Annual Research Review: The neurobiology and physiology of resilience and adaptation across the life course

Childhood trauma is linked to epigenetic age deceleration in young adults with previous youth residential care placements

Background: Early adversity increases the risk for mental and physical disorders as well as premature death. Epigenetic processes, and altered epigenetic aging in particular, might mediate these effects. While the literature that examined links between early adversity and epigenetic aging is growing, results have been heterogeneous.Objective: In the current work, we explored the link between early adversity and epigenetic aging in a sample of formerly out-of-home placed young adults.Method: A total of N = 117 young adults (32% women, age mean = 26.3 years, SD = 3.6 years) with previous youth residential care placements completed the Childhood Trauma Questionnaire (CTQ) and the Life Events Checklist (LEC-R) and provided blood samples for the analysis of DNA methylation using the Illumina Infinium MethylationEPIC BeadChip Microarray. Epigenetic age was estimated using Hovarth's and Hannum's epigenetic clocks. Furthermore, Hovarth's and Hannum's epigenetic age residuals were calculated as a proxy of epigenetic aging by regressing epigenetic age on chronological age. The statistical analysis plan was preregistered (https://osf.io/b9ev8).Results: Childhood trauma (CTQ) was negatively associated with Hannum's epigenetic age residuals, β = -.23, p = .004 when controlling for sex, BMI, smoking status and proportional white blood cell type estimates. This association was driven by experiences of physical neglect, β = -.25, p = .001. Lifetime trauma exposure (LEC-R) was not a significant predictor of epigenetic age residuals.Conclusion: Childhood trauma, and physical neglect in particular, was associated with decelerated epigenetic aging in our sample. More studies focusing on formerly institutionalized at-risk populations are needed to better understand which factors affect stress-related adaptations following traumatic experiences.

The role of resilience in the relationship between stress and alcohol

Stress plays a well-documented role in alcohol consumption and the risk for developing alcohol use disorder. The concept of resilience - coping with and successfully adapting to stressful life experiences - has received increasing attention in the field of addiction research in recent decades, and there has been an accumulation of evidence for resilience as a protective factor against problematic alcohol consumption, risk for alcohol use disorder, disorder severity, and relapse. The conceptual and methodological approaches used in the generation of this evidence vary considerably across investigations, however. In light of this, we carried out this review in order to provide a more thorough understanding of the meaning and scope of resilience, what factors contribute to resilience, how it is measured, and how it relates to alcohol-associated phenotypes. Implications for treatment through the use of resilience-building interventions are likewise discussed, as well as implications for future research on the role of resilience in the etiology and clinical outcomes of alcohol use disorder.

Cognitive Functioning of Children in Out-of-Home Care

PURPOSE

Most children who enter out-of-home care (OHC) have been subjected to prolonged maltreatment. Maltreatment potentially contributes to a cumulative deficit in neurocognitive maturation and development that is likely to proceed with the child's placement into OHC and persist throughout adulthood. From the theoretical perspective of how maltreatment may affect the developing brain, this study examines the IQ and executive function of children placed in OHC on standardized, norm-referenced measures. Furthermore, the study investigates the prevalence of serious cognitive delays, defined by scores in the clinical range on the administered instruments.

METHODS

The study included 153 children in foster care (66% female), aged 6-15 (M = 10.5, SD = 2.1). Independent two-sample t-tests were run to test for significant differences between the sample and the norm population on the applied neuropsychological measures.

RESULTS

The results showed that discrepancies in cognitive development were global in scope, with the children lagging significantly behind the norm population on all applied measures with discrepancies ranging from 0.61 to 2.10 SD (p < .001). Also, serious developmental delays in all cognitive domains were vastly overrepresented in the sample ranging from 11.3% (IQ) to 66.0% (executive function).

CONCLUSIONS

The results document a very high prevalence of cognitive deficits and delays among the children in the sample. The implications of identifying the neurocognitive effects of maltreatment in the practices of the child welfare system are discussed in terms of developing suitable assessment and intervention strategies.

Salivary Brain-Derived Neurotrophic Factor and Cortisol Associated with Psychological Alterations in University Students

INTRODUCTION

Recent evidence reported mental health issues in university students such as anxiety and depressive symptoms and poor sleep quality. Decreased plasma brain-derived neurotrophic factor (BDNF) levels have been proposed as a biomarker of depressive symptoms, whereas cortisol levels are an index of energy mobilization and stress and have been linked to sleep quality. Given that salivary biomarkers represent an interesting new field of research, the aim of this cross-sectional study was to evaluate salivary BDNF and cortisol levels in university students to assess whether they have associations with psychological disturbances such as anxiety and depressive symptoms, sleep quality, and stress level.

METHODS

Salivary BDNF and cortisol levels were measured by specific immunoassays in 70 students whose mental health was also evaluated on the same day through the evaluation of anxiety and depression symptoms (Goldberg scale), sleep quality (Pittsburg Sleep Quality Index and Athens Insomnia Scale), and stress (self-perceived stress scale) and healthy lifestyle habits (alcohol consumption, smoking, regular exercise, and body mass index) were also measured. Multivariate regression analyses were performed in order to identify the strengths of associations between psychological alterations and the concentrations of BDNF, cortisol, and other variables.

RESULTS

Salivary BDNF levels were significantly higher in students with more depressive symptoms, whereas no significant differences were found for cortisol levels. When performing the binary logistic regression model, BDNF levels are included as a predictor variable for a high-depressive-symptoms burden (p < 0.05). Students with worse sleep quality on the Pittsburg Scale had higher cortisol levels (p < 0.05). The subdomains of sleep latency and sleep medication were those significantly associated with salivary cortisol levels in logistic regression analyses (OR = 15.150, p = 0.028). Sleep medication only appeared to be related to cortisol levels (OR = 185.142, p = 0.019). Perceived stress levels and anxiety symptoms were not associated with BDNF or cortisol levels.

CONCLUSIONS

BDNF could play a key role in the pathophysiology of mood-related disorders, and elevation of its peripheral levels could contribute to protecting neurons from the development of mental illness. Higher salivary cortisol levels measured in the morning are accompanied by poorer sleep quality. More research is needed, focusing on salivary biomarkers of disorders related to depressive symptoms and poor sleep quality as a potential tool for the diagnosis and prevention of mental illness.

Building resilience through daily smartphone app use: results of a pilot study of the JoyPop app with social work students

Background

The JoyPop™ smartphone app is a digital intervention designed to enhance day-to-day resilience in youth, particularly those exposed to traumatogenic events [adverse childhood experiences (ACEs)]. Processes of adaptation that foster resilience in response to high stress include affect, cognitive, and behavioral regulation, and social interaction. Digital interventions have application for youth and those who provide them support, including social work trainees navigating the stressors of university studies concurrent with practice internships. Research on resilience-enhancing apps is needed to understand the underlying mechanisms by which change occurs and who is most likely to benefit from these interventions.

Methods

Social work student participants (N = 91) were invited to use the JoyPop app two times daily for 28 days. Baseline ACE exposure and change-over-time in affect regulation, stress responsivity, and social support were evaluated after 2 and 4 weeks of app use with t-tests and generalized estimating equation (GEE) modeling.

