Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease

Lived and care experiences of young people with chronic musculoskeletal pain and mental health conditions: a systematic review with qualitative evidence synthesis

ABSTRACT

Chronic musculoskeletal pain (CMP) and coexisting mental health conditions impact young people; however, little is known about their lived and care experiences. In a prospectively registered systematic review with qualitative evidence synthesis (PROSPERO: CRD42022369914), we explored the following: (1) lived physical, psychological, and social experiences; and (2) care experiences/preferences of young people living with CMP and mental health conditions. Inclusion criteria: studies using qualitative methods; participants aged 16 to 24 years with CMP and coexisting mental health condition(s); phenomenon explored included lived and/or care experiences. Seven databases were searched (inception to 19-May-2024), study quality was assessed, data were extracted and analysed thematically, and GRADE-CERQual was used to assess confidence in findings. Twenty-two studies (23 reports) were included (>239 participants, 82% women). Lived experiences yielded 4 themes (9 findings): 2-way relationship between CMP and mental health (2 findings, low to moderate confidence); psychosocial implications of CMP (3 findings, very low-moderate confidence); uncertainty about future (2 findings, low-moderate confidence); coping with CMP and mental health conditions (2 findings, low-moderate confidence). Care experiences/preferences yielded 3 themes (8 findings): navigating healthcare systems (2 findings, moderate confidence); receiving appropriate care (3 findings, very low-moderate confidence); point-of-care experiences and care preferences (3 findings, very low-moderate confidence). Chronic musculoskeletal pain and mental health conditions are interconnected, significantly impacting young people's lives, identities, and socialisation, yet services for CMP and mental health are often inadequate and poorly integrated. The mechanisms and interplay of CMP and mental health require deeper exploration, including how young people may be better supported with personalised, holistic, developmentally and/or life-stage-appropriate integrated care.

Relationship between menopausal status and suicidal behavior among the Korean population

OBJECTIVE

We investigated whether, in the Korean population, the risk of suicidal behavior is associated with menopausal status and especially age at menopause. For a deeper understanding of suicidal behavior, participants were asked about suicidal ideation and plans, and actual suicide attempts.

METHODS

This cross-sectional, population-based study involved 27,524 women for analyzing suicidal ideation, 26,893 women for suicidal plans, 28,682 women for suicide attempts, registered in the Korea National Health and Nutrition Examination Survey (2010-2022). Data on menopausal status, including age at menopause, and suicidal behavior were obtained from a self-reported questionnaire. A logistic regression model was applied to examine whether premature ovarian insufficiency, early menopause, and normal menopause significantly impact rates of suicidal behavior, which was further stratified by depression. Weighted prevalence of suicidal behavior according to age at menopause was also analyzed.

RESULTS

Compared with premenopausal status, the risk of suicidal ideation was increased in women with premature ovarian insufficiency by an odds ratio (95 % confidence interval) of 1.53 (1.17-2.01), in women with early menopause by 1.57 (1.28-1.92), and in women with clinically normal menopause by 1.17 (1.00-1.37). The risk of suicidal planning was also increased in women in each of these three respective menopausal groups: 1.92 (1.06-3.47), 1.55 (0.96-2.51), and 1.61 (1.13-2.30). The risk of suicide attempt was also increased in women with premature ovarian insufficiency, by an odds ratio of 2.01 (0.91-4.44), and in women with a clinically normal menopause, by 1.97 (1.22-3.18). The weighted prevalence of suicidal ideation decreased with age at menopause, grouped as ≤30 (21.5 %), 31-40 (14.8 %), 41-50 (11.1 %), and ≥50 (9.4 %).

CONCLUSION

The risks of suicidal ideation and planning were higher in women with premature ovarian insufficiency, early menopause, and clinically normal menopause. The risk of suicide attempt was also higher in women with premature ovarian insufficiency and normal menopause, compared with premenopausal women. Younger age at menopause led to a higher risk of suicidal ideation and planning in general. Due to the limitations of this study's cross-sectional design, longitudinal studies must be conducted to establish more strongly this relationship between menopause and suicidal behavior.

Uncovering mediational pathways behind racial and socioeconomic disparities in brain volumes: insights from the UK Biobank study

Mediation pathways explaining racial/ethnic and socioeconomic (SES) disparities in structural MRI markers of brain health remain underexplored. We examined racial/ethnic and SES disparities in sMRI markers and tested total, direct, and indirect effects through lifestyle, health-related, and cognition factors using a structural equations modeling approach among 36,184 UK Biobank participants aged 40-70 years at baseline assessment (47% men). Race (non-White vs. White) and lower SES-predicted poorer brain sMRI volumetric outcomes at follow-up, with racial/ethnic disparities in sMRI outcomes involving multiple pathways and SES playing a central role in those pathways. Mediational patterns differed across outcomes, with the SES-sMRI total effect being partially mediated for all outcomes. Over 20% of the total effect (TE) of race/ethnicity on WMH was explained by the indirect effect (IE), by a combination of different pathways going through SES, lifestyle, health-related, and cognition factors. This is in contrast to < 10% for total brain, gray matter (GM), white matter (WM), and frontal GM left/right. Another significant finding is that around 57% of the total effect for SES and the normalized white matter hyperintensity (WMH) was attributed to an indirect effect. This effect encompasses many pathways that involve lifestyle, health-related, and cognitive aspects. Aside from WMH, the percent of TE of SES mediated through various pathways ranged from ~ 5% for WM to > 15% up to 36% for most of the remaining sMRI outcomes, which are composed mainly of GM phenotypes. Race and SES were important determinants of brain volumetric outcomes, with partial mediation of racial/ethnic disparities through SES, lifestyle, health-related, and cognition factors.

A systematic review of epidemiological studies of life course socioeconomic status and adult structural brain changes

INTRODUCTION

Disadvantaged socioeconomic status (SES) are linked with adverse cognitive outcomes in ageing and heightened dementia risk. Few studies have examined relationships between life course SES and adult structural brain changes that may be associated with cognitive decline.

AIMS

This systematic review assesses evidence from neuroimaging based epidemiological studies that have explored relationships between life course SES and adult structural brain changes.

METHODS

Embase, PsycINFO and Medline from inception to November 2020 were systematically searched according to strict search criteria which captured studies examining relationships between life course SES and adult structural neuroimaging changes. Bibliographies and citations of relevant papers were selected. Searches were limited to English language publications.

RESULTS

Amongst 8134 search results, 91 unique titles were screened and 24 studies selected. All 24 studies demonstrated at least partial relationships between disadvantaged life SES and adverse structural brain changes. Selected studies utilised diverse structural imaging techniques, neuroanatomical sites and operational definitions of life course SES. The methodological approaches and statistical analysis varied significantly between studies. We specifically discuss the neurobiological interpretation of Diffusion weighted MRI based studies and MRI volumetric studies investigating associations between life course SES and adult brain structural changes and the wider global health implications of these studies.

CONCLUSION

Disadvantaged life course SES may have associations with structural brain changes which underlie adverse ageing outcomes. Given heterogeneity of study designs and operationalisation of SES, the cross-sectional design of studies and wide-ranging neuroimaging modalities any association should be considered with caution. Mediatory mechanisms including malnutrition, stress, markers of inflammation, hormonal changes and cognitive reserve and health behaviour are presented in selected studies. Targeting life course SES in public health-based interventions may offer approaches to maintain healthy brain structure and function in ageing.

Annual Research Review: Exposure to environmental chemicals and psychosocial stress and the development of children's learning difficulties

Although awareness of the role of environmental exposures in children's cognitive development is increasing, learning difficulties have not yet been a major focus of environmental health science. Learning difficulties disproportionately affect children living in economic disadvantage, yielding an 'achievement gap.' Studies examining the neurobiology of reading and math have mostly included economically advantaged youth, leaving a great deal unknown about the neural underpinnings of reading and math difficulties in youth living in disadvantaged contexts. Critically, due to environmental injustice, these youth are disproportionately exposed to environmental neurotoxicants. Herein, we review literature supporting a theoretical framework of environmentally associated phenotypes of learning difficulties. We propose that prenatal exposure to neurotoxicants and early-life exposure to psychosocial stressors increases risk for learning difficulties via effects on neural circuits that support cognitive processes which, in addition to literacy and numeracy, are integral to acquiring and performing academic skills. We describe models in which (1) prenatal exposure to air pollution has a main effect on learning via brain structure and function or associated domain-general cognitive processes and (2) a joint 'two-hit' pathway in which prenatal air pollution exposure followed by early life stress-when combined and sequential-increases risk for learning difficulties also via effects on brain structure, function, and/or associated cognitive processes. We review a select literature documenting effects of exposure to pollutants and early life stress on relevant neural circuits and associated cognitive processes in animal models and parallel findings in human epidemiologic studies. We advocate for team science in which researchers, practitioners, and policymakers collaborate to increase health literacy about environmentally associated phenotypes of learning difficulties and support the development of precision-oriented instructional and environmental intervention methods for youth living in economic disadvantage.

