a variety of adverse medical outcomes, these findings suggest that in some contexts, persistence may actually undermine well-being and good health.

Perceived stress and telomere length: A systematic review, meta-analysis, and methodologic considerations for advancing the field

IMPORTANCE

Psychological stress contributes to numerous diseases and may do so in part through damage to telomeres, protective non-coding segments on the ends of chromosomes.

OBJECTIVE

We conducted a systematic review and meta-analysis to determine the association between self-reported, perceived psychological stress (PS) and telomere length (TL).

DATA SOURCES

We searched 3 databases (PubMed, PsycInfo, and Scopus), completed manual searches of published and unpublished studies, and contacted all study authors to obtain potentially relevant data.

STUDY SELECTION

Two independent reviewers assessed studies for original research measuring (but not necessarily reporting the correlation between) PS and TL in human subjects. 23 studies met inclusion criteria; 22 (totaling 8948 subjects) could be meta-analyzed.

DATA EXTRACTION AND SYNTHESIS

We assessed study quality using modified MINORS criteria. Since not all included studies reported PS-TL correlations, we obtained them via direct calculation from author-provided data (7 studies), contact with authors (14 studies), or extraction from the published article (1 study).

MAIN OUTCOMES AND MEASURES

We conducted random-effects meta-analysis on our primary outcome, the age-adjusted PS-TL correlation. We investigated potential confounders and moderators (sex, life stress exposure, and PS measure validation) via post hoc subset analyses and meta-regression.

RESULTS

Increased PS was associated with a very small decrease in TL (n=8724 total; r=-0.06; 95% CI: -0.10, -0.008; p=0.01; α=0.025), adjusting for age. This relationship was similar between sexes and within studies using validated measures of PS, and marginally (nonsignificantly) stronger among samples recruited for stress exposure (r=-0.13; vs. general samples: b=-0.11; 95% CI: -0.27, 0.01; p=0.05; α=0.013). Publication bias may exist; correcting for its effects attenuated the relationship.

CONCLUSIONS AND RELEVANCE

Our analysis finds a very small, statistically significant relationship between increased PS (as measured over the past month) and decreased TL that may reflect publication bias, although fully parsing the effects of publication bias from other sample-size correlates is challenging, as discussed. The association may be stronger with known major stressors and is similar in magnitude to that noted between obesity and TL. All included studies used single measures of short-term stress; the literature suggests long-term chronic stress may have a larger cumulative effect. Future research should assess for potential confounders and use longitudinal, multidimensional models of stress.

Basic needs, stress and the effects of tailored health communication in vulnerable populations

This study examined whether unmet basic needs (food, housing, personal and neighborhood safety, money for necessities) and perceived stress affect recall of and response to a tailored print intervention one month later. Participants (N = 372) were adults who had called 2-1-1 Missouri between June 2010 and June 2012. A series of path analyses using Mplus were conducted to explore the relationships among basic needs, perceived stress, number of health referrals received in a tailored intervention, recalling the intervention and contacting a health referral. Participants were mainly women (85%) and African-American (59%) with a mean age of 42.2 years (SD = 13.3; range 19-86); 41% had annual household income <$10 000. Unmet basic needs were positively associated with increased levels of perceived stress, which, in turn, were negatively associated with recalling the intervention and calling any of the health referrals provided. Tailored printed interventions may be less effective in populations with acute unmet basic needs. More broadly, the effectiveness of minimal contact behavioral interventions might be enhanced by simultaneous efforts to address unmet basic needs.

Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology

Divorce is a relatively common stressful life event that is purported to increase risk for all-cause mortality. One problem in the literature on divorce and health is that it is fragmented and spread across many disciplines; most prospective studies of mortality are based in epidemiology and sociology, whereas most mechanistic studies are based in psychology. This review integrates research on divorce and death via meta-analysis and outlines a research agenda for better understanding the potential mechanisms linking marital dissolution and risk for all-cause mortality. Random effects meta-analysis with a sample of 32 prospective studies (involving more than 6.5 million people, 160,000 deaths, and over 755,000 divorces in 11 different countries) revealed a significant increase in risk for early death among separated/divorced adults in comparison to their married counterparts. Men and younger adults evidenced significantly greater risk for early death following marital separation/divorce than did women and older adults. Quantification of the overall effect size linking marital separation/divorce to risk for early death reveals a number of important research questions, and this article discusses what remains to be learned about four plausible mechanisms of action: social selection, resource disruptions, changes in health behaviors, and chronic psychological distress.