Results

Participants identified predominantly as cisgender women of European descent, mean age 26 years (SD = 6.78), 70% undergraduates, and reported consistent daily app use (Mean days = 26.9, SD = 1.90). Self-reported baseline ACE exposure was high (30% ≥ 5+). We tested change-over-time with generalized estimating equation and saw improvement in affect regulation in the Abbreviated Dysregulation Inventory scale (β = -3.38, p = <.001), and subscales of behavioral (β = -1.63, p = <.001), affect (β = -3.24, p = <.001), and cognitive regulation (β = 1.50, p = .009). Perceived stress decreased with app use (β = -2.65, p = <.001) and even more so for participants with reported exposure to more than 4 ACEs (β = -3.786, p = .030).

Conclusions

The exploratory findings from our pilot study suggest that consistent use of the app may enhance multidimensional resilience amongst university students who self-report higher than average levels of baseline traumatogenic exposures. Our findings support an approach modeling resilience as a complex, dynamic, multicomponent process supported by resources within and between individuals. Further testing of the mechanisms of adaptation in response to high stress that enhance resilience and identification of the JoyPop™ app features that influence this change is needed to validate that daily app use could help youth with experiences of past and current high stress to better regulate their affect, reduce stress reactivity, and increase resilience.

The gendered health consequences of persistent exposure to short sleep duration during adolescence

INTRODUCTION

Despite evidence that sleep duration is associated with adolescent health, there remain several gaps in the literature. Little is known about: (1) the extent to which persistent exposure to short sleep duration is associated with adolescent health and (2) whether this association varies by gender.

METHODS

Using six waves of longitudinal data from the 2011-2016 Korean Children and Youth Panel Survey (N = 6147), this study examined whether persistent exposure to short sleep duration is related to two adolescent health outcomes (overweight status and self-rated health). Fixed effects models were estimated to account for individual-level heterogeneity.

RESULTS

Short sleep duration was associated with being overweight and self-rated health in different ways for boys and girls. Gender-stratified analysis suggests that, for girls, the risk of being overweight increased for 5 years in a row as short sleep duration persisted. Prolonged short sleep duration also resulted in a continued decline in girls' self-rated health. For boys, persistent exposure to short sleep duration predicted a lower likelihood of being overweight up to the fourth year, but then began to recover. No association between persistent exposure to short sleep duration and self-rated health was observed for boys.

CONCLUSION

Persistent exposure to short sleep duration was found to be more harmful to the health of girls than boys. Promoting longer sleep duration during adolescence may be an effective intervention to improve adolescent health, especially for girls.

Don't Shoot Me: Potential Consequences of Force-on-Force Training Modulate the Human Stress Response

ABSTRACT

Jensen, AE, Bernards, JR, Hamilton, JA, Markwald, RR, Kelly, KR, and Biggs, AT. Do not shoot me: potential consequences of force-on-force training modulate the human stress response. J Strength Cond Res 37(9): 1761-1769, 2023-Close-quarters combat (CQC) engagements trigger the "fight-or-flight" response, activating the sympathetic nervous system and hypothalamic-pituitary-adrenal axis in response to perceived threats. However, it has yet to be shown if a force-on-force (FoF) CQC training environment will lead to adaptations in the physiological stress response or performance. United States Marines and Army infantry personnel participated in a 15-day CQC training program. The CQC program focused heavily on FoF training with the use of nonlethal training ammunition (NLTA). Data collections occurred on training days 1 and 15, during a simulated FoF-hostage rescue (HR) scenario and photorealistic target drill. For the FoF-HR, subjects were instructed to clear the shoot house, rescue the hostage, and only shoot hostile threat(s) with NLTA. The photorealistic target drills were similar, but replaced the role players in the FoF-HR with paper targets. Salivary alpha-amylase (sAA) and salivary cortisol were obtained immediately before entering and exiting the shoot house. Time to completion significantly decreased, between days 1 and 15, for both the FoF-HR and the photorealistic drills by 67.7 and 54.4%, respectively ( p < 0.05). Analyses revealed that the change in sAA, nonsignificantly, doubled from day 1 to 15 during FoF-HR ( p > 0.05), whereas the change in sAA decreased during the photorealistic drills across days ( p < 0.05). Cortisol was significantly higher during the FoF-HR in comparison to the photorealistic drills ( p < 0.05). These data suggest that potential consequences of FoF training heighten the stress response in conjunction with enhanced performance.

Separating the influences of means and daily variations of sleep on the stress-induced salivary cortisol response

BACKGROUND

Previous research regarding the effects of sleep quality and quantity on the acute stress response has yielded inconsistent findings. This may be attributed to various factors, including composite sleep components (i.e., means and daily variations) and mixed cortisol stress response (i.e., reactivity and recovery). Thus, this study aimed to separate the effects of means and daily variations of sleep on the reactivity and recovery of cortisol responses to psychological challenges.

METHODS

In study 1, we recruited 41 healthy participants (24 women; age range, 18-23 years), monitored their sleep during seven consecutive days via wrist actigraphy and sleep diaries, and adopted the Trier Social Stress Test (TSST) paradigm to induce acute stress. Study 2 consisted of a validation experiment using the ScanSTRESS paradigm, which included 77 additional healthy individuals (35 women; age range, 18-26 years). Similarly to the TSST, the ScanSTRESS induces acute stress using uncontrollability and social evaluation. In both studies, saliva samples from the participants were collected before, during, and after the acute stress task.

RESULTS

Using residual dynamic structural equation modeling, both study 1 and study 2 demonstrated that higher means of objective sleep efficiency, and longer means of objective sleep duration were related to greater cortisol recovery. In addition, fewer daily variations in objective sleep duration were associated with greater cortisol recovery. However, there was no correlation between sleep variables and cortisol reactivity, except for the daily variations in objective sleep duration in study 2. No correlation was observed between subjective sleep and cortisol response to stress.

CONCLUSIONS

The present study separated two features of multi-day sleep patterns and two components of cortisol stress response, providing a more comprehensive picture of the effect of sleep on the stress-induced salivary cortisol response, and contributing to the future development of targeted interventions for stress-related disorders.

Going Beyond Conventional Assessment of Developmental Motor Disorders: Exploring Video Methods for Early Identification Among Children 0 to 3 Years

Motor skills and movement-related functioning significantly shape how children experience and interact with the world around them. Among infants and young children, developmental motor disorders contribute to delays with motor, cognitive, and psychosocial development. Early and accurate identification of these disorders is necessary to facilitate timely access to therapeutic interventions that minimize the long-term effects of disability on everyday activities and participation. In the United States, motor assessments commonly used among children 0 to 3 years focus on completion of specific motor skills at a single point in time, which provides only a part of the greater picture that is a child's motor and movement-related functioning. Video-capture methods, like the General Movements Assessment (GMA) and the Infant Motor Profile (IMP), offer greater accuracy and predictive power to (1) identify motor deficits in young children and (2) facilitate early access to supportive, therapeutic intervention.

Prevalence and Impact of Adverse Childhood Experiences in an Interdisciplinary, School-Based Pediatric Clinic

INTRODUCTION

This study's purpose was to ascertain the prevalence of adverse childhood experiences (ACEs) in a pediatric population and their connection to other health history information.

METHOD

Using health history data, a retrospective, descriptive study was undertaken with 1,028 children seen at a school-based, interprofessional clinic over 1 academic year.

RESULTS

Nearly 58% of children had at least one ACE, and 9.5% had four or more, similar to the prevalence of ACEs in adults reported in the original study by Felitti et al. (1998). With increasing ACEs, children had higher rates of intrauterine drug exposure, intensive care on delivery, homelessness, substance abuse, behavioral problems, mental illness, learning difficulties, and weight issues.