Dyadic Comparison of Pain and Stress in Alzheimer's Disease and Caregivers

BACKGROUND

Millions of people live with dementia worldwide, relying heavily on family caregivers. Pain is common in both people living with Alzheimer's disease (PLWAD) and their caregivers, contributing to stress and burden. To our knowledge, this is the first study to examine the relationship between pain, stress, hair cortisol, and mental health in PLWAD and their caregivers and how these factors are linked to caregiver burden.

METHODS

This exploratory pilot study included five PLWAD-caregiver dyads. Participants completed questionnaires on pain, mental health, and demographics. Hair samples were collected for cortisol analysis. Pearson correlation coefficients (r) were used to assess relationships between various factors of PLWAD and their caregivers.

RESULTS

Contrary to expectations, pain and mental health measures for PLWAD displayed a trend toward negative correlation with their hair cortisol levels. Conversely, caregiver pain and mental health measures had a trend toward positive correlation with their hair cortisol levels. There was also a trend that higher pain in PLWAD was associated with higher caregiver burden.

CONCLUSION

This exploratory pilot study showed associational trends suggesting a complex relationship between pain, mental health, and stress in PLWAD-caregiver dyads. This preliminary work will inform future studies that can help advance targeted, tailored interventions.

Genetic, Epigenetic, and Hormonal Regulation of Stress Phenotypes in Major Depressive Disorder: From Maladaptation to Resilience

Major Depressive Disorder (MDD) is a complex psychiatric disorder with varied molecular mechanisms underlying its aetiology, diagnosis, and treatment. This review explores the crucial roles of stress, genetics, epigenetics, and hormones in shaping susceptibility and resilience to mood disorders. We discuss how acute stress can be beneficial, while prolonged stress disrupts brain function, leading to MDD. The review also highlights the significance of various animal models in understanding depression pathophysiology, including zebrafish, mice, and rats, which exhibit distinct sex differences in stress responses. Furthermore, we delve into the molecular bases of susceptible and resilient phenotypes, focusing on genetic aspects such as gene polymorphisms, mutations, and telomere length alterations. The review also examines epigenetic aspects including DNA methylation, histone acetylation and deacetylation, histone methylation and HMTs, and miRNA, which contribute to the development of MDD. Additionally, we explore the role of hormones such as estrogen, progesterone, and prolactin in modulating stress responses and influencing MDD susceptibility and resilience. Finally, we discuss the clinical implications of these findings, including recent clinical methods for determining MDD susceptibility and resiliency phenotypes. By consolidating the current knowledge and insights, this review aims to provide a comprehensive understanding of the molecular basis of susceptibility and resilience in mood disorders, contributing to the ongoing efforts in combating this debilitating disorder.

Comparison of vitamin B levels in febrile children with and without febrile seizures: A prospective single-center study

Febrile seizures (FS) are among the most common neurological disorders in childhood, and their pathogenesis may be influenced by multiple factors. As scientific research progresses, the significant role of B vitamins in the nervous system has become progressively clearer. In this study, children clinically diagnosed with FS were selected as the experimental group, and febrile children without a history of convulsions or a family history of seizures were selected as the control group to investigate the potential correlation between FS and whole-blood B vitamin levels. The concentrations of B vitamins in whole blood were measured using liquid chromatography-mass spectrometry, and statistical analyses were conducted using SPSS 25.0, followed by significance testing. The levels of vitamins B1, B2, B5, B6, B7, and B12 in the experimental group were significantly higher than those in the control group, particularly vitamins B5 and B7 (P < .05). Additionally, statistically significant differences were observed between sodium and calcium ion levels. These results suggest that febrile convulsions are the complex outcome of multiple factors, including known ion channel defects. Vitamin B may play a role in febrile convulsions and warrants further investigation.

On the role of epigenetic modifications of HPA axis in posttraumatic stress disorder and resilience

Stress is a fundamental adaptive response that invokes amygdala and hypothalamus-pituitary-adrenal (HPA) axis along with other brain regions. Extreme or chronic stress, however, can result in a multitude of neuropsychiatric disorders, including anxiety, paranoia, bipolar disorder (BP), major depressive disorder (MDD), and posttraumatic stress disorder (PTSD). Despite widespread exposure to trauma (70.4%), the incidence of PTSD is relatively low (6.8%), suggesting that either individual susceptibility or adaptability driven by epigenetic and genetic mechanisms are likely at play. PTSD takes hold from exposure to traumatic events, such as death threats or severe abuse, with its severity being impacted by the magnitude of trauma, its frequency, and the nature. This comprehensive review examines how traumatic experiences and epigenetic modifications in hypothalamic-pituitary axis (HPA), such as DNA methylation, histone modifications, noncoding RNAs, and chromatin remodeling, are transmitted across generations, and impact genes such as FKBP prolyl isomerase 5 (FKBP5), nuclear receptor subfamily 3 group C member 1 (NR3C1), brain-derived neurotrophic factor (BDNF), and solute carrier family 6 member 4 (SLC6A4). It also provides a comprehensive overview on trauma reversal, resilience mechanisms, and pro-resilience factors such as histone acetyltransferases (HATs)/histone deacetylases (HDACs) ratio, dehydroepiandrosterone (DHEA)/cortisol ratio, testosterone levels, and neuropeptide Y, thus highlighting potential therapeutic approaches for trauma-related disorders. The studies highlighted here underscore the narrative, for the first time, that the examination and treatment of PTSD and other depressive disorders must invoke a multitude of approaches to seek out the most effective and personalized strategies. We also hope that the discussion emanating from this review will also inform government policies directed toward intergenerational trauma and PTSD.

Relationship between dietary diversity, eating behavior, and cognitive performance in economically disadvantaged school children

OBJECTIVE

The effect of dietary diversity and eating behavior on attention, and concentration among children lacking in resources is unclear. We aim to investigate the association between dietary diversity, eating behavior, and cognitive abilities among economically disadvantaged children at high risk of cognitive impairment.

METHODS

This study enrolled 676 children aged 10-12 years from 16 free academic tutoring centers across Taiwan. Demographic and dietary behavior data were collected through self-administered questionnaires. Cognitive abilities, specifically attention and concentration, were assessed using the following validated tools: The Attention Test for Elementary School Children and the Concentration Questionnaire.

RESULTS

Those who reported poor concentration and attention tend to have a higher prevalence of obesity. After adjustment for confounding variables by general linear model, a significant positive correlation was identified between dietary diversity score (DDS) and classroom concentration score (regression coefficient (β) = 0.24; P < 0.0001). Conversely, the frequency of unhealthy food intake exhibited a negative correlation with concentration (β: -0.09; P = 0.025). Moreover, a negative correlation was observed between the frequency of instant food intake and the attention (β: -0.08; P = 0.04) and concentration scores (β: -0.09; P = 0.026).

CONCLUSIONS

Enhancing dietary diversity and reducing unfavorable food intake may improve cognitive performance in socioeconomically disadvantaged children.

Neuroscience-based relational art therapy and deep brain reorienting in the treatment of dissociative identity disorder

Art therapy (AT) has been proposed as a treatment for post-traumatic conditions, potentially by providing somatic sensory input that can (i) enhance the client's sense of self and embodiment, (ii) modulate arousal, and (iii) aid in rethinking and reframing traumatic memories. However, evidence supporting AT as a treatment for dissociative disorders remains limited. The theoretical basis for the efficacy of AT is discussed in relation to findings regarding the traumatized person's brain and mindset, as well as its altered functional network connectivity. It is crucial to consider specific alterations in brain networks associated with trauma, particularly those occurring in the deep brain regions, which include the midbrain, the brainstem, and the cerebellum. The hypothesis suggests that early or severe trauma can impair the brain's higher regulatory functions, as explained by the cascade theory. This theory explains how diverse activation patterns within the midbrain's periaqueductal gray (PAG) of the midbrain influence the limbic system and cortices, thereby modulating states of being and behavior. Phase-specific, resource-oriented, and long-term therapy for complexly traumatized and dissociative individuals can benefit from novel insights from neuroimaging studies to inform and enhance therapeutic methods. This is illustrated in a clinical vignette with a client diagnosed with dissociative identity disorder (DID), where deep brain reorienting (DBR) was combined with relational AT. The AT component is hypothesized to have facilitated a sense of grounding in the present moment and enhanced the client's access to her neurophenomenological self. Moreover, changes may have occurred at implicit and non-verbal levels. DBR is believed to have helped the client remain present with her previously avoided and unbearable internal experience. To validate these assumptions, the second author conducted a semi-structured interview that focused on the client's experiences of being dissociative and in psychotherapy, including the effect of DBR when introduced after AT. The client's experiences were articulated through a thematic analysis of the interview, which yielded the following themes: Loneliness, getting help, and moving towards togetherness. Further research on and development of therapy methods that enhance the neuroplasticity necessary for highly dissociative clients to change and heal are highly recommended.