Acute psychosocial stress induces differential short-term changes in catecholamine sensitivity of stimulated inflammatory cytokine production

BACKGROUND

We have previously shown that psychosocial stress induces acute changes in glucocorticoid (GC) sensitivity of pro-inflammatory cytokine production. However, hormones of the sympathetic adrenal medullary system complement endocrine regulation of inflammatory responses. The current study therefore aimed at investigating the effects of repeated acute stress exposure on catecholamine sensitivity of inflammatory cytokine production.

METHODS

Twenty healthy male participants were subjected to the Trier Social Stress Test on two consecutive days. Blood samples were taken before and repeatedly after stress. Whole blood was stimulated with lipopolysaccharide and incubated with increasing concentrations of epinephrine (E) and norepinephrine (NE) for 18h. Tumor-necrosis-factor (TNF) alpha and interleukin (IL)-6 were measured in culture supernatants.

RESULTS

Overall, incubation with E and NE induced dose-dependent suppression of TNF-alpha (NE: F=77.66, p<.001; E: F=63.38, p<.001), and IL-6 production (NE: F=28.79, p<.001; E: F=24.66, p<.001). Acute stress exposure resulted in reduced sensitivity of TNF-alpha (NE: F=6.36, p<.001; E: F=4.86, p=.005), but not IL-6 (NE: F=1.07, p=.38; E: F=0.88, p=.50) to the inhibitory signals of E and NE. No evidence of habituation of these effects was found (all p⩾.22).

CONCLUSIONS

The present findings extend our knowledge on changes in inflammatory target tissue sensitivity in response to acute psychosocial stress from glucocorticoid-dependent effects to catecholamine-dependent effects. Stress-induced decreases in catecholamine sensitivity thereby suggest intracellular processes aiding in maintaining a healthy endocrine-immune interplay. Longitudinal studies will have to investigate the processes leading from a supposedly beneficial short-term catecholamine resistance in response to acute stress to basal catecholamine resistance observed in relation to negative health outcomes.

Race/ethnicity moderates the relationship between depressive symptom severity and C-reactive protein: 2005-2010 NHANES data

Because few studies have examined depression facets or potential moderators of the depression-inflammation relationship, our aims were to determine whether particular depressive symptom clusters are more strongly associated with C-reactive protein (CRP) levels and whether race/ethnicity moderates these relationships. We examined data from 10,149 adults representative of the U.S. population (4858 non-Hispanic White, 1978 non-Hispanic Black, 2260 Mexican American, 1053 Other Hispanic) who participated in the cross-sectional National Health and Nutrition Examination Survey between 2005 and 2010. Depressive symptoms were assessed by the Patient Health Questionnaire-9, and high-sensitivity serum CRP was quantified by latex-enhanced nephelometry. Total (p<.001), somatic (p<.001), and nonsomatic (p=.001) depressive symptoms were each positively related to serum CRP in individual models. However, in the simultaneous model that included both symptom clusters, somatic symptoms (p<.001), but not nonsomatic symptoms (p=.98), remained associated with serum CRP. Evidence of moderation by race/ethnicity was also observed, as six of the nine depressive symptoms×race/ethnicity interactions were significant (ps<.05). Among non-Hispanic Whites, the pattern of results was identical to the full sample; only somatic symptoms (p<.001) remained related to serum CRP in the simultaneous model. No relationships between total, somatic, or nonsomatic symptoms and serum CRP were observed among the non-Hispanic Black, Mexican American, or Other Hispanic groups. Our findings indicate that the link between depressive symptoms and systemic inflammation may be due to the somatic symptoms of sleep disturbance, fatigue, appetite changes, and psychomotor retardation/agitation and may be strongest among non-Hispanic Whites.