DISCUSSION

Because ACEs are prevalent among children, pediatric providers should use trauma-informed care principles and teach and model a loving and supportive adult presence in children's lives.

Adverse childhood experiences in children and adolescents with sickle cell disease: A retrospective cohort study

BACKGROUND

Adverse childhood experiences (ACEs) are linked to poor health outcomes; however, the relationship between ACEs and health outcomes among children and adolescents with sickle cell disease (SCD) has limited documentation in the published literature.

PROCEDURE

This retrospective cohort study involved 45 children and 30 adolescents. Participants were screened using the Center for Youth Wellness ACE Questionnaire. Parents completed the questionnaire for children. Adolescents provided self-report. ACEs were treated as continuous and categorical scales: 0-1 verus ≥2 original ACEs (individual and/or familial level); 0-1 versus ≥2 additional ACEs (community level); and 0-3 versus ≥4 expanded ACEs (original + additional). Pain and acute chest syndrome events were compared using Wilcoxon rank-sum tests, and correlated with cumulative ACE scores using Spearman's correlation. Multivariable models were fitted to examine the association between ACEs and pain/acute chest syndrome.

RESULTS

The cumulative number of original ACEs positively correlated with acute chest syndrome events (rho = .53, p = .003) and pain (rho = .40, p = .028) among adolescents. Adolescents with ≥2 versus 0-1 original ACEs had a higher number of acute chest syndrome events (4.9 ± 2.6 vs. 1.6 ± 2.2, p = .002); however, this association was confounded by asthma. Acute chest syndrome events and hospitalizations for pain did not differ among child ACE groups. Emergency department (ED) pain visits were higher among children with ≥4 versus 0-3 expanded ACEs (1.6 ± 2.8 vs. 3.3 ± 3.2, p = .042), even after controlling for SCD genotype, asthma, disease-modifying treatment, and follow-up years (p = .027).

CONCLUSION

ACEs are linked to increased morbidity among children and adolescents with SCD. Prospective studies are needed to further understand this relationship and test ACE-protective remedies.

The anticipatory response to stress and symptoms of depression and anxiety in early adulthood

BACKGROUND

Whilst cortisol reactivity has been associated with depression and anxiety disorders, research examining cortisol reactivity with early symptoms of these conditions in males and females is limited.

METHODS

At age 18, 748 males and females from Gen2 of the Raine Study were assessed for their salivary cortisol response to a psychosocial stressor using the Trier Social Stress Test (TSST). Participants later completed the Depression Anxiety Stress Scale (DASS-21) at age 20 which was used as the outcome measure in regression models.

RESULTS

We found differences in DASS-21 across TSST responder categories in females but not males. Female reactive-responders (RR) and non-responders (NR) had increased symptoms of depression and anxiety compared to anticipatory-responders (AR). AR were associated with the lowest symptomology in females. We found limited evidence for an association between salivary cortisol summary measures (C_BL, C_MAX, C_MIN, C_RANGE, AUC_G and AUC_R) and depression/anxiety symptoms at age 20.

CONCLUSIONS

This study sheds new light on adaptive and maladaptive physiological responses to psychosocial stress in terms of depression and anxiety symptoms. These preliminary findings indicate the pattern of response to a psychosocial stressor may contribute to individual vulnerability for stress-related diseases in a sex-specific manner.

Association between Self-Reported Childhood Difficulties and Obesity and Health-Related Behaviors in Adulthood-A Cross-Sectional Study among 28,047 Adults from the General Population

The aim of the present study was to examine the associations between self-reported childhood difficulties, weight status, and lifestyle behaviors among a representative sample of Norwegian adults. This cross-sectional study included 28,047 adults (>18 years old) living in southern Norway. A self-report questionnaire was used to assess information about the overall quality of the respondents’ childhood retrospectively in addition to current weight status and current lifestyle behaviors. Multivariable logistic regression models adjusted for gender, age, and educational level showed that evaluating childhood as difficult was associated with increased odds of obesity (OR: 1.29; 95% CI; 1.16–1.44) in adulthood. Moreover, a difficult childhood was associated with increased odds of unhealthy lifestyle behaviors in adulthood, including low consumption of fruit and berries (1.21; 1.09–1.34) and fish (1.43; 1.30–1.57), high consumption of sugar-sweetened beverages (1.30; 1.14–1.48), low level of physical activity (1.10; 1.01–1.21), smoking cigarettes (1.78; 1.61–1.97), and using smokeless tobacco (1.20; 1.07–1.36). Overall, results from the present study suggest that experiencing childhood as difficult is associated with an increased risk of obesity and a range of unhealthy lifestyle behaviors in adulthood. Thus, our findings highlight the importance of identifying and providing support to children in difficult life circumstances in addition to customized and targeted public health efforts in adulthood.

Inhibition of adult neurogenesis reduces avoidance behavior in male, but not female, mice subjected to early life adversity

Early life adversity (ELA) increases the risk of developing neuropsychiatric illnesses such as anxiety disorders. However, the mechanisms connecting these negative early life experiences to illness later in life remain unclear. In rodents, plasticity mechanisms, specifically adult neurogenesis in the ventral hippocampus, have been shown to be altered by ELA and important for buffering against detrimental stress-induced outcomes. The current study sought to explore whether adult neurogenesis contributes to ELA-induced changes in avoidance behavior. Using the GFAP-TK transgenic model, which allows for the inhibition of adult neurogenesis, and CD1 littermate controls, we subjected mice to an ELA paradigm of maternal separation and early weaning (MSEW) or control rearing. We found that mice with intact adult neurogenesis showed no behavioral changes in response to MSEW. After reducing adult neurogenesis, however, male mice previously subjected to MSEW had an unexpected decrease in avoidance behavior. This finding was not observed in female mice, suggesting that a sex difference exists in the role of adult-born neurons in buffering against ELA-induced changes in behavior. Taken together with the existing literature on ELA and avoidance behavior, this work suggests that strain differences exist in susceptibility to ELA and that adult-born neurons may play a role in regulating adaptive behavior.

A School-Based Progressive Muscle Relaxation Program for Female Adolescents: Development and the Effectiveness on Physiological and Psychological Evidence

(1) Background: A variety of stressors may be potentially harmful to adolescents' health and well-being. Relaxation techniques have been recognized as a valid method for stress release, but the challenge is to apply them practically in schools to produce the desired effects. (2) Methods: This feasibility study used the Perceived Stress Scale (PSS) and hair cortisol concentration (HCC) to test the effects of an abbreviated progressive muscle relaxation (APMR) program on female adolescents. The participants were recruited from a high school and assigned by class cluster to either the experimental group (EG, n = 40) or the control group (CG, n = 35). Both received 4 weeks of stress-related lessons. The EG received 60 additional sessions of APMR over 12 weeks. (3) Results: The program dropout rate of the participants was 1.3%. The EG's program adhesion rate was 99.1%, and nearly half felt satisfied with the program. After adjusting for the BMI and the pretest in the ANCOVA, it was found that the CG had a greater change in HCC between the pre- and post-tests than the EG, while the PSS did not change significantly in either group. (4) Conclusion: APMR is a valid practice for physiological homeostasis of HCC for female adolescents, but it has no significant effect on perceived stress.