Biological embodiment of educational attainment and future risk of breast cancer: findings from a French prospective cohort

BACKGROUND

Women with higher educational attainment have a higher risk of developing breast cancer (BC). Despite the acknowledged impact of reproductive and lifestyle factors, some excess risks remain unexplained. Many studies support the hypothesis that education has a distinctive effect on physiological processes associated with health, independently of known risk factors.

OBJECTIVES

In this study, we aimed to determine whether the biological embodiment of education could be part of the observed social inequalities in BC risk. We focused on biomarkers from several physiological systems examined individually, and jointly through a biological health score (BHS).

DESIGN

Prospective cohort study.

SETTING

This study, based on a subsample of the French E3N cohort, included women with biological data from four nested case-control studies.

PARTICIPANTS

The study included 3048 postmenopausal women (17% BC).

MAIN OUTCOME MEASURES

We first evaluated the association between educational attainment and each biomarker, separately (N=11) and by combining them into a BHS, indicative of an augmented biological health hazard when elevated. Finally, we explored the relationships between the socially patterned biomarkers and BHS, and risk of incident BC.

RESULTS

Women with higher educational attainment exhibited a lower BHS in comparison to those with lower educational attainment (βhigh education=-0.21 (95% CI -0.42; 0.01), model 2). Specific biomarkers associated with the cardiovascular (systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), high-density lipoprotein (HDL)), inflammatory (C reactive protein (CRP)) and hormonal systems (sex hormone-binding globulin (SHBG) and oestradiol) were found socially distributed (OR CRP-high=0.70 (95% CI 0.54; 0.91), OR TG-high=0.79 (95% CI 0.61; 1.04), OR DBP-high=0.69 (95% CI 0.53; 0.90), OR SBP-high=0.57 (95% CI 0.44; 0.74), OR HDL-high=0.79 (95% CI 0.60; 1.03), (OR SHBG-high=0.67 (95% CI 0.52; 0.88), OR oestradiol-high=1.34 (95% CI 1.00; 1.79); model 1). Associations persisted after adjustment for cofounders and a large set of potential mediators for two of the investigated cardiovascular markers (OR DBP-high=0.75 (95% CI 0.57; 1.00), OR SBP-high=0.61 (95% CI 0.46; 0.81); model 2). No associations were found between the socially stratified biomarkers and BHS with risk of BC.

CONCLUSION

Educational attainment has a direct impact on biological processes suggesting that the biological embodiment of the social environment could be a potential pathway that mediates the association between educational attainment and health. Further studies are needed to specifically investigate the relationships between socially stratified biomarkers and BC risk.

Hypothalamus-pituitary-adrenal and gut-brain axes in biological interaction pathway of the depression

The hypothalamus-pituitary-adrenal (HPA) and gut-brain axes are vital biological pathways in depression. The HPA axis regulates the body's stress response, and chronic stress can lead to overactivation of the HPA axis, resulting in elevated cortisol levels that contribute to neuronal damage, particularly in regions such as the hippocampus and prefrontal cortex, both of which are involved in mood regulation and mental disorders. In parallel, the gut-brain axis, a bidirectional communication network between the gut microbiota and the central nervous system, influences emotional and cognitive functions. Imbalances in gut microbiota can affect the HPA axis, promoting inflammation and increasing gut permeability. This allows endotoxins to enter the bloodstream, contributing to neuroinflammation and altering neurotransmitter production, including serotonin. Since the majority of serotonin is produced in the gut, disruptions in this pathway may be linked to depressive symptoms. This review explores the interplay between the HPA axis and the gut-brain axis in the context of depression.

Maternal Immune Activation and Child Brain Development: A Longitudinal Population-Based Multimodal Neuroimaging Study

BACKGROUND

Maternal immune activation (MIA) has been hypothesized to have an adverse effect on child neurodevelopment, but only a few neuroimaging studies have been performed to date, mostly in neonates. In this population-based cohort study, we investigated the association between MIA and multiple neuroimaging modalities depicting brain development from childhood to adolescence.

METHODS

We used data of mother-child pairs from the Generation R Study. To define our exposure, we measured interleukin (IL) 1β, IL-6, IL-17a, IL-23, interferon gamma, and C-reactive protein at 2 time points during pregnancy. Because levels of these 5 cytokines were highly correlated, we were able to compute a cytokine index. We used multiple brain imaging modalities as outcomes, including global and regional measures of brain morphology (structural magnetic resonance imaging, volume; n = 3295), white matter microstructure (diffusion magnetic resonance imaging, fractional anisotropy and mean diffusivity; n = 3267), and functional connectivity (functional magnetic resonance imaging, graph theory measures, and network-level connectivity; n = 2914) in the children at ages 10 and 14 years. We performed mixed effects models using child's age as a continuous time variable.

RESULTS

We found no significant effect of time on any neuroimaging outcomes in children over time, and there was no time × MIA interaction. These associations were similar for the cytokine index, C-reactive protein, and individual cytokines. We observed no evidence for differential effects of timing of prenatal MIA or child sex after multiple testing correction.

CONCLUSIONS

In this longitudinal population-based study, we found no evidence for an association between MIA and child brain development in the general population. Our findings differ from previous research in neonates that have shown structural and functional brain abnormalities after MIA.

Socioeconomic Factors in Brain Research: Increasing Sample Representativeness with Portable MRI

People of low socioeconomic status (SES) are often underrepresented in biomedical research. The importance of demographically diverse research samples is widely recognized, especially given socioeconomic disparities in health, but have been challenging to achieve. One barrier to research participation by low SES individuals is their distance from research centers and the difficulty of traveling. This article examines the promise of portable magnetic resonance imaging (pMRI) for enrolling participants of diverse SES in structural neuroimaging studies, and anticipates some of the challenges, practical and ethical, that may arise in the course of such research.

Pituitary adenylyl cyclase-activating polypeptide modulates the stress response: the involvement of different brain areas and microglia

Stress is necessary for survival. However, chronic unnecessary stress exposure leads to cardiovascular, gastrointestinal and neuropsychiatric disorders. Thus, understanding the mechanisms involved in the initiation and maintenance of the stress response is essential since it may reveal the underpinning pathophysiology of these disorders and may aid in the development of medication to treat stress-mediated diseases. Pituitary adenylyl cyclase activating polypeptide (PACAP) and its receptors (PAC1, VPAC1 and VPAC2) are expressed in the hypothalamus and other brain areas as well as in the adrenal gland. Previous research has shown that this peptide/receptor system serves as a modulator of the stress response. In addition to modulating the stress response, this system may also be connected to its emerging role as neuroprotective against hypoxia, ischemia, and neurodegeneration. This article aims to review the literature regarding the role of PACAP and its receptors in the stress response, the involvement of different brain regions and microglia in PACAP-mediated modulation of the stress response, and the long-term adaptation to stress recognizable clinically as survival with resilience while manifested in anxiety, depression and other neurobehavioral disorders.