Goal Adjustment Capacities, Subjective Well-Being, and Physical Health

This article addresses how individuals can adjust to the experience of unattainable goals and protect their subjective well-being and physical health. We discuss theoretical aspects involved in the self-regulation of unattainable goals and point to the importance of general individual differences in goal disengagement and goal reengagement capacities. In addition, we review the extant literature, suggesting that goal disengagement capacities can reduce psychological distress and ameliorate patterns of biological dysregulation and physical health problems if individuals experience unattainable goals. Goal reengagement capacities, by contrast, are shown to be associated with positive indicators of subjective well-being (e.g., positive affect or purpose in life), but rarely predict psychological distress or physical health outcomes. We finally address several remaining issues that have become apparent in the extant literature and may deserve more attention in future research.

Perfectionism, Type D personality, and illness-related coping styles in cardiac rehabilitation patients

This study investigated the associations among trait perfectionism, perfectionistic self-presentation, Type D personality, and illness-specific coping styles in 100 cardiac rehabilitation patients. Participants completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Type D Scale-14, and the Coping with Health Injuries and Problems Scale. Correlational analyses established that emotional preoccupation coping was associated with trait perfectionism, perfectionistic self-presentation, and Type D personality. Perfectionism was linked with both facets of the Type D construct (negative emotionality and social inhibition). Our results suggest that perfectionistic Type D patients have maladaptive coping with potential negative implications for their cardiac rehabilitation outcomes.

Divorce and Death: A Case Study for Health Psychology

Marital separation and divorce are associated with increased risk for early death, and the magnitude of this association rivals that of many well-established public health factors. In the case of divorce, however, the mechanisms explaining precisely why and how some people are at risk for early death remain unclear. This paper reviews what is known about the association between divorce and risk for all-cause mortality, then discusses four emerging themes in this area of research: the biological intermediaries linking divorce to pathophysiology and disease onset, moving beyond the statistical mean, focusing research on the diathesis-stress model, and studying how opportunity foreclosures may place people on a trajectory toward poor distal health outcomes. These ideas are grounded in a set of public lay commentaries about the association between divorce and death; in this way, the paper seeks to integrate current research ideas with how the general public thinks about divorce and its correlates. Although this paper focuses on divorce, many of the emerging themes are applicable to the study of psychosocial stress and health more generally. Therefore, the study of divorce and death provides a good case study for health psychology and considers new questions that can be pursued in a variety of research areas.

Depressive symptoms are not associated with inflammation in younger and older adults in the Philippines

Depression is not associated with inflammation among adults in the Philippines, in contrast to prior research in the US. These results suggest that higher levels of microbial exposure in the Philippines may promote the development of immuno-regulatory pathways that prevent the emergence of a relationship between depression and inflammation.

Depression is positively associated with chronic inflammation in industrialized settings with low burdens of infectious disease, but the pattern of association in environments with higher levels of microbial exposure is not known. We measured C-reactive protein (CRP) and interleukin 6 (IL6) in community-based samples of young adults (20–22 years) and older women (35–69 years) in the Philippines. Concentrations of CRP and IL6 were low, and bivariate and multivariate regression analyses indicated no associations between depressive symptoms and inflammation in either sample. Results are interpreted in light of prior research indicating that higher levels of microbial exposure in infancy have lasting effects on the regulation of inflammation, and may prevent the emergence of a relationship between depression and inflammation in adulthood.

Clustering of depression and inflammation in adolescents previously exposed to childhood adversity

BACKGROUND

There is mounting interest in the hypothesis that inflammation contributes to the pathogenesis of depression and underlies depressed patients' vulnerability to comorbid medical conditions. However, research on depression and inflammation has yielded conflicting findings, fostering speculation that these conditions associate only in certain subgroups, such as patients exposed to childhood adversity.

METHODS

We studied 147 female adolescents. All were in good health at baseline but at high risk for depression because of family history or cognitive vulnerability. Subjects were assessed every 6 months for 2.5 years, undergoing diagnostic interviews and venipuncture for measurement of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6). Childhood adversity was indexed by parental separation, low socioeconomic status, and familial psychopathology.

RESULTS

Multilevel models indicated that childhood adversity promotes clustering of depression and inflammation. Among subjects exposed to high childhood adversity, the transition to depression was accompanied by increases in both CRP and IL-6. Higher CRP remained evident 6 months later, even after depressive symptoms had abated. These lingering effects were bidirectional, such that among subjects with childhood adversity, high IL-6 forecasted depression 6 months later, even after concurrent inflammation was considered. This coupling of depression and inflammation was not apparent in subjects without childhood adversity.