Association of stress and resilience with cardiometabolic health among American Indian and Alaska Native adults

Evidence suggests that perceived stress and psychological resilience are related to the presence and severity of cardiometabolic disease. Despite increased stress and cardiometabolic disease burden among American Indian and Alaska Native (AI/AN) people, the relationships between these factors are not well established in these populations. The objective of this study was to evaluate the relationships of stress with five cardiometabolic health indicators and to assess whether psychological resilience mediates these relationships in AI/AN adults. Four hundred and ninety-six AI/AN attendees were surveyed at three powwows. The questionnaire included sociodemographic items, questions on self-reported obesity, prediabetes, diabetes, high blood pressure, and high cholesterol, the Perceived Stress Scale, and the Brief Resilience Scale. Multivariable logistic regression models were used to measure associations of health indicators with Perceived Stress Scale and Brief Resilience Scale scores while controlling for sociodemographic characteristics. Among respondents, obesity was the most common cardiometabolic health indicator reported (48%), followed by high blood pressure, prediabetes, diabetes, and high cholesterol. Mean Perceived Stress Scale and Brief Resilience Scale scores were 16.1 (6.4 SD) and 3.5 (0.7 SD), respectively. Higher Perceived Stress Scale scores were associated with greater odds of self-reported prediabetes and diabetes. Brief Resilience Scale scores did not serve as a mediator. These results suggest that perceived stress is associated with some self-reported indicators of cardiometabolic health among AI/AN adults, but findings are limited by the convenience sample, reliance on self-report, and cross-sectional design. Future work should capitalize on nationally representative data, longitudinal designs, and objective measures of cardiometabolic health.

Repeated exposure to challenging environmental conditions influences telomere dynamics across adult life as predicted by changes in mortality risk

The effects of stress exposure are likely to vary depending on life-stage and stressor. While it has been postulated that mild stress exposure may have beneficial effects, the duration of such effects and the underlying mechanisms are unclear. While the long-term effects of early-life stress are relatively well studied, we know much less about the effects of exposure in adulthood since the early- and adult-life environments are often similar. We previously reported that repeated experimental exposure to a relatively mild stressor in female zebra finches, first experienced in young adulthood, initially had no effect on mortality risk, reduced mortality in middle age, but the apparently beneficial effects disappeared in old age. We show here that this is underpinned by differences between the control and stress-exposed group in the pattern of telomere change, with stress-exposed birds showing reduced telomere loss in middle adulthood. We thereby provide novel experimental evidence that telomere dynamics play a key role linking stress resilience and aging.

Surviving All the Way to College: Pathways Out of One of America's Most Crime Ridden Cities

The purpose of this study is to better understand the factors and processes related to resilience of youth who are among the most at risk for academic failure and involvement in the criminal justice system. To address the research questions about resilience and risk, in-depth interviews were conducted with a racially and ethnically diverse sample (N = 146) from one of the "most dangerous" cities in America. To obtain an objective assessment of risk, crime data were disaggregated by the city's census tracts. Respondents were recruited from a college campus that is located within the city limits of the research site. The retrospective interviews included questions related to family structure and dynamics, educational experiences and support, peers, mentors, extra-curricular activities, neighborhood attributes, inner traits of the respondent, and adverse childhood experiences (ACEs). Results suggest that this diverse sample of college students and recent graduates were not immune from the dangers and adversity known to exist within the northeastern city where they grew up. Crime rates and poverty indicators within the neighborhoods far exceeded national averages and findings indicate participants were exposed to serious forms and levels of community violence. Furthermore, outcome data suggest that participants also suffered from many traditional ACEs (e.g., high rates of parental separation, household substance abuse and mental illness, and family incarceration). The outcomes suggested a trifecta of protective factors in the respondent's resilience: engaged parenting, self-selected high schools, and the interaction of an individual's inner traits and local ecological supports. Community level suggestions include targeted parental programming, educational support, gang and crime resistance initiatives, and coping interventions for community violence exposure. Future resilience studies should consider an array of ecological factors that may help mediate the harms associated with exposure to community violence as well as data on household level stressors.

The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study

BACKGROUND

Early life stress (ELS) has been linked to poor mental and physical health outcomes in adolescence and adulthood. Mindfulness reduces symptoms of depression and anxiety and improves cognitive and social outcomes in both youth and adults. However, little is known whether mindfulness can mitigate against the adverse neurobiological and psychological effects of ELS. This study aimed to examine the feasibility of conducting a group mindfulness intervention in adolescents with ELS and provide preliminary indication of potential effects on stress-related biomarkers and mental health symptoms.

METHODS

Forty adolescents were randomized to receive either eight sessions of Mindfulness-Based Stress Reduction for Teens in group format (MBSR-T; n = 21) or Treatment as Usual Control group (CTRL; n = 17). Outcomes were assessed at baseline and follow-up and included measures associated with neurobiological functioning (immune and endocrine biomarkers) and self-reported mental health (depressive) symptoms. Linear mixed effects models were used to assess the effects of group and time on these outcome measures.

RESULTS

Sixteen of the 21 adolescents completed the intervention, attending an average of 6.5 sessions. The model examining cortisol responses to stress induction revealed medium effects trending toward significance (Cohen's d = .56) for anticipatory cortisol levels in the MBSR-T relative to CTRL groups. No significant effects were found in models examining C-reactive protein or interleukin 6 inflammatory markers. The model examining depressive symptoms revealed a medium effect for symptom reduction (Cohen's d = .69) in the MBSR-T relative to CTRL groups.

CONCLUSIONS

This study demonstrated feasibility of conducting a group-based MBSR-T intervention for adolescents with ELS. There was some evidence for efficacy on a symptom level with potential subtle changes on a biological level. Future larger studies are needed to determine the efficacy of group-based mindfulness interventions in this population.

TRIAL REGISTRATION

Identifier # NCT03633903 , registered 16/08/2018.

Medical, neurobiological, and psychobehavioral perspectives of mastocytosis: a case report

Background

Cutaneous mastocytosis is a rare pathology characterized by an abnormal proliferation and degranulation of mast cells, affecting the skin. Here we present the case of a patient suffering from chronic resistant mastocytosis. An original integrative method of evaluation was tested in this patient, to improve therapeutic management. It integrated the interactions between stressful life events and medical history as well as psychobehavioral components and neurobiological factors.

Case presentation

The patient was a 65-year-old Caucasian woman. The cutaneous symptoms of mastocytosis had progressively evolved over the past 36 years, increasingly affecting the patient’s quality of life. At the time of the evaluation, psoralen and ultraviolet A therapy had reduced pruritus, but very unsightly brown-red maculopapules persisted on the chest, back, and arms. We proposed an integrative diagnosis that combined a semistructured interview, a psychometric assessment with the Millon Behavioral Medicine Diagnostic tool, and the collection of medical data. The medical data were compared with the analysis of the significant events in the patient’s life, to determine the threshold of tolerance to stress beyond which the skin symptoms led to profuse thrusts of pruritus. At the same time, the psychobehavioral profile of the patient was determined; this highlighted how social isolation, the denigrated coping style, and problematic compliance could influence the extension of dermatological symptoms. The effects of stressors on the infiltration and degranulation of skin mast cells have been discussed in light of the neurobiological processes currently known. At the end of the evaluation, a new therapeutic strategy was proposed.

Conclusion

This case report reveals the mind–body relationship of a patient suffering from mastocytosis. It highlights the points of vulnerability and the adaptative strategies specific to each patient to be considered in therapeutic management of other resistant chronic diseases.