Improving brain health via the central executive network

Cognitive and physical stress have significant effects on brain health, particularly through their influence on the central executive network (CEN). The CEN, which includes regions such as the dorsolateral prefrontal cortex, anterior cingulate cortex and inferior parietal lobe, is central to managing the demands of cognitively challenging motor tasks. Acute stress can temporarily reduce connectivity within the CEN, leading to impaired cognitive function and emotional states. However a rebound in these states often follows, driven by motivational signals through the mesocortical and mesolimbic pathways, which help sustain inhibitory control and task execution. Chronic exposure to physical and cognitive challenges leads to long-term improvements in CEN functionality. These changes are supported by neurochemical, structural and systemic adaptations, including mechanisms of tissue crosstalk. Myokines, adipokines, anti-inflammatory cytokines and gut-derived metabolites contribute to a biochemical environment that enhances neuroplasticity, reduces neuroinflammation and supports neurotransmitters such as serotonin and dopamine. These processes strengthen CEN connectivity, improve self-regulation and enable individuals to adopt and sustain health-optimizing behaviours. Long-term physical activity not only enhances inhibitory control but also reduces the risk of age-related cognitive decline and neurodegenerative diseases. This review highlights the role of progressive physical stress through exercise as a practical approach to strengthening the CEN and promoting brain health, offering a strategy to improve cognitive resilience and emotional well-being across the lifespan.

The Mind Under Pressure: What Roles Does Education Play in the Relationship Between Chronic Stress and Cognitive Ability?

Chronic stress is an important predictor of mental and physical health, but little is known about its association with cognitive abilities and education during the lifespan. We hypothesized that chronic stress would be negatively correlated with cognitive abilities, particularly crystallized intelligence, and that this association would be stronger among individuals with lower educational attainment due to limited stress-coping resources. We used cross-sectional data from the German National Educational Panel Study (NEPS SC6), comprising 10,416 adults aged 29 to 71 years (50.80% female; 49.20% male). Fluid and crystallized intelligence were assessed with a reasoning test and a vocabulary test, respectively; chronic stress was assessed with a questionnaire on social stress and anxiety. The tests and the questionnaire were conceptualized for a heterogeneous and large-scale sample. Our results show small negative associations between chronic stress and both fluid and crystallized cognitive abilities, which persist after controlling for demographic variables. However, there were no significant differences between educational groups. Although the study does not address longitudinal patterns, it highlights the complex interaction between stress and cognition, and it underscores the need for further research to explore how educational resources may mitigate the impact of chronic stress on cognitive health.

Sex in aging matters: exercise and chronic stress differentially impact females and males across the lifespan

Assessing sex as a biological variable is critical to determining the influence of environmental and lifestyle risks and protective factors mediating behavior and neuroplasticity across the lifespan. We investigated sex differences in affective behavior, memory, and hippocampal neurogenesis following short- or long-term exposure to exercise or chronic mild stress in young and aged mice. Male and female mice were assigned control, running, or chronic stress rearing conditions for 1 month (young) or for 15 months (aged), then underwent a behavioral test battery to assess activity, affective behavior, and memory. Stress exposure into late-adulthood increased hyperactivity in both sexes, and enhanced anxiety-like and depressive-like behavior in aged female, but not male, mice. One month of stress or running had no differential effects on behavior in young males and females. Running increased survival of BrdU-labelled hippocampal cells in both young and aged mice, and enhanced spatial memory in aged mice. These findings highlight the importance of considering sex when determining how aging is differently impacted by modifiable lifestyle factors across the lifespan.

The elevated open platform stress suppresses excitatory synaptic transmission in the layer V anterior cingulate cortex

There are various forms of stress including; physical, psychological and social stress. Exposure to physical stress can lead to physical sensations (e.g. hyperalgesia) and negative emotions including anxiety and depression in animals and humans. Recently, our studies in mice have shown that acute physical stress induced by the elevated open platform (EOP) can provoke long-lasting mechanical hypersensitivity. This effect appears to be related to activity in the anterior cingulate cortex (ACC) at the synaptic level. Indeed, EOP exposure induces synaptic plasticity in layer II/III pyramidal neurons from the ACC. However, it is still unclear whether or not EOP exposure alters intrinsic properties and synaptic transmission in layer V pyramidal neurons. This is essential because these neurons are known to be a primary output to subcortical structures which may ultimately impact the behavioral stress response. Here, we studied both intrinsic properties and excitatory/inhibitory synaptic transmission by using whole-cell patch-clamp method in brain slice preparations. The EOP exposure did not change intrinsic properties including resting membrane potentials and action potentials. In contrast, EOP exposure suppressed the frequency of miniature and spontaneous excitatory synaptic transmission with an alteration of kinetics of AMPA/GluK receptors. EOP exposure also reduced evoked synaptic transmission induced by electrical stimulation. Furthermore, we investigated projection-selective responses of the mediodorsal thalamus to the layer V ACC neurons. EOP exposure produced short-term depression in excitatory synaptic transmission on thalamo-ACC projections. These results suggest that the EOP stress provokes abnormal excitatory synaptic transmission in layer V pyramidal neurons of the ACC.

Anticipatory Violence and Health Among Black Adults in the United States

This study analyzes the relationship between anticipatory community and police violence and health outcomes including mental and physical well-being, sleep problems, and functional disability. Using data from a nationally representative survey of 3015 self-identified Black and African American adults in the USA collected in 2023, findings from a series of regression analyses reveal that anticipating community violence is linked to poorer self-rated health and increased sleep problems. Anticipatory police violence is associated with poorer physical health and sleep disturbances. These associations persist even after accounting for previous experiences of violence. The results underscore the potential health consequences of anticipating violence, suggesting that the fear of personal victimization can adversely influence health. Addressing anticipatory violence through trauma-informed public health policies and practices is critical for improving health outcomes and reducing disparities in violence-exposed communities. Future research should explore longitudinal impacts and extend analyses to additional racial groups and health outcomes.

Dimensions of Early-Life Adversity Are Differentially Associated With Patterns of Delayed and Accelerated Brain Maturation

BACKGROUND

Different types of early-life adversity (ELA) have been associated with children's brain structure and function. However, understanding the disparate influence of distinct adversity exposures on the developing brain remains a major challenge.

METHODS

This study investigates the neural correlates of 10 robust dimensions of ELA identified through exploratory factor analysis in a large community sample of youth from the Adolescent Brain Cognitive Development Study. Brain age models were trained, validated, and tested separately on T1-weighted (n = 9524), diffusion tensor (n = 8834), and resting-state functional (n = 8233) magnetic resonance imaging data from two time points (mean age = 10.7 years, SD = 1.2, age range = 8.9-13.8 years).

RESULTS

Bayesian multilevel modeling supported distinct associations between different types of ELA exposures and younger- and older-looking brains. Dimensions generally related to emotional neglect, such as lack of primary and secondary caregiver support and lack of caregiver supervision, were associated with lower brain age gaps, i.e., younger-looking brains. In contrast, dimensions generally related to caregiver psychopathology, trauma exposure, family aggression, substance use and separation from biological parent, and socioeconomic disadvantage and neighborhood safety were associated with higher brain age gaps, i.e., older-looking brains.

CONCLUSIONS

The findings suggest that dimensions of ELA are differentially associated with distinct neurodevelopmental patterns, indicative of dimension-specific delayed and accelerated brain maturation.

Trauma-Informed Strategies in Pediatric Primary Care

Child trauma, particularly within the context of the caregiving relationship, can have profound impacts on health, thus pediatric clinicians have a crucial role in recognizing and responding to trauma. Yet, trauma-informed care (TIC) is often described by its guiding principles rather than an approach to implementation. TIC requires the pediatric clinician to not only be familiar with the physiology of trauma, but actively promote resilience and employ strategies for primary prevention, secondary response and tertiary treatment of trauma. This study covers practical approaches to care that allow for promoting resilience, and the recognition, diagnosis and management of trauma.

Exploring the Potential of Probiotics and Prebiotics in Major Depression: From Molecular Function to Clinical Therapy

Major depressive disorder (MDD) represents a complex and challenging mental health condition with multifaceted etiology. Recent research exploring the gut-brain axis has shed light on the potential influence of gut microbiota on mental health, offering novel avenues for therapeutic intervention. This paper reviews current evidence on the role of prebiotics and probiotics in the context of MDD treatment. Clinical studies assessing the effects of prebiotic and probiotic interventions have demonstrated promising results, showcasing improvements in depression symptoms and metabolic parameters in certain populations. Notably, prebiotics and probiotics have shown the capacity to modulate inflammatory markers, cortisol levels, and neurotransmitter pathways linked to MDD. However, existing research presents varied outcomes, underscoring the need for further investigation into specific microbial strains, dosage optimization, and long-term effects. Future research should aim at refining personalized interventions, elucidating mechanisms of action, and establishing standardized protocols to integrate these interventions into clinical practice. While prebiotics and probiotics offer potential adjunctive therapies for MDD, continued interdisciplinary efforts are vital to harnessing their full therapeutic potential and reshaping the landscape of depression treatment paradigms.