CONCLUSIONS

These findings suggest that childhood adversity promotes the formation of a neuroimmune pipeline in which inflammatory signaling between the brain and periphery is amplified. Once established, this pipeline leads to a coupling of depression and inflammation, which may contribute to later affective difficulties and biomedical complications.

Acute and chronic stress induced changes in sensitivity of peripheral inflammatory pathways to the signals of multiple stress systems --2011 Curt Richter Award Winner

Exposure to psychosocial stress has been associated with increasing rates of morbidity in humans and in animal models, but the underlying mechanisms are not completely understood. Major stress responsive systems, such as the hypothalamus-pituitary adrenal (HPA) axis and the autonomic nervous system (ANS) are under investigation as underlying pathways, but although acute stress reliably activates these systems, findings of long-term alternations in baseline activity are inconsistent at present. Emerging evidence suggests that stress-related changes in the sensitivity of target systems toward glucocorticoid (GC) regulation, i.e. development of GC resistance, might help explain inflammatory disinhibition and development of disease related to inflammation. More recent findings further show that the autonomic nervous system might play an important role in the regulatory control of the inflammatory cascade. The major argument put forward in this manuscript is that target tissues for stress system modulation, such as the inflammatory cascade, vary in their ability to respond to stress system signaling, and that assessing alterations in this stress signal sensitivity which can be caused by stress or disease processes, might be necessary to understand and explain stress effects on health. This review focuses on the inflammatory system in particular, because anti-inflammatory effects of most stress systems have been documented, but the general assumption might have to be generalized to other target systems. The main conclusion to be made is that reduction in glucocorticoid sensitivity of target tissues is the most consistent finding at present, and that assessing such changes in glucocorticoid sensitivity might be necessary to understand many stress-related changes in physiology.

The Psychological Benefits of Vigorous Exercise: A Study of Discordant MZ Twin Pairs

The physiological benefits of vigorous exercise are well established. The existence of psychological benefits is less clear, however, due to methodological limitations common to investigatory studies. Two of these limitations are the difficulty of establishing appropriate control groups and the large variety of highly specific measures of psychological function available for consideration of effects. To address these limitations, we identified 63 pairs of monozygotic twins from the National Survey of Midlife Development in the United States who were discordant for the amount of vigorous exercise in which they engaged regularly. The twins who regularly engaged in vigorous exercise experienced greater positive psychological functioning than their nonexercising co-twins as measured by the latent factor representing the variance common to 8 measures of mood, optimism, control over life, and interpersonal aspects of personality. The magnitude of the difference was in excess of .4 standard deviations.

Associations between transition-specific stress experience, nocturnal decline in ambulatory blood pressure, and C-reactive protein levels among transgender men

OBJECTIVES

To characterize challenges experienced during stages of female-to-male sex transition and investigate associations between transition-specific measures of psychosocial stress, nocturnal decline in ambulatory blood pressure (amBP), and changes in C-reactive protein (CRP) levels.

METHODS

For this biocultural study, 65 healthy transmen who were using testosterone (T) therapy participated in interviews to assess transition-specific stress experience. They provided perceived stress scores, self-esteem scores, 24-h amBP measures, salivary samples for T levels, and a blood spot for CRP levels. Psychosocial stress was examined in relation to amBP and CRP using linear regression while adjusting for age, body mass index, and smoking.

RESULTS

There were no differences in mean levels of amBP in association with stage of transition. Men reporting stress associated with being "out" as transgender had significantly diminished nocturnal decline in systolic and diastolic amBP compared to men who did not report such stress. The associations remained significant when examined among men in stages 1 and 2 (≤ 3 years on T), but not among men in stage 3 (>3 years on T) of transition. Men reporting stress related to "passing" as someone born male had higher CRP levels than those who did not report such stress. The association remained significant when examined among men in stages 2 and 3 (>0.5-3 years on T).

CONCLUSION

Measures of stress that captured individuals' experiences of gender liminality were associated with diminished nocturnal decline in amBP and increased levels of CRP. There are significant differences between men grouped into different stages of the transition process.