The moderating role of childhood socioeconomic status on the impact of nudging on the perceived threat of coronavirus and stockpiling intention

Communications that include nudges and framing strategies are ubiquitous in our daily lives. In this paper, we investigate how different nudging strategies during a public health campaign, particularly supplementary information and statistics, influence perceptions of threat and stockpiling intentions, while also considering the role of childhood socioeconomic status. Specifically, building upon prior work in behavioral economics, we hypothesize that the presence of additional statistics elicits lower perceived threat and intention to stockpile. In addition, we predict find that the childhood socioeconomic status of individuals influences these effects. Three studies offer evidence for those predictions and demonstrate the importance of message framing in uncertain circumstances. Overall, this work contributes to the literature on nudging and life history theory by investigating how communication strategies can be used to increase or decrease perceived threat in order to achieve desired outcomes (e.g., limiting stockpiling or respecting social distancing).

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The information presented and the design of health campaigns significantly influence perceived threats and irrational behaviors such as stockpiling intentions.

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Childhood socioeconomic status of individuals has an impact on the effectiveness of these advertising strategies.

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Health campaign design about COVID-19 and childhood SES influence perceived threat and stockpiling intentions.

The interplay between adolescent friendship quality and resilient functioning following childhood and adolescent adversity

Background

Child and adolescent adversity ('CA') is a major predictor of mental health problems in adolescence and early adulthood. However, not all young people who have experienced CA develop psychopathology; their mental health functioning can be described as resilient. We previously found that resilient functioning in adolescence following CA is facilitated by adolescent friendships.However, during adolescence, friendships undergo significant change. It is unknown whether resilient functioning after CA fluctuates with these normative changes in friendship quality.

Methods

We used Latent Change Score Modelling in a large sample of adolescents (i.e. the ROOTS cohort; N=1238) to examine whether and how emergent friendship quality and resilient functioning at ages 14 and 17 inter-relate and change together.

Results

We found that friendships quality and resilient functioning had strong associations at age 14, although friendships at 14 did not predict higher resilient functioning at 17. Higher resilient functioning in 14-year-olds with a history of CA was associated with a positive change in friendships from age 14 to 17. Finally, improvements in friendship quality and resilient functioning went hand in hand, even when taking into account baseline levels of both, the change within friendship quality or resilient functioning over time, and the association between resilient functioning and change in friendship quality over time.

Conclusions

We show that friendship quality and resilient functioning after CA inter-relate and change together between ages 14 and 17. Our results suggest that improving friendship quality or resilient functioning within this timeframe may benefit this vulnerable adolescent group, and this should be tested in future research.

Possible involvement of neuropeptide and neurotransmitter receptors in Adenomyosis

BACKGROUND

Accumulating data indicate that sensory nerve derived neuropeptides such as substance P and calcitonin gene related-protein (CGRP) can accelerate the progression of endometriosis via their respective receptors, so can agonists to their respective receptors receptor 1 (NK1R), receptor activity modifying protein 1 (RAMP-1) and calcitonin receptor-like receptor (CRLR). Adrenergic β2 receptor (ADRB2) agonists also can facilitate lesional progression. In contrast, women with endometriosis appear to have depressed vagal activity, concordant with reduced expression of α7 nicotinic acetylcholine receptor (α7nAChR). The roles of these receptors in adenomyosis are completely unknown.

METHODS

Adenomyotic tissue samples from 30 women with adenomyosis and control endometrial tissue samples from 24 women without adenomyosis were collected and subjected to immunohistochemistry analysis of RAMP1, CRLR, NK1R, ADRB2 and α7nAChR, along with their demographic and clinical information. The extent of tissue fibrosis was evaluated by Masson trichrome staining.

RESULTS

We found that the staining levels of NK1R, CRLR, RAMP1 and ADRB2 were all significantly elevated in adenomyotic lesions as compared with control endometrium. In contrast, α7nAChR staining levels were significantly reduced. The severity of dysmenorrhea correlated positively with lesional ADRB2 staining levels.

CONCLUSIONS

Our results suggest that SP, CGRP and noradrenaline may promote, while acetylcholine may stall, the progression of adenomyosis through their respective receptors on adenomyotic lesions. Additionally, through the activation of the hypothalamic-pituitary-adrenal (HPA)-sympatho-adrenal-medullary (SAM) axes and the lesional overexpression of ADRB2, adenomyosis-associated dysmenorrhea and adenomyotic lesions may be mutually promotional, forming a viscous feed-forward cycle.

Life stress and cortisol reactivity: An exploratory analysis of the effects of stress exposure across life on HPA-axis functioning

Stressful experiences affect biological stress systems, such as the hypothalamic-pituitary-adrenal (HPA) axis. Life stress can potentially alter regulation of the HPA axis and has been associated with poorer physical and mental health. Little, however, is known about the relative influence of stressors that are encountered at different developmental periods on acute stress reactions in adulthood. In this study, we explored three models of the influence of stress exposure on cortisol reactivity to a modified version of the Trier Social Stress Test (TSST) by leveraging 37 years of longitudinal data in a high-risk birth cohort (N = 112). The cumulative stress model suggests that accumulated stress across the lifespan leads to dysregulated reactivity, whereas the biological embedding model implicates early childhood as a critical period. The sensitization model assumes that dysregulation should only occur when stress is high in both early childhood and concurrently. All of the models predicted altered reactivity, but do not anticipate its exact form. We found support for both cumulative and biological embedding effects. However, when pitted against each other, early life stress predicted more blunted cortisol responses at age 37 over and above cumulative life stress. Additional analyses revealed that stress exposure in middle childhood also predicted more blunted cortisol reactivity.

Developmental Risks in Vulnerable Children from a Low-Income South African Community

OBJECTIVE

To describe the developmental risks, and its influence, in young children from a low-income South African community.

METHOD

An exploratory, cross-sectional research study design was employed. Developmental screening was conducted during home visits with 126 caregivers and children between 0 and 42 months of age from a low-income South African community. Children who failed the rescreen were referred for diagnostic assessment. A binomial logistic regression was used to determine the effect of developmental risks on developmental outcomes.

RESULTS

Seventy-three percent of children screened were identified with a possible developmental delay (n = 59) according to caregiver-report using the PEDS tools. The regression model was statistically significant (χ² (3) = 34.902, p < 0.001) with exposure to multiple languages (p < 0.05; odds ratio 3.810, CI 1.2-12.4) most indicative of potential developmental delay. Older children (19-42 months) were also more at risk of developmental delay (p < 0.001) than younger children (0-18 months).

CONCLUSIONS FOR PRACTICE

Healthcare professionals serving these vulnerable populations should create awareness amongst caregivers about the effect of developmental risks, in particularly multiple language exposure, on development.

The changing opioid crisis: development, challenges and opportunities

The current opioid epidemic is one of the most severe public health crisis in US history. Responding to it has been difficult due to its rapidly changing nature and the severity of its associated outcomes. This review examines the origin and evolution of the crisis, the pharmacological properties of opioids, the neurobiology of opioid use and opioid use disorder (OUD), medications for opioid use disorder (MOUD), and existing and promising approaches to prevention. The results of the review indicate that the opioid epidemic is a complex, evolving phenomenon that involves neurobiological vulnerabilities and social determinants of health. Successfully addressing the epidemic will require advances in basic science, development of more acceptable and effective treatments, and implementation of public health approaches, including prevention. The advances achieved in addressing the current crisis should also serve to advance the science and treatment of other substance use disorders.