Cocoa flavanols rescue stress-induced declines in endothelial function after a high-fat meal, but do not affect cerebral oxygenation during stress in young, healthy adults

Food choices during stressful periods often worsen, which can influence the impact of stress on vascular health. For instance, fat consumption impairs the recovery of endothelial function following mental stress, while flavanols have been shown to enhance recovery. This randomised, counterbalanced, double-blinded, crossover, postprandial intervention study examined whether flavanols consumed in combination with fat can mitigate the negative impact of fat on stress-induced impairments in endothelial function. Twenty-three young, healthy males and females ingested a high-fat meal (56.5 g fat) with high-flavanol (150 mg (-)-epicatechin) or low-flavanol (<6 mg (-)-epicatechin) cocoa 1.5 hours before an 8-minute mental stress task. The primary outcome, brachial flow-mediated dilatation (FMD), was assessed at pre-intervention baseline and 30 and 90 minutes post-stress. Pre-frontal cortical oxygenation was assessed post-meal at rest and during stress. Forearm blood flow (FBF), blood pressure (BP), cardiovascular activity, common carotid artery (CCA) diameter and blood flow and mood were assessed before, during and/or after stress. FMD was impaired at 30 and 90 minutes post-stress after the low-flavanol cocoa. High-flavanol cocoa attenuated FMD impairments at 30 minutes and improved FMD at 90 minutes post-stress. Mental stress induced similar increases in cortical oxygenation, FBF, BP, cardiovascular activity, and disruptions to mood, in both conditions. CCA diameter increased and CCA retrograde blood flow decreased post-stress, with no difference between conditions. In summary, flavanols can counteract declines in endothelial function induced by consuming fat in the context of stress, but do not impact cerebral oxygenation. These findings can have important implications for flavanol-rich dietary choices to protect the vasculature from stress.

Investigating Serum Cortisol Dynamics and Cardiovascular Impacts Amid University Exam Stress: A Pre-Post Cohort Study

Objective

Our objective was to investigate the perceived stress levels among pharmacy students enrolled at the University of Duhok both prior to and following examination periods, with a concurrent assessment of potential cardiovascular effects.

Methods

The study included 49 participants from the College of Pharmacy at the University of Duhok and utilized a pre-post cohort design. High-stress pre-examination assessments were scheduled at 8:30 AM on the day of the examination, and low-stress post-examination assessments were also conducted at 8:30 AM over a two-week period without academic examinations.

Results

The pre-exam serum cortisol level was significantly higher compared to the post-exam period (16.66 vs. 14.04 μg/dL; p = 0.013). Elevated levels of non-high-density lipoprotein (HDL) cholesterol, and cholesterol/HDL ratio were recorded during high-stress periods. Remarkably, social media emerged as the sole significant predictor (p = 0.038) with a negative impact on serum cortisol levels during the pre-exam phase. Additionally, we observed that females had higher stress levels during both periods, as indicated by the regression model.

Conclusions

This investigation revealed a significant elevation in serum cortisol levels during the pre-examination phase, likely attributable to the stress induced by impending examinations.

Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

BACKGRUOUND

Social determinants of health (SDOH) have been associated with diabetes risk; however, their association with cardiovascular disease (CVD) events in individuals with diabetes is poorly described. We hypothesized that a greater number of SDOH among individuals with diabetes would be associated with a higher risk of CVD events.

METHODS

The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national, biracial cohort of 30,239 individuals ≥45 years old recruited in 2003-2007. We included 6,322 participants with diabetes at baseline, defined as healthcare professional diagnosis, diabetes medication use, or blood glucose values. Seven SDOH that were individually associated with CVD events were included (P<0.20). The outcome was CVD events, a composite of expert-adjudicated myocardial infarction, stroke, or cardiovascular death. We estimated Cox proportional hazard models to examine associations between number of SDOH (0, 1, 2, ≥3) and CVD events.

RESULTS

In an age and sex adjusted model, the presence of multiple SDOH significantly increased the risk of any CVD event (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.26 to 1.74 for two SDOH; HR, 1.68; 95% CI, 1.43 to 1.96 for ≥3 SDOH). This finding was attenuated but remained statistically significant in a fully adjusted model (HR, 1.19; 95% CI, 1.01 to 1.40 for two SDOH; HR, 1.27; 95% CI, 1.07 to 1.50 for ≥3 SDOH).

CONCLUSION

Having multiple SDOH was independently associated with an increased risk of CVD events, a finding driven by cardiovascular death. Identifying individuals with diabetes who have multiple SDOH may be helpful for detecting those at higher risk of experiencing or dying from CVD events.

Mapping computational cognitive profiles of aging to dissociable brain and sociodemographic factors

Aging is associated with declines in cognition and brain structural integrity. However, there is equivocality over (1) the specificity of affected domains in different people, (2) the location of associated patterns of brain structural deterioration, and (3) the sociodemographic factors contributing to 'unhealthy' cognition. We aimed to identify cognitive profiles displayed by older adults and determine brain and sociodemographic features potentially shaping these profiles. A sample of Southeast-Asian older adults (N = 386) participated in a multi-session study comprising cognitive testing, neuroimaging, and a structured interview. We used computational models to extract latent mechanisms underlying cognitive flexibility and response inhibition. Data-driven methods were used to construct cognitive profiles based on standard performance measures and model parameters. We also investigated grey matter volume and machine-learning derived 'brain-ages'. A profile associated with poor set-shifting and rigid focusing was associated with widespread grey matter reduction in cognitive control regions. A slow responding profile was associated with advanced brain-age. Both profiles were correlated with poor socioeconomic standing and cognitive reserve. We found that the impact of sociodemographic factors on cognitive profiles was partially mediated by total grey and white matter, and dorsolateral prefrontal and cerebellar volumes. This study furthers understanding of how distinct aging profiles of cognitive impairment uniquely correspond to specific vs. global brain deterioration and the significance of socioeconomic factors in informing cognitive performance in older age.

Effect of Relaxation-Based Virtual Reality on Psychological and Physiological Stress of Substance Abusers Under Detoxification: A Randomized Controlled Trial

INTRODUCTION

Substance abuse is a widespread problem, with high rates of treatment dropout. Stress plays a crucial role in this problem, so innovative interventions with stressed patients can assist them in completing treatment.

METHODS

This study is a randomized controlled trial with 60 participants who have substance abuse disorder undergoing detoxification at a residency facility in Tehran, Iran. Participants were randomly assigned to one of three groups: watching a 360° video of nature, a 360° video of a city environment, or no virtual experience. The intervention was performed only for one session. Psychological stress was measured using the Positive and Negative Affect Schedule and Perceived Stress Scale before and after the intervention. Physiological stress was assessed through respiratory rate, skin conductance, and heart rate recordings during the virtual reality (VR) experience. Data analysis was performed using R software (version 4.2).

RESULTS

Paired t-test results indicated significant psychological differences before and after virtual nature experiences, but not in the control and city groups. The repeated measure ANOVA showed a significant reduction in skin conductance (p < 0.01) and respiratory rate (p < 0.01) scores in the nature group.

CONCLUSION

The findings suggest that VR relaxation could be a potentially beneficial intervention for reducing stress in patients during detoxification.

Neurobiological Implications of Chronic Stress and Metabolic Dysregulation in Inflammatory Bowel Diseases

Chronic stress is a significant factor affecting modern society, with profound implications for both physical and mental health. Central to the stress response is cortisol, a glucocorticoid hormone produced by the adrenal glands. While cortisol release is adaptive in acute stress, prolonged exposure to elevated levels can result in adverse effects. This manuscript explores the neurobiological implications of chronic stress and its impact on metabolic dysregulation, particularly in the context of inflammatory bowel diseases (IBDs). The hypothalamic-pituitary-adrenal (HPA) axis regulates cortisol production, which influences metabolism, immune response, and neurobiology. Elevated cortisol levels are associated with the development and exacerbation of metabolic disorders like IBD and contribute to neurodegenerative processes, including cognitive impairments and increased susceptibility to psychiatric conditions. The interaction between cortisol and its receptors, particularly glucocorticoid receptors, underscores the complexity of these effects. This review aims to elucidate the mechanisms through which chronic stress and cortisol dysregulation impact metabolic health and neurobiological function, providing insights into potential therapeutic strategies for mitigating these effects.