Resilience in the Context of Chronic Stress and Health in Adults

Over the past several decades, stress research has experienced a broadening of its pathologic focus to encompass the concept of resilience. There is a wealth of research on resilience but no general consensus regarding its conceptualization. Some define resilience as attaining eventual favorable outcomes following exposure to adversity. Others define it as specific relatively short-term responses characterized by a return to homeostasis after initial disruption due to a stressor, and still others refer to resilience as resources that enable the individual to withstand or recover from major stressors. Many of the existing conceptualizations of resilience are not applicable in the context of chronic stress which is particularly harmful to health. How do adults who experience chronic stress survive, manage, and thrive, and what resources enable them to do so? In this paper, we consider these questions by reviewing traditions of research and definitions of resilience in order to inform an understanding of resilience in general, and for the study of chronic stress in adults. Based on a review of the literature, we developed a taxonomy of resilience resources that can be applied broadly, and guide future research.

Variability in stress system regulatory control of inflammation: a critical factor mediating health effects of stress

Chronic stress has been associated with disease but the biological pathways are not completely understood. Stress systems such as the hypothalamus-pituitary-adrenal axis and the autonomic nervous system are prime candidates but alterations in their baseline activity are not consistently found in chronic stress. Evidence suggests that stress-related changes in the sensitivity of inflammatory pathways towards glucocorticoid regulation, that is, the development of glucocorticoid resistance, might help explain inflammatory disinhibition and the subsequent development of disease. Recent data show a similarly important role for sympathetic and parasympathetic modulation of the inflammatory cascade for the maintenance of health. This article argues that variation of target tissue sensitivity towards anti-inflammatory effects of the hypothalamus-pituitary-adrenal axis, as well as sympathetic and parasympathetic signaling, might be involved in the development of low-grade inflammation under chronic psychosocial stress.

Depression following open-heart surgery: a path model involving interleukin-6, spiritual struggle, and hope under preoperative distress

Faith factors (i.e., factors pertaining to religion/spirituality) have been linked with well-being and adequate coping. Few studies have investigated negative aspects of religious coping, such as spiritual struggle. Based on the multidisciplinary literature and on previous findings, the study's analysis estimated parallel psychophysiological pathways from preoperative distress to postoperative depression in patients undergoing open heart surgery. Plasma samples for interleukin(IL)-6 were obtained before surgery. The results showed that a link between spiritual struggle and IL-6 mediated the indirect effects of preoperative anxiety on postoperative depression. Avoidant coping also mediated the influence of anxiety on postoperative maladjustment. Further, hope played a protective mediating role to moderate the undesirable influences of the spiritual struggle-IL-6 link and maladaptive coping on postoperative mental health attributes.

Childhood adversity heightens the impact of later-life caregiving stress on telomere length and inflammation

OBJECTIVE

To address the question of whether childhood abuse and other adversities have lasting, detectable consequences for inflammation and cell aging late in life, and whether the effects are large enough to be discernible beyond that of a major chronic stressor, dementia family caregiving. Previous research on the physical health consequences of childhood abuse and other adversities has been based on data from young or middle-aged adults.

METHOD

In this community sample of 132 healthy older adults (mean age = 69.70 years; standard deviation = 10.14), including 58 dementia family caregivers and 74 non-caregivers, blood samples were analyzed for interleukin (IL)-6, tumor necrosis factor (TNF)-α, and telomere length, a measure of cell aging. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale.

RESULTS

After controlling for age, caregiving status, gender, body mass index, exercise, and sleep, the presence of multiple childhood adversities was related to both heightened IL-6 (0.37 ± 0.03 log10 pg/mL versus 0.44 ± 0.03 log10 pg/mL) and shorter telomeres (6.51 ± 0.17 Kb versus 5.87 ± 0.20 Kb), compared with the absence of adversity; the telomere difference could translate into a 7- to 15-year difference in life span. Abuse was associated with heightened IL-6 and TNF-α levels; for TNF-α, this relationship was magnified in caregivers compared with controls. Moreover, abuse and caregiving status were associated significantly and independently with higher levels of depressive symptoms.

CONCLUSIONS

Adverse childhood events are related to continued vulnerability among older adults, enhancing the impact of chronic stressors. Childhood adversities cast a very long shadow.