Hippocampal synaptoproteomic changes of susceptibility and resilience of male rats to chronic social isolation

The susceptibility of an individual to chronic social isolation (CSIS) stress may cause major depression (MD) whereby some individuals are resistant to the stress. Recent studies relate MD with altered expression of synaptic proteins in specific brain regions. To explore the neurobiological underpinnings and identify candidate biomarkers of susceptibility or resilience to CSIS, a comparative proteomic approach was used to map hippocampal synaptic protein alterations of rats exposed to 6 weeks of CSIS, an animal model of depression. This model generates two stress-response phenotypes: CSIS-sensitive (depressive-like behaviour) and CSIS-resilience assessed by means of sucrose preference and forced swim tests. Our aim was to characterize the synaptoproteome changes representative of potential long-term changes in protein expression underlying susceptibility or resilience to stress. Proteomic data showed increased expression of glycolytic enzymes, the energy-related mitochondrial proteins, actin cytoskeleton, signalling transduction and synaptic transmission proteins in CSIS-sensitive rats. Protein levels of glutamate-related enzymes such as glutamate dehydrogenase and glutamine synthetase were also increased. CSIS-resilient rats showed similar proteome changes, however with a weaker increase compared to CSIS-sensitive rats. The main difference was observed in the level of protein expression of vesicle-mediated transport proteins. Nonetheless, only few proteins were uniquely up-regulated in the CSIS-resilient rats, whereby Cytochrome b-c1 complex subunit 2, mitochondrial (Uqcrc2) and Voltage-dependent anion-selective channel protein 1 (Vdac1) were uniquely down-regulated. Identified altered activated pathways and potential protein biomarkers may help us better understand the molecular mechanisms underlying synaptic neurotransmission in MD or resilience, crucial for development of new therapeutics.

Evidence in Support for the Progressive Nature of Ovarian Endometriomas

CONTEXT

Whether endometriosis is a progressive disease is a highly contentious issue. While progression is reported to be unlikely in asymptomatic deep endometriosis, progression in symptomatic deep endometriosis has recently been reported, especially in menstruating women. However, pathophysiological reasons for these differences are unclear.

OBJECTIVE

This study was designed to investigate whether ovarian endometrioma (OE) is progressive or not.

SETTING, DESIGN, PATIENTS, INTERVENTION AND MAIN OUTCOME MEASURES

Thirty adolescent patients, aged 15 to 19 years, and 32 adult patients, aged 35 to 39 years, all laparoscopically and histologically diagnosed with OE, were recruited into this study after informed consent. Their demographic and clinical information were collected. Their OE tissue samples were collected and subjected to immunohistochemical analysis for E-cadherin, α-smooth muscle actin (α-SMA), desmin, and adrenergic receptor β2 (ADRB2), as well as quantification of lesional fibrosis by Masson trichrome staining.

RESULTS

OE lesions from the adolescent and adult patients are markedly different, with the latter exhibiting more extensive and thorough progression and more extensive fibrosis, suggesting that lesions in adults progressed to a more advanced stage. Adult lesions and higher staining level of α-SMA and ADRB2 are positively associated with the extent of lesional fibrosis, while the lesion size and the E-cadherin staining are negatively associated.

CONCLUSIONS

Our data provide a more definitive piece of evidence suggesting that OE is a progressive disease, since the adult lesions have had a longer time to progress. In addition, the pace of progression depends on lesional age as well as the severity of endometriosis-associated dysmenorrhea, if any.

What is resilience: an affiliative neuroscience approach

Resilience - a key topic in clinical science and practice - still lacks a clear conceptualization that integrates its evolutionary and human-specific features, refrains from exclusive focus on fear physiology, incorporates a developmental approach, and, most importantly, is not based on the negation (i.e., absence of symptoms following trauma). Building on the initial condition of mammals, whose brain matures in the context of the mother's body and caregiving behavior, we argue that systems and processes that participate in tuning the brain to the social ecology and adapting to its hardships mark the construct of resilience. These include the oxytocin system, the affiliative brain, and biobehavioral synchrony, all characterized by great flexibility across phylogenesis and ontogenesis. Three core features of resilience are outlined: plasticity, sociality and meaning. Mechanisms of sociality by which coordinated action supports diversity, endurance and adaptation are described across animal evolution. Humans' biobehavioral synchrony matures from maternal attuned behavior in the postpartum to adult-adult relationships of empathy, perspective-taking and intimacy, and extends from the mother-child relationship to other affiliative bonds throughout life, charting a fundamental trajectory in the development of resilience. Findings from three high-risk cohorts, each tapping a distinct disruption to maternal-infant bonding (prematurity, maternal depression, and early life stress/trauma), and followed from birth to adolescence/young adulthood, demonstrate how components of the neurobiology of affiliation confer resilience and uniquely shape the social brain.

Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth

Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.

From the crisis in acute care to postdischarge resilience - The communication experience of Geriatric patients: A qualitative study

BACKGROUND

Hospital readmissions due to illness among geriatric patients result in human suffering and psychological trauma. Resilience in chronic illness protects geriatric patients from outcomes of trauma leads to psychological and physical well-being and enables bouncing back to life. While communication has been linked to improved health outcomes, little is known about communication pathways in the context of postdischarge resilience.

AIM AND OBJECTIVE

To explore the role of communication pathways that acute-care clinicians used with geriatric patients in postdischarge resilience.

METHODOLOGICAL DESIGN AND JUSTIFICATION

Participants were ten geriatric patients who were readmitted several times in the past year. Twenty narrative interviews were conducted, one upon discharge and the other a month thereafter. Data for each phase of interviews were analysed using methods of selection mechanisms and Bricolage.

ETHICAL ISSUES

The ethics committee approved the study. Participants signed an informed-consent form for participation and publication.

FINDINGS

Communication in acute care that enhanced health literacy, perceived control and reflection, contributed to higher comprehensibility and manageability during the hospitalisation and postdischarge meaningfulness postdischarge, contributing resilience. Participants who experienced other forms of communication demonstrated anxiety and helplessness with lingering psychological trauma postdischarge.

CONCLUSIONS

Acute care may provide clinicians with opportunities to alleviate the suffering of geriatric patients and contribute to their postdischarge resilience. The suggested T.E.R model delineates communication pathways to fuel the trajectory from psychological trauma to postdischarge resilience in practice.

Centenarians: An excellent example of resilience for successful ageing

Centenarians are remarkable not only because of their prolonged life, but also because they compress morbidity until the very last moments of their lives, thus being proposed as a model of successful, extraordinary ageing. From the medical viewpoint, centenarians do not escape the physiological decline or the age-related diseases or syndromes (i.e. frailty), but the rate of such processes is slow enough to be counterbalanced by their increased intrinsic capacity to respond to minor stresses of daily life (i.e. resilience). These new concepts are reviewed in this paper. Allostatic stresses lead to a chronic low-grade inflammation that has led to the proposal of the "inflammaging" theory of ageing and frailty. The biology of centenarians, described in this review, provides us with clues for intervention to promote healthy ageing in the general population. One of the major reasons for this healthy ageing has to do with the genetic signature that is specific for centenarians and certainly different from octogenarians who do not enjoy the extraordinary qualities of centenarians.