Diverging Effects of Violence Exposure and Psychiatric Symptoms on Amygdala-Prefrontal Maturation During Childhood and Adolescence

BACKGROUND

Violence exposure during childhood and adolescence is associated with increased prevalence and severity of psychopathology. Neurobiological correlates suggest that abnormal maturation of emotion-related brain circuitry, such as the amygdala-prefrontal cortex (PFC) circuit, may underlie the development of psychiatric symptoms after exposure. However, it remains unclear how amygdala-PFC circuit maturation is related to psychiatric risk in the context of violence.

METHODS

In this study, we analyzed individual differences in amygdala-PFC circuit maturity using data collected from the PNC (Philadelphia Neurodevelopmental Cohort) (n = 1133 youths). Neurodevelopment models of amygdala-PFC resting-state functional connectivity were built using deep learning and trained to predict chronological age in typically developing youths (not violence exposed and without a psychiatric diagnosis). Using the brain age gap estimate, an index of relative circuit maturation, patterns of atypical neurodevelopment were investigated.

RESULTS

Violence exposure was associated with delayed maturation of basolateral amygdala (BLA)-PFC circuits, driven by increased BLA-medial orbitofrontal cortex functional connectivity. In contrast, increased psychiatric symptoms were associated with advanced maturation of BLA-PFC functional connectivity, driven by decreased BLA-dorsolateral PFC functional connectivity.

CONCLUSIONS

Delayed frontoamygdala maturation after exposure to violence suggests atypical, but adaptive, development of threat appraisal processes, potentially reflecting a greater threat generalization characteristic of younger children. Advanced circuit maturation with increasing symptoms suggests divergent neurodevelopmental mechanisms underlying illness after emotion circuits have adapted to adversity, exacerbated by preexisting vulnerabilities to early maturation. Disentangling the effects of adversity and psychopathology on neurodevelopment is crucial for helping youths recover from violence and preventing illness from continuing into adulthood.

Enduring Neurobiological Consequences of Early-Life Stress: Insights from Rodent Behavioral Paradigms

Stress profoundly affects physical and mental health, particularly when experienced early in life. Early-life stress (ELS) encompasses adverse childhood experiences such as abuse, neglect, violence, or chronic poverty. These stressors can induce long-lasting changes in brain structure and function, impacting areas involved in emotion regulation, cognition, and stress response. Consequently, individuals exposed to high levels of ELS are at an increased risk for mental health disorders like depression, anxiety, and post-traumatic stress disorders, as well as physical health issues, including metabolic disorders, cardiovascular disease, and cancer. This review explores the biological and psychological consequences of early-life adversity paradigms in rodents, such as maternal separation or deprivation and limited bedding or nesting. The study of these experimental models have revealed that the organism's response to ELS is complex, involving genetic and epigenetic mechanisms, and is associated with the dysregulation of physiological systems like the nervous, neuroendocrine, and immune systems, in a sex-dependent fashion. Understanding the impact of ELS is crucial for developing effective interventions and preventive strategies in humans exposed to stressful or traumatic experiences in childhood.

Racial/ethnic disparities in chronic wounds: Perspectives on linking upstream factors to health outcomes

This review explores the complex relationship between social determinants of health and the biology of chronic wounds associated with diabetes mellitus, with an emphasis on racial/ethnic disparities. Chronic wounds pose significant healthcare challenges, often leading to severe complications for millions of people in the United States, and disproportionally affect African American, Hispanic, and Native American individuals. Social determinants of health, including economic stability, access to healthcare, education, and environmental conditions, likely influence stress, weathering, and nutrition, collectively shaping vulnerability to chronic diseases, such as obesity and DM, and an elevated risk of chronic wounds and subsequent lower extremity amputations. Here, we review these issues and discuss the urgent need for further research focusing on understanding the mechanisms underlying racial/ethnic disparities in chronic wounds, particularly social deprivation, weathering, and nutrition, to inform interventions to address these disparities.

Machine Learning, Deep Learning, and Data Preprocessing Techniques for Detecting, Predicting, and Monitoring Stress and Stress-Related Mental Disorders: Scoping Review

BACKGROUND

Mental stress and its consequent mental health disorders (MDs) constitute a significant public health issue. With the advent of machine learning (ML), there is potential to harness computational techniques for better understanding and addressing mental stress and MDs. This comprehensive review seeks to elucidate the current ML methodologies used in this domain to pave the way for enhanced detection, prediction, and analysis of mental stress and its subsequent MDs.

OBJECTIVE

This review aims to investigate the scope of ML methodologies used in the detection, prediction, and analysis of mental stress and its consequent MDs.

METHODS

Using a rigorous scoping review process with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, this investigation delves into the latest ML algorithms, preprocessing techniques, and data types used in the context of stress and stress-related MDs.

RESULTS

A total of 98 peer-reviewed publications were examined for this review. The findings highlight that support vector machine, neural network, and random forest models consistently exhibited superior accuracy and robustness among all ML algorithms examined. Physiological parameters such as heart rate measurements and skin response are prevalently used as stress predictors due to their rich explanatory information concerning stress and stress-related MDs, as well as the relative ease of data acquisition. The application of dimensionality reduction techniques, including mappings, feature selection, filtering, and noise reduction, is frequently observed as a crucial step preceding the training of ML algorithms.

CONCLUSIONS

The synthesis of this review identified significant research gaps and outlines future directions for the field. These encompass areas such as model interpretability, model personalization, the incorporation of naturalistic settings, and real-time processing capabilities for the detection and prediction of stress and stress-related MDs.

Brain Glucose Metabolism and COMT Val 158 Met Polymorphism in Female Patients with Work-Related Stress

Stress is a ubiquitous challenge in modern societies. Symptoms range from mood swings and cognitive impairment to autonomic symptoms. This study explores the link between work-related stress and the neurobiological element of brain processing, testing the hypothesis that patients with occupational stress have altered cerebral glucose consumption compared to healthy controls. The participants' present conditions were evaluated using an adapted WHO SCAN interview. Neural activity at rest was assessed by positron emission tomography (PET) with the glucose analogue [18F]fluorodeoxyglucose. Participants were genotyped for the Val158Met polymorphism of the COMT gene, believed to influence stress resilience. This study included 11 women with work-related stress and 11 demographically comparable healthy controls aged 28-62 years, with an average of 46.2 years. The PET scans indicated clusters of decreased glucose consumption primarily located in the white matter of frontal lobe sub-gyral areas in stress patients. COMT Val158Met polymorphism detection indicated no immediate relation of the homozygous alleles and stress resilience; however, healthy controls mainly had the heterozygous allele. In conclusion, the results support that work-related stress does affect the brain in the form of altered glucose metabolism, suggesting neurobiological effects could be related to white matter abnormalities rather than gray matter deterioration. Genotyping indicates a more complex picture than just that of the one type being more resilient to stress. Further studies recruiting a larger number of participants are needed to confirm our preliminary findings.

The effect of stress on the antibody response after vaccination in children aged 0-18 years: A systematic review

Stress has been associated with less effective vaccine responses in adults. This review aims to investigate the evidence for a similar association in children. A systematic review search was conducted in January 2021 in three databases: Medline, Embase and PsycInfo. An updated search of the Medline database was systematically conducted until the most recent update on September 25th, 2023, to ensure the inclusion of the most current research available. Keywords related to stress, vaccines and children were used, and a total of 7263 (+1528) studies were screened by two independent investigators. Six studies met the inclusion criteria for data extraction and analysis. For quality assessment of the studies, the risk of bias in non-randomized studies-of interventions (ROBINS-I) tool was applied. Most of the studies suggest a negative role of stress on vaccine responses. However, the scarcity of studies, lack of confirmatory studies, risk of bias and heterogeneity according to age, type of vaccine, measures of stress and vaccine responses prevent a clear conclusion. Future studies should emphasize the use of as strict study designs as possible, including well-defined stress metrics and thorough examination of both pre- and post-vaccination responses. Systematic review registration: Prospero CRD42021230490.

Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone

BACKGROUND

The relationships between opioid use disorder (OUD), chronic pain, and mental health distress are complex and multidirectional. The objective of this exploratory study was to examine the relationship between mental health conditions and Chronic pain severity and interference among patients stabilized on either buprenorphine or methadone.

METHODS

We report baseline data from a randomized trial of a mind-body intervention conducted at 5 outpatient clinics that provided either buprenorphine or methadone treatment. Validated scales were used to measure substance use, mental health distress, and pain severity and interference. Statistical analyses examined the relationship between mental health conditions and pain severity and interference.

RESULTS

Of 303 participants, 57% (n = 172) reported Chronic pain. A total of 88% (n = 268) were prescribed buprenorphine. Mental health conditions were common, with one-quarter of the sample screening positive for all 3 mental health conditions (anxiety, depression, and posttraumatic stress disorder [PTSD]). Compared to participants without Chronic pain, participants with Chronic pain were more likely to screen positive for moderate-severe anxiety (47% vs 31%); moderate-severe depression (54% vs 41%); and the combination of anxiety, depression, and PTSD (31% vs 18%). Among participants with Chronic pain, mental health conditions were associated with higher pain interference. Pain severity was higher among participants with mental health conditions, but only reached statistical significance for depression. Pain interference scores increased with a higher number of co-occurring mental health conditions.

CONCLUSIONS

Among individuals stabilized on either buprenorphine or methadone, highly symptomatic and comorbid mental health distress is common and is associated with increased pain interference. Adequate screening for, and treatment of, mental health conditions in patients with OUD and Chronic pain is needed.

Structural and functional brain correlates of socioeconomic status across the life span: A systematic review

It is well-established that higher socioeconomic status (SES) is associated with improved brain health. However, the effects of SES across different life stages on brain structure and function is still equivocal. In this systematic review, we aimed to synthesise findings from life course neuroimaging studies that investigated the structural and functional brain correlates of SES across the life span. The results indicated that higher SES across different life stages were independently and cumulatively related to neural outcomes typically reflective of greater brain health (e.g., increased cortical thickness, grey matter volume, fractional anisotropy, and network segregation) in adult individuals. The results also demonstrated that the corticolimbic system was most commonly impacted by socioeconomic disadvantages across the life span. This review highlights the importance of taking into account SES across the life span when studying its effects on brain health. It also provides directions for future research including the need for longitudinal and multimodal research that can inform effective policy interventions tailored to specific life stages.

Seven robust and easy to obtain biomarkers to measure acute stress

With the purpose of identifying a sensitive, robust, and easy-to-measure set of biomarkers to assess stress reactivity, we here study a large set of relatively easy to obtain markers reflecting subjective, autonomic nervous system (ANS), endocrine, and inflammatory responses to acute social stress (n = 101). A subset of the participants was exposed to another social stressor the next day (n = 48) while being measured in the same way. Acute social stress was induced following standardized procedures. The markers investigated were self-reported positive and negative affect, heart rate, electrodermal activity, salivary cortisol, and ten inflammatory markers both in capillary plasma and salivary samples, including IL-22 which has not been studied in response to acute stress in humans before. Robust effects (significant effect in the same direction for both days) were found for self-reported negative affect, heart rate, electrodermal activity, plasma IL-5, plasma IL-22, salivary IL-8 and salivary IL-10. Of these seven markers, the participants' IL-22 responses on the first day were positively correlated to those on the second day. We found no correlations between salivary and capillary plasma stress responses for any of the ten cytokines and somewhat unexpectedly, cytokine responses in saliva seemed more pronounced and more in line with previous literature than cytokines in capillary plasma. In sum, seven robust and easy to obtain biomarkers to measure acute stress response were identified and should be used in future stress research to detect and examine stress reactivity. This includes IL-22 in plasma as a promising novel marker.

Accumulating burden: Exposure to interpersonal discrimination based on multiple attributes and allostatic load

Exposure to interpersonal discrimination is an acute type of social stressor. Extant evidence suggests a positive association exists between experiencing interpersonal discrimination and physiological dysregulation measured by allostatic load. However, research to date has overlooked the role of exposure to interpersonal discrimination based on multiple attributes. This is an important oversight because individuals who confront discrimination often accredit the experiences to more than one attribute, which may be associated with increased stress and adverse physiological functioning. Using data from the Wave V biomarker subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health), I investigate the relationship between reports of interpersonal discrimination based on multiple attributes and allostatic load among adults ages 33-44. I also consider the roles of frequency of exposure to discrimination and perceived stress in this relationship through moderation and mediation analyses. Results reveal a positive association between the number of forms of discrimination that individuals report and allostatic load. However, frequency of exposure to discrimination does not moderate this association. Moreover, frequency of discrimination did not mediate the association between the number of forms of discrimination and perceived stress only marginally mediated it. This study offers novel and important insight into the role of exposure to more than one form of discrimination and allostatic load. Given that heightened allostatic load is a precursor to the development of chronic conditions and a strong risk factor for mortality, efforts to reduce discrimination among Americans adults will work to improve physical health.

The neurophysiological consequences of racism-related stressors in Black Americans

Racism-related stressors, from experiences of both implicit and explicit racial discrimination to systemic socioeconomic disadvantage, have a cumulative impact on Black Americans' health. The present narrative review synthesizes peripheral (neuroendocrine and inflammation markers), psychophysiological (heart-rate variability, skin conductance), and neuroimaging (structural and functional) findings that demonstrate unique associations with racism-related stress. Emerging evidence reveals how racism-related stressors contribute to differential physiological and neural responses and may have distinct impacts on regions involved with threat and social processing. Ultimately, the neurophysiological effects of racism-related stress may confer biological susceptibility to stress and trauma-related disorders. We note critical gaps in the literature on the neurophysiological impact of racism-related stress and outline additional research that is needed on the multifactorial interactions between racism and mental health. A clearer understanding of the interactions between racism-related stress, neurophysiology, and stress- and trauma-related disorders is critical for preventative efforts, biomarker discovery, and selection of effective clinical treatments for Black Americans.

Lifetime Stressful Events Associated with Alzheimer's Pathologies, Neuroinflammation and Brain Structure in a Risk Enriched Cohort

OBJECTIVE

Along with the known effects of stress on brain structure and inflammatory processes, increasing evidence suggest a role of chronic stress in the pathogenesis of Alzheimer's disease (AD). We investigated the association of accumulated stressful life events (SLEs) with AD pathologies, neuroinflammation, and gray matter (GM) volume among cognitively unimpaired (CU) individuals at heightened risk of AD.

METHODS

This cross-sectional cohort study included 1,290 CU participants (aged 48-77) from the ALFA cohort with SLE, lumbar puncture (n = 393), and/or structural magnetic resonance imaging (n = 1,234) assessments. Using multiple regression analyses, we examined the associations of total SLEs with cerebrospinal fluid (1) phosphorylated (p)-tau181 and Aβ1-42/1-40 ratio, (2) interleukin 6 (IL-6), and (3) GM volumes voxel-wise. Further, we performed stratified and interaction analyses with sex, history of psychiatric disease, and evaluated SLEs during specific life periods.

RESULTS

Within the whole sample, only childhood and midlife SLEs, but not total SLEs, were associated with AD pathophysiology and neuroinflammation. Among those with a history of psychiatric disease SLEs were associated with higher p-tau181 and IL-6. Participants with history of psychiatric disease and men, showed lower Aβ1-42/1-40 with higher SLEs. Participants with history of psychiatric disease and women showed reduced GM volumes in somatic regions and prefrontal and limbic regions, respectively.

INTERPRETATION

We did not find evidence supporting the association of total SLEs with AD, neuroinflammation, and atrophy pathways. Instead, the associations appear to be contingent on events occurring during early and midlife, sex and history of psychiatric disease. ANN NEUROL 2024;95:1058-1068.

Unpredictable chronic mild stress shows neuronal remodeling in multipolar projection neurons of hippocampal complex in postnatal chicks

The hippocampal complex of birds is a narrow-curved strip of tissue that plays a crucial role in learning, memory, spatial navigation, and emotional and sexual behavior. This study was conducted to evaluate the effect of unpredictable chronic mild stress in multipolar neurons of 3-, 5-, 7-, and 9-week-old chick's hippocampal complex. This study revealed that chronic stress results in neuronal remodeling by causing alterations in dendritic field, axonal length, secondary branching, corrected spine number, and dendritic branching at 25, 50, 75, and 100 µm. Due to stress, the overall dendritic length was significantly retracted in 3-week-old chick, whereas no significant difference was observed in 5- and 7-week-old chick, but again it was significantly retracted in 9-week-old chick along with the axonal length. So, this study indicates that during initial days of stress exposure, the dendritic field shows retraction, but when the stress continues up to a certain level, the neurons undergo structural modifications so that chicks adapt and survive in stressful conditions. The repeated exposure to chronic stress for longer duration leads to the neuronal structural disruption by retraction in the dendritic length as well as axonal length. Another characteristic which leads to structural alterations is the dendritic spines which significantly decreased in all age groups of stressed chicks and eventually leads to less synaptic connections, disturbance in physiology, and neurology, which affects the learning, memory, and coping ability of an individual.