Habituation and novelty detection fNIRS brain responses in 5- and 8-month-old infants: The Gambia and UK

The first 1,000 days of life are a critical window of vulnerability to exposure to socioeconomic and health challenges (i.e. poverty/undernutrition). The Brain Imaging for Global Health (BRIGHT) project has been established to deliver longitudinal measures of brain development from 0 to 24 months in UK and Gambian infants and to assess the impact of early adversity. Here results from the Habituation-Novelty Detection (HaND) functional near-infrared spectroscopy (fNIRS) task at 5 and 8 months are presented (N = 62 UK; N = 115 Gambia). In the UK cohort distinct patterns of habituation and recovery of response to novelty are seen, becoming more robust from 5 to 8 months of age. In The Gambia, an attenuated habituation response is evident: a larger number of trials are required before the response sufficiently suppresses relative to the response during the first presented trials. Furthermore, recovery of response to novelty is not evident at 5 or 8 months of age. As this longitudinal study continues in The Gambia, the parallel collection of socioeconomic, caregiving, health and nutrition data will allow us to stratify how individual trajectories of habituation and recovery of response to novelty associate with different risk factors and adaptive mechanisms in greater depth. Given the increasing interest in the use of neuroimaging methods within global neurocognitive developmental studies, this study provides a novel cross-culturally appropriate paradigm for the study of brain responses associated with attention and learning mechanisms across early development.

Validation of short instruments assessing parental and caregivers' perceptions on child health and development for personalized prevention

Systematically exploring parental as well as other caregivers' concerns is a main component in preventive child health care (PCHC) for family-centred practice and personalized health care. To facilitate communication and early identification of emerging mental health problems, a PCHC toolkit based on short instruments was developed. This article investigates the reliability and validity of (1) two visual analogue scales (VAS) to assess parent-reported 'parenting' and 'child behaviour', (2) a professional caregiver-reported VAS to assess 'child competence' and (3) the parents' evaluation of developmental status (PEDS) in Dutch PCHC. Parents as well as child care, kindergarten and preschool teachers completed instruments in a community-based sample of children (N = 346) aged 3 years at baseline. The three VAS and PEDS were associated with standardized questionnaires assessing the same constructs. Overall predictive accuracy showed: good to excellent for 'parenting' VAS, fair to good for 'child behaviour' VAS and poor for 'child competence' VAS. The PEDS, 'parenting' VAS and 'child behaviour' VAS, demonstrated high sensitivity at various cut-off points of index test and reference standard. At follow-up, approximately 1 year later, results were similar. Although the 'child competence' VAS scored lower on one aspect of validity, the PEDS and the different VAS are reliable, valid and useful as brief monitoring tools in daily Dutch PCHC practice.

Glucocorticoids and resilience

All organisms endure frequent challenges to homeostasis, or stressors, that require adaptation. Depending on the individual, the context, and the magnitude of stress, this active adaptation can lead to behavioral susceptibility or resilience. The latter is an under-appreciated consequence of stress, as the damaging effects of chronic stress and chronically elevated glucocorticoids have received much more attention. We suggest here that neural pathways promoting resilience are initiated at the time of stress, and that they involve glucocorticoid signaling. By focusing on the neurobiology of resilience induction and the identification of vulnerable individuals, we may be able to intervene in the future at the time of stress to promote positive adaptation.

Antecedents of women managers’ resilience: conceptual discussion and implications for HRM

Purpose

This paper aims to provide a framework with the antecedents of women managers’ resilience in SMEs.

Design/methodology/approach

This developmental study uses a comprehensive literature review and a set of propositions to identify the antecedent of women managers’ resilience and develops a conceptual framework for resilience.

Findings

The results indicate that in addition to personal resilience traits, interactive engagement with the work environment, career adaptability and positive human resource management (HRM) interventions are the main antecedents of women managers’ resilience.

Research limitations/implications

This paper contributes to theory by providing a new perspective on the study of resilience as a process at the organisational level and as a trait at personal level. It contributes to the women employee-centric resilience discussion in HRM literature and explores the relationship between resilience and women managers’ career progression. This is a developmental study, and despite the strengths of the undertaken approach, there are a number of limitations due to the lack of empirical evidence. Therefore, future research activities should focus on validating the framework and determining any potential boundaries of this resilience framework.

Practical implications

The study reveals a number of practical implications leading to a recommended resilience toolkit for HR managers of organisations to develop and promote resilience in their women managers and aspiring managers.

Social implications

The social implications of this study include the social relationships within the work-setting, better employee engagement and interaction with the work environment and flexible career progression pathways.

Originality/value

The paper is based on rich conceptual and theoretical discussion that identifies the key antecedents of women managers’ resilience. The study also conceptually establishes the moderating relationship between women managers’ resilience and work stress and burnout.

Giving a good start to a new life via maternal brain allostatic adaptations in pregnancy

Successful pregnancy requires adjustments to multiple maternal homeostatic mechanisms, governed by the maternal brain to support and enable survival of the growing fetus and placenta. Such adjustments fit the concept of allostasis (stability through change) and have a cost: allostatic load. Allostasis is driven by ovarian, anterior pituitary, placental and feto-placental hormones acting on the maternal brain to promote adaptations that support the pregnancy and protect the fetus. Many women carry an existing allostatic load into pregnancy, from socio-economic circumstances, poor mental health and in 'developed' countries, also from obesity. These pregnancies have poorer outcomes indicating negative interactions (failing allostasis) between pre-pregnancy and pregnancy allostatic loads. Use of animal models, such as adult prenatally stressed female offspring with abnormal neuroendocrine, metabolic and behavioural phenotypes, to probe gene expression changes, and epigenetic mechanisms in the maternal brain in adverse pregnancies are discussed, with the prospect of ameliorating poor pregnancy outcomes.

Health and Disease-Emergent States Resulting From Adaptive Social and Biological Network Interactions

Health is an adaptive state unique to each person. This subjective state must be distinguished from the objective state of disease. The experience of health and illness (or poor health) can occur both in the absence and presence of objective disease. Given that the subjective experience of health, as well as the finding of objective disease in the community, follow a Pareto distribution, the following questions arise: What are the processes that allow the emergence of four observable states-(1) subjective health in the absence of objective disease, (2) subjective health in the presence of objective disease, (3) illness in the absence of objective disease, and (4) illness in the presence of objective disease? If we consider each individual as a unique biological system, these four health states must emerge from physiological network structures and personal behaviors. The underlying physiological mechanisms primarily arise from the dynamics of external environmental and internal patho/physiological stimuli, which activate regulatory systems including the hypothalamic-pituitary-adrenal axis and autonomic nervous system. Together with other systems, they enable feedback interactions between all of the person's system domains and impact on his system's entropy. These interactions affect individual behaviors, emotional, and cognitive responses, as well as molecular, cellular, and organ system level functions. This paper explores the hypothesis that health is an emergent state that arises from hierarchical network interactions between a person's external environment and internal physiology. As a result, the concept of health synthesizes available qualitative and quantitative evidence of interdependencies and constraints that indicate its top-down and bottom-up causative mechanisms. Thus, to provide effective care, we must use strategies that combine person-centeredness with the scientific approaches that address the molecular network physiology, which together underpin health and disease. Moreover, we propose that good health can also be promoted by strengthening resilience and self-efficacy at the personal and social level, and via cohesion at the population level. Understanding health as a state that is both individualized and that emerges from multi-scale interdependencies between microlevel physiological mechanisms of health and disease and macrolevel societal domains may provide the basis for a new public discourse for health service and health system redesign.

The Dual Impact of Early and Concurrent Life Stress on Adults' Diurnal Cortisol Patterns: A Prospective Study

Major life stress often produces a flat diurnal cortisol slope, an indicator of potential long-term health problems. Exposure to stress early in childhood or the accumulation of stress across the life span may be responsible for this pattern. However, the relative impact of life stress at different life stages on diurnal cortisol is unknown. Using a longitudinal sample of adults followed from birth, we examined three models of the effect of stress exposure on diurnal cortisol: the cumulative model, the biological-embedding model, and the sensitization model. As its name implies, the cumulative model focuses on cumulative life stress. In contrast, the biological-embedding model implicates early childhood stress, and the sensitization model posits that current life stress interacts with early life stress to produce flat diurnal cortisol slopes. Our analyses are consistent with the sensitization model, as they indicate that the combination of high stress exposure early in life and high current stress predict flat diurnal cortisol slopes. These novel findings advance understanding of diurnal cortisol patterns and point to avenues for intervention.

Somatic symptoms in children who have a parent with cancer: A systematic review

BACKGROUND

This systematic review explored the occurrence and types of somatic symptoms in children (0-20 years) who have experienced parental cancer.

METHODS

We complemented a systematic literature search from PubMed and PsycInfo with a reference search. We identified 1,694 articles, which were independently screened by two authors; they further evaluated potentially relevant papers for quality and extracted the data. We found nine relevant studies (10 publications) on altogether 672 children with a parent who had cancer; four studies included a control group.

RESULTS

The studies typically focused on children's psychosocial reactions on parental cancer rather than somatic complaints, so symptom prevalence cannot be reliably summarized. Several studies were small, and the types of somatic symptoms were only specified in five studies. Somatic symptoms were reported as a measure of emotional reactions in the remaining four studies. Three studies provided longitudinal data. The main types of specific symptoms reported were eating problems, pain, sleeping troubles, and bed-wetting. Children of cancer patients tended to show an increase of unspecified somatic symptoms and pain, but evidence was inconsistent. There was a tendency that somatic complaints were associated with increased emotional distress in the children. The material did not allow for separate analysis by age group or bereavement status.

CONCLUSIONS

Children in families with parental cancer may present with somatic complaints, but the prevalence and significance is not possible to estimate due to very sparse research in this area. Health professionals or counselling providers should not overlook this possible sign of distress. Qualitative studies report significant health anxiety in these children; this may represent a specific topic for counselling in this population. Targeted studies are needed to evaluate the prevalence and significance of somatic symptoms, and especially vulnerable groups need to be identified.

Exploring the involvement of Tac2 in the mouse hippocampal stress response through gene networking

Tachykinin 2 (Tac2) is expressed in a number of areas throughout the brain, including the hippocampus. However, knowledge about its function has been only well explored in the hypothalamus in the context of reproductive health. In this study, we identified and validated increased hippocampal Tac2 mRNA expression in response to chronic mild stress in mice. Expression quantitative trait locus (eQTL) analysis showed Tac2 is cis-regulated in the hippocampus. Using a systems genetics approach, we constructed a Tac2 co-expression network to better understand the relationship between Tac2 and the hippocampal stress response. Our network identified 69 total genes associated with Tac2, several of which encode major neuropeptides involved in hippocampal stress signaling as well as critical genes for producing neural plasticity, indicating that Tac2 is involved in these processes. Pathway analysis for the member of Tac2 gene network revealed a strong connection between Tac2 and neuroactive ligand-receptor interaction, calcium signaling pathway, as well as cardiac muscle contraction. In addition, we also identified 46 stress-related phenotypes, specifically fear conditioning response, that were significantly correlated with Tac2 expression. Our results provide evidence for Tac2 as a strong candidate gene who likely plays a role in hippocampal stress processing and neural plasticity.

Environmental conditions shape the temporal pattern of investment in reproduction and survival

The relationship between environmental stress exposure and ageing is likely to vary with stressor severity, life-history stage and the time scale over which effects are measured. Such factors could influence whether stress exposure accelerates or slows the ageing process, but their interactions have not previously been experimentally investigated. We found that experimental exposure of zebra finches to mildly challenging environmental circumstances from young to old adulthood, which increased exposure to stress hormones, reduced breeding performance during early adulthood, but had positive effects when individuals were bred in old adulthood. This difference was not due to selective mortality, because the effects were evident within individuals, and no evidence of habituation in the response to the stressor was found. The more stressful environment had no effects on survival during young or old adulthood, but substantially improved survival during middle age. Changes in the effects at different ages could be due to the duration and nature of the challenging exposure, or to variation in coping capacity or strategy with age. These results show that living under challenging environmental circumstances can influence ageing trajectories in terms of both reproductive performance and longevity. Our results provide experimental support for the emerging idea that stress exposure needs to be optimized rather than minimized to obtain the best health outcomes.

Maternal depression impacts child psychopathology across the first decade of life: Oxytocin and synchrony as markers of resilience

BACKGROUND

While maternal depression is known to carry long-term negative consequences for offspring, very few studies followed children longitudinally to address markers of resilience in the context of maternal depression. We focused on oxytocin (OT) and mother-child synchrony - the biological and behavioral arms of the neurobiology of affiliation - as correlates of resilience among children of depressed mothers.

METHOD

A community birth-cohort was recruited on the second postbirth day and repeatedly assessed for maternal depression across the first year. At 6 and 10 years, mothers and children underwent psychiatric diagnosis, mother-child interactions were coded for maternal sensitivity, child social engagement, and mother-child synchrony, children's OT assayed, and externalizing and internalizing problems reported.

RESULTS

Exposure to maternal depression markedly increased child propensity to develop Axis-I disorder at 6 and 10 years. Child OT showed main effects for both maternal depression and child psychiatric disorder at 6 and 10 years, with maternal or child psychopathology attenuating OT response. In contrast, maternal depression decreased synchrony at 6 years but by 10 years synchrony showed only child disorder effect, highlighting the shift from direct to indirect effects as children grow older. Path analysis linking maternal depression to child externalizing and internalizing problems at 10 years controlling for 6-year variables indicated that depression linked with decreased maternal sensitivity and child OT, which predicted reduced child engagement and synchrony, leading to higher externalizing and internalizing problems. OT and synchrony mediated the effects of maternal depression on child behavior problems and an alternative model without these resilience components provided less adequate fit.

CONCLUSIONS

Maternal depression continues to play a role in children's development beyond infancy. The mediating effects of OT and synchronous, mutually regulated interactions underscore the role of plasticity in resilience. Results emphasize the need to follow children of depressed mothers across middle childhood and construct interventions that bolster age-appropriate synchrony.

Biopsychosocial approach to understanding resilience: Stress habituation and where to intervene

BACKGROUND

Resilience in the face of adversity is a human experience that leads to better health, both mentally and physically. We briefly review its historical origins rooted in ecological biology and its adoption into health care. Resilience is the common response to adversity or potential traumatic events. Individual differences in emotion regulation and coping skills as well as social capital and one's physical environment influence a person's ability to achieve resilience.

PROPOSED MECHANISM

One potential biopsychosocial measure of resilience includes stress habituation to repeated stress as demonstrated in the laboratory, possibly providing a tool to observe mastery of resilience training in the clinic. Evidence-based interventions at the individual and small group level (eg, family, classroom) have successfully shown development of resilient behaviours and improved mental and physical health outcomes. However, the role of social context and public policy clearly influence an individual's ability to be resilient.

CONCLUSIONS

Despite the current limited evidence of the effectiveness of resilience building interventions, clinicians, researchers, and other health care professions have an obligation to become advocates for laws and policies that support the most vulnerable, and least resilient, in our society to attain resilience for their health. This salutary effect will enable them to become socially as well as economically productive members of the community at large. It is not possible to remove stress or adversity from life, but we can influence the development of regulatory flexibility and decrease the sociocultural factors linked to the nonresilient experience, thus mitigating adversity's long-term effects on health.