The higher dietary inflammation is associated with a higher burden of multimorbidity of cardio-metabolic and mental health disorders in an urbanizing community of southern India: A cross-sectional analysis for the APCAPS cohort

Background & aims

Habitual dietary pattern has been shown to be a major modulator of systemic inflammation and is considered a modifiable risk factor for cardio-metabolic diseases (CMDs) and mental health disorders. We examined whether dietary-inflammation is associated with the multimorbidity of CMDs and mental health disorders in urbanizing-villages in southern India. We hypothesized that the participants with higher dietary-inflammation would have a higher burden of multimorbidity.

Materials & methods

We conducted a cross-sectional analysis of 5984 adults (53% male) participating in the Andhra Pradesh Children and Parents' Study. We assessed dietary-inflammation using dietary inflammatory index (DII®) based on intake of 27 micro- and macro-nutrients which were measured using a validated food-frequency-questionnaires. The CMDs and mental health disorders were assessed using standardized clinical procedures and validated questionnaires. 'Multimorbidity' was defined as a co-existence of one or more CMDs (hypertension, diabetes, myocardial infarction, heart failure, angina and stroke) and one or more mental health disorders (depression and anxiety). The association of multimorbidity with dietary-inflammation was examined using robust Poisson regression.

Results

The prevalence of multimorbidity was 3.5% and ∼75% of participants were consuming a pro-inflammatory diet (DII >0.0). As compared to the 1st DII-quartile (least dietary-inflammatory group), the adjusted prevalence ratio (95% confidence interval) for the presence of multimorbidity was 1.46(0.87, 2.46) for 2nd, 1.75(1.05, 2.89) for 3rd, and 1.77(1.06, 2.96) for 4th DII-quartile (p-trend = 0.021). There was no evidence of an interaction between DII and sex on multimorbidity.

Conclusions

Dietary-inflammation had a positive linear association with the multimorbidity, which suggest that even modest reduction in dietary-inflammation may reduce the multimorbidity burden.

Risk factors and their association network for young adults' suicidality: a cross-sectional study

BACKGROUND

Understanding the intricate influences of risk factors contributing to suicide among young individuals remains a challenge. The current study employed interpretable machine learning and network analysis to unravel critical suicide-associated factors in Chinese university students.

METHODS

A total of 68,071 students were recruited between Sep 2016 and Sep 2020 in China. Students reported their lifetime experiences with suicidal thoughts and behaviors, categorized as suicide ideation (SI), suicide plan (SP), and suicide attempt (SA). We assessed 36 suicide-associated factors including psychopathology, family environment, life events, and stigma. Local interpretations were provided using Shapley additive explanation (SHAP) interaction values, while a mixed graphical model facilitated a global understanding of their interplay.

RESULTS

Local explanations based on SHAP interaction values suggested that psychoticism and depression severity emerged as pivotal factors for SI, while paranoid ideation strongly correlated with SP and SA. In addition, childhood neglect significantly predicted SA. Regarding the mixed graphical model, a hierarchical structure emerged, suggesting that family factors preceded proximal psychopathological factors, with abuse and neglect retaining unique effects. Centrality indices derived from the network highlighted the importance of subjective socioeconomic status and education in connecting various risk factors.

CONCLUSIONS

The proximity of psychopathological factors to suicidality underscores their significance. The global structures of the network suggested that co-occurring factors influence suicidal behavior in a hierarchical manner. Therefore, prospective prevention strategies should take into account the hierarchical structure and unique trajectories of factors.

Personalized Stress Detection Using Biosignals from Wearables: A Scoping Review

Stress is a natural yet potentially harmful aspect of human life, necessitating effective management, particularly during overwhelming experiences. This paper presents a scoping review of personalized stress detection models using wearable technology. Employing the PRISMA-ScR framework for rigorous methodological structuring, we systematically analyzed literature from key databases including Scopus, IEEE Xplore, and PubMed. Our focus was on biosignals, AI methodologies, datasets, wearable devices, and real-world implementation challenges. The review presents an overview of stress and its biological mechanisms, details the methodology for the literature search, and synthesizes the findings. It shows that biosignals, especially EDA and PPG, are frequently utilized for stress detection and demonstrate potential reliability in multimodal settings. Evidence for a trend towards deep learning models was found, although the limited comparison with traditional methods calls for further research. Concerns arise regarding the representativeness of datasets and practical challenges in deploying wearable technologies, which include issues related to data quality and privacy. Future research should aim to develop comprehensive datasets and explore AI techniques that are not only accurate but also computationally efficient and user-centric, thereby closing the gap between theoretical models and practical applications to improve the effectiveness of stress detection systems in real scenarios.

Test-retest reliability and time-of-day variations of perfusion imaging at rest and during a vigilance task

Arterial spin-labeled perfusion and blood oxygenation level-dependent functional MRI are indispensable tools for noninvasive human brain imaging in clinical and cognitive neuroscience, yet concerns persist regarding the reliability and reproducibility of functional MRI findings. The circadian rhythm is known to play a significant role in physiological and psychological responses, leading to variability in brain function at different times of the day. Despite this, test-retest reliability of brain function across different times of the day remains poorly understood. This study examined the test-retest reliability of six repeated cerebral blood flow measurements using arterial spin-labeled perfusion imaging both at resting-state and during the psychomotor vigilance test, as well as task-induced cerebral blood flow changes in a cohort of 38 healthy participants over a full day. The results demonstrated excellent test-retest reliability for absolute cerebral blood flow measurements at rest and during the psychomotor vigilance test throughout the day. However, task-induced cerebral blood flow changes exhibited poor reliability across various brain regions and networks. Furthermore, reliability declined over longer time intervals within the day, particularly during nighttime scans compared to daytime scans. These findings highlight the superior reliability of absolute cerebral blood flow compared to task-induced cerebral blood flow changes and emphasize the importance of controlling time-of-day effects to enhance the reliability and reproducibility of future brain imaging studies.

Effects of the suppression of 5-HT1A receptors in the left, right, or bilateral basolateral amygdala on memory consolidation in chronic stress in male rats

The serotonin-1A receptors (5-HT1A) in the two cerebral hemispheres are differentially involved in memory. The distribution of 5-HT1A receptors in the left and right amygdala is different. Furthermore, evidence shows that the 5-HT1A receptors in the left and right amygdala work differently in memory function. The basolateral amygdala (BLA) also regulates hippocampal long-term potentiation (LTP) during stress. However, which BLA structure in each hemisphere underlies such lateralized function is unclear. The present research investigated the possible involvement of 5-HT1A lateralization in the BLA on stress-induced memory impairment. 5-HT1A receptor antagonist (Way-100-635) was injected into the left, right, or bilateral BLA twenty minutes before chronic restraint stress (CRS) for 14 consecutive days. Results indicated that suppression of 5HT1A-receptors in the BLA plays an essential role in reducing the acquisition of passive avoidance in the shuttle box test and spatial memory in the Barnes maze test in the stress animals. This decrease was significant in the CRS animals with left and bilateral suppressed 5HT1A-receptors in the BLA. Field potential recording results showed that the left, right, and bilateral injection of Way-100-635 into the BLA significantly reduced the slope and amplitude of fEPSP in the CA1 area of the hippocampus in stressed rats. No significant difference was observed in neuronal arborization in the CA1 area of the hippocampus. In conclusion, the 5-HT1A receptor in the left and right sides of BLA nuclei play a different role in memory consolidation in the hippocampus under stress.

Prolonged HPA axis dysregulation in postpartum depression associated with adverse early life experiences: A cross-species translational study

Childhood and adolescent stress increase the risk of postpartum depression (PPD), often providing an increased probability of treatment refractoriness. Nevertheless, the mechanisms linking childhood/adolescent stress to PPD remain unclear. Our study investigated the longitudinal effects of adolescent stress on the hypothalamic-pituitary-adrenal (HPA) axis and postpartum behaviors in mice and humans. Adolescent social isolation prolonged glucocorticoid elevation, leading to long-lasting postpartum behavioral changes in female mice. These changes were unresponsive to current PPD treatments but improved with post-delivery glucocorticoid receptor antagonist treatment. Childhood/adolescent stress significantly impacted HPA axis dysregulation and PPD in human females. Repurposing glucocorticoid receptor antagonists for some cases of treatment-resistant PPD may be considered.

Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies

Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and mini-systems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain.