Daily cortisol activity, loneliness, and coping efficacy in late adolescence: A longitudinal study of the transition to college

Postpartum symptoms of anxiety, depression and stress: differential relationships to women's cortisol profiles

PURPOSE

Women are at high risk of stress, anxiety, and depression during the postpartum but the ways in which these different types of psychological distress are related to cortisol regulation is not clear. We examined the distinct association of each type of distress with women's average cortisol level, cortisol awakening response (CAR), cortisol decline across the day (diurnal slope), and overall amount of cortisol secretion across the day (AUCG).

METHODS

At 6 months postpartum, a diverse group of 58 women completed measures of depression, anxiety, perceived stress, and life stressors. Each woman provided 4 salivary samples for cortisol assay from waking to bedtime on each of 2 consecutive days. Linear regressions were used to examine associations of stress, anxiety and depression to each of the 4 cortisol measures, controlling for number of stressful life events.

RESULTS

Depressive symptoms were associated with less of a rise in the CAR (β = -.46, p = 0.01), steeper diurnal slope (β = .51, p = 0.006), and higher average cortisol level (β = .42, p = .01). Women who met the clinical cutoff for an anxiety disorder had lower overall cortisol output (β = -.29, p = 0.03). Stress was not related to any cortisol metric.

CONCLUSIONS

Findings suggest that stress is less associated with cortisol alterations in the postpartum than are more severe types of psychological distress. Anxiety and depression may have distinct and opposite profiles of cortisol dysregulation. Results indicate that mental health assessment is critical even in the later postpartum so that interventions can be initiated to reduce emotional suffering and the risk of impaired cortisol regulation.

College students' daily mind wandering is related to lower social well-being

Objective: This study sought to examine how daily mind wandering is related to loneliness, felt connection to others, and school belonging among college students. Participants: Three samples (n = 209, n = 173, and n = 266) from two US campuses were recruited. Methods: Data were collected via ecological momentary assessment over the course of two academic quarters in one sample and an academic semester in two samples. Results: Social well-being declined throughout the academic term in all samples. Lower day-to-day mind wandering predicted lower loneliness at the next time point and was concurrently related to a higher felt connection to others and higher school belonging. Thoughts about the past and future were associated with lower social well-being than present-focused thoughts. Conclusions: This study supports the proposition that promoting present-centered attention can benefit college students' social well-being and alleviate their feelings of loneliness and isolation that they often experience.

A stress-is-enhancing mindset is associated with lower traumatic stress symptoms during the COVID-19 pandemic

BACKGROUND

A stress-is-enhancing mindset is associated with lower perceived stress and better coping. However, work examining the prospective associations of stress mindset on perceived traumatic stress symptoms during a stressful real-world life event is limited. The present prospective study explored whether stress-is-enhancing mindset measured before the onset of the COVID-19 global pandemic was associated with later traumatic stress symptoms in response to the COVID-19 global pandemic.

METHODS

University students (N = 179; 68% female; Mage = 19.31, SD = 0.79 years) completed the Stress Mindset Measure (SMM) prior to COVID-19 pandemic onset as part of a larger study. The Impact of Event Scale-Revised (IES-R) with respect to the COVID-19 pandemic was completed 1 year into the pandemic.

RESULTS

SMM negatively predicted the IES-R subscales intrusion, avoidance, and hyperarousal such that a more stress-is-enhancing mindset was associated with lower intrusion, avoidance, and hyperarousal following the onset of COVID-19.

CONCLUSIONS

Results suggest a more positive stress mindset is associated with fewer traumatic stress symptoms following a traumatic life event. Altering stress mindset may be an avenue for future interventions to cope with stress.

"Gutting It Out" Does Not Work: Why Mental Health Days are Needed

College student mental health issues negatively impact academic performance. Over half of college students in the U.S. report a mental health issue, with 60% reporting one at the two-year mark. Even when aware of such mental health issues, students are still hesitant to seek treatment. As such, investigating perceptions of mental health time off may illuminate perceived usefulness of such policies as well as potential processes for defining and implementing such policies. This study sought to answer the question, "What are the perspectives of time-off for mental health?" Using Reddit's responses, this study extracted (N = 392) quotes and used thematic analysis to identify four main themes. Implications include the need for school-level mental health time-off policies or integration of instructors' policies into their syllabi for transparency to students, which may alleviate student stress and further stigmatization.

Corona virus anxiety and Chinese students' cognitive, affective, and behavioral engagement, and academic resilience: correlations and perceptions

BACKGROUND

This study delves into the correlation between Corona Virus Anxiety (CVA) and the engagement as well as academic resilience of Chinese students. The context is set against the backdrop of the global pandemic, highlighting the potential psychological impact of COVID-19 on students' well-being and academic performance.

OBJECTIVES

The primary objectives of this research are to investigate the relationship between CVA and various dimensions of student engagement, including affective, behavioral, and cognitive aspects. Additionally, the study aims to explore how CVA influences academic resilience, with a focus on persistence and self-regulation. The dual-objective approach employs both quantitative and qualitative methods to provide a comprehensive understanding of the subject matter.

METHODOLOGY

A mixed-methods approach is employed, combining quantitative data from scales measuring CVA, engagement, and academic resilience with qualitative insights obtained through interviews. The research sample consists of 390 students from Mudanjiang Medical University. Quantitative data are analyzed using Pearson correlation tests, while thematic analysis is applied to interpret the qualitative findings from interviews.

RESULTS

Quantitative data analysis reveals significant negative correlations between CVA and multiple dimensions of student engagement, indicating that higher CVA levels are associated with lower engagement levels. Academic resilience, though relatively high among participants, also exhibits negative correlations with CVA, particularly in terms of persistence and self-regulation. The qualitative findings uncover six main themes elucidating the impact of CVA on students, ranging from emotional and cognitive engagement to the social and technological challenges posed by the pandemic.

CONCLUSIONS AND IMPLICATIONS

The research concludes that CVA significantly influences students' engagement and academic resilience. The qualitative insights contribute to a nuanced understanding of the diverse challenges students face during the pandemic. These findings have broad implications for students, university administrators, educators, and educational psychologists, highlighting the importance of addressing mental health concerns and providing adequate support systems in the context of global crises.

Prospective association between 24-hour movement behaviors and mental health among overweight/obese college students: a compositional data analysis approach

Background

24-h movement behaviors, including light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), screen-based sedentary behavior (SSB), non-screen-based sedentary behavior (NSB) and sleep are crucial components affecting mental health. This study aimed to examine the associations of movement behaviors with mental health outcomes among overweight/obese college students using a compositional data analysis approach.

Methods

Using a prospective design, 437 Chinese college students (20.1 ± 1.7 years, 51.7% female) completed a two-wave online data collection, where demographics and movement behaviors (LPA, MVPA, SSB, NSB, sleep) were collected at baseline, while depression, anxiety and stress were measured at the 2-month follow-up (Apr-Jul 2022). Compositional data analyses were implemented using R.

Results

Depression, anxiety, and stress were negatively associated with time spent in MVPA and sleep (p < 0.001) and positively associated with time spent in SSB and NSB (p < 0.001). Reallocating 15 min to MVPA from LPA, SSB and NSB predicted improvements in depression (LPA: -0.234 unit; SSB: -0.375 unit; NSB: -0.249 unit), anxiety (LPA: -0.092 unit; SSB: -0.284 unit; NSB: -0.165 unit), and stress (LPA: -0.083 unit; SSB: -0.312 unit; NSB: -0.191 unit). For dose-response relationships of 5-55 min isotemporal substitution, when time was reallocated to MVPA from LPA, NSB, and SSB, the estimated detriments to mental health were larger in magnitude than the estimated benefits of time reallocation from MVPA to LPA, NSB, and SSB.

Conclusion

The findings emphasize the importance of participating in MVPA to improve mental health in overweight/obese college students during the post-COVID-19 era. The compositional analysis produced clear targets for the time allocation of these behaviors for future interventions and policymaking.

Generalized Anxiety Mediates the Relationship Between Loneliness and Sleep Quality Amongst Young Adults During the COVID-19 Pandemic

Since the outbreak of COVID-19, restrictions to minimize its spread have had a profound effect. Government instigated restrictions, such as social isolation, have affected millions worldwide, and the downstream consequences of perceived loneliness upon mental health and sleep are largely unknown. A total of 1662 individuals participated in an online survey. Loneliness, anxiety, and sleep quality were assessed using the UCLA Loneliness Scale, the Generalized Anxiety Disorders scale, and the Pittsburgh Sleep Quality Index, respectively. Higher levels of perceived loneliness, as well as each one-unit increase in anxiety, were independent predictors of poor sleep quality, where OR = 1.16 (95% CI: 1.03-1.31) and 1.16 (1.11-1.21), respectively, and after adjustment. In our path analysis, we revealed significant direct effects between loneliness and sleep quality (β = 0.25, p < .001), as well as generalized anxiety and sleep quality (β = 0.28, p < .001), and generalized anxiety mediated the relationship between loneliness and sleep quality (β = 0.33, p < .001). Heightened anxiety and perceived loneliness appear to be significant drivers of poor sleep quality during the COVID-19 pandemic. Digital media platforms that encourage support groups for those experiencing social isolation are encouraged, along with self-help and meditative practices, which may minimize an increase of mental health and sleep disorder diagnoses post COVID-19.

How does loneliness "get under the skin" to become biologically embedded?

Loneliness is linked to declining physical health across cardiovascular, inflammatory, metabolic, and cognitive domains. As a result, loneliness is increasingly being recognized as a public health threat, though the mechanisms that have been studied do not yet explain all loneliness-related health risk. Potential mechanisms include loneliness having 1.) direct, causal impacts on health, possibly maintained by epigenetic modification, 2.) indirect effects mediated through health-limiting behaviors, and 3.) artifactual associations perhaps related to genetic overlap and reverse causation. In this scoping review, we examine the evidence surrounding each of these pathways, with a particular emphasis on emerging research on epigenetic effects, in order to evaluate how loneliness becomes biologically embedded. We conclude that there are significant gaps in our knowledge of how psychosocial stress may lead to physiological changes, so more work is needed to understand if, how, and when loneliness has a direct influence on health. Hypothalamic-pituitary adrenocortical axis disruptions that lead to changes in gene expression through methylation and the activity of transcription factor proteins are one promising area of research but are confounded by a number of unmeasured factors. Therefore, wok is needed using causally informative designs, such as twin and family studies and intensively longitudinal diary studies.

Impact of closed management on gastrointestinal function and mental health of Chinese university students during COVID-19

BACKGROUND

The innovative closed management of universities may have influenced the physical and mental health of students during the fourth stage of the COVID-19 pandemic in China. The study aimed to assess the gastrointestinal and mental health status of students in this stage and to explore the possible risk factors and mechanisms to provide a reference for future school responses to similar stressful events.

METHOD

A multicenter, cross-sectional survey was administered to 598 college students from 10 Chinese universities. The study used the 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), Fear of COVID-19 Scale (FCV-19 S), and the Diagnostic Tendency of Functional Bowel Disease Scale (DT-FBD) to evaluate anxiety, depression, fear of COVID-19 and likelihood of being diagnose diagnosed with functional bowel disease (FBD), respectively.

RESULTS

A total of 516 college students completed the questionnaire. The proportions of students with more severe anxiety, more severe depression, greater fear of COVID-19, and a greater likelihood of being diagnosed with FBD were 49.8%, 57.0%, 49%, and 49%, respectively. These symptoms were significantly and positively correlated with the frequency of irregular sleep and eating (p < 0.05). Students in high-risk areas were more likely to experience anxiety and depression than students in areas with low/medium risk (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.12-3.24, p = 0.017; OR = 2.14, 95% CI: 1.11-4.11, p = 0.022). A high likelihood of being diagnosed with FBD was positively associated with the severity of anxiety and depression symptoms and fear of COVID-19 (all p < 0.001). Moreover, mediation analysis revealed the following pathway in college students: fear of COVID-19 → depression and anxiety → poor diet → likelihood of being diagnosed with FBD.

CONCLUSION

College students generally exhibited higher more severe anxiety and depression symptoms and psychological symptoms with a greater higher propensity likelihood of being to be diagnosed with FBD. Good lifestyle habits, especially adequate sleep and a regular diet, can alleviate these problems. In addition, appropriate psychological intervention is very important.

Breaking the vicious cycle: The interplay between loneliness, metabolic illness, and mental health

Loneliness, or perceived social isolation, is a leading predictor of all-cause mortality and is increasingly considered a public health epidemic afflicting significant portions of the general population. Chronic loneliness is itself associated with two of the most pressing public health epidemics currently facing the globe: the rise of mental illness and metabolic health disorders. Here, we highlight the epidemiological associations between loneliness and mental and metabolic health disorders and argue that loneliness contributes to the etiology of these conditions by acting as a chronic stressor that leads to neuroendocrine dysregulation and downstream immunometabolic consequences that manifest in disease. Specifically, we describe how loneliness can lead to overactivation of the hypothalamic-pituitary-adrenal axis and ultimately cause mitochondrial dysfunction, which is implicated in mental and metabolic disease. These conditions can, in turn, lead to further social isolation and propel a vicious cycle of chronic illness. Finally, we outline interventions and policy recommendations that can reduce loneliness at both the individual and community levels. Given its role in the etiology of the most prevalent chronic diseases of our time, focusing resources on alleviating loneliness is a vitally important and cost-effective public health strategy.

Changes in stress predict worse mental health outcomes for college students than does loneliness; evidence from the COVID-19 pandemic

Objectives: Although loneliness and stress have been widely implicated in worse mental health outcomes for college students, the relationship between them remains poorly understood. Participants: Data were collected from 111 undergraduates at a large Midwestern university in fall 2019 - winter 2020. A subset (N = 34) of those responded to a follow-up survey during the COVID-19 pandemic (May 2020). Methods: At both time points, participants completed measures of loneliness and stress, as well as well-validated measures of depression and anxiety. Results: Prior to the pandemic, stress mediated the positive relationship between loneliness and depression. During the pandemic, mental health outcomes, stress, and loneliness all increased. Stress, but not loneliness, predicted college students' worse mental health outcomes during the pandemic. Conclusions: Stress plays a key role in college students' worsening mental health. Reducing loneliness may be a potential strategy to mitigate the negative impact of stress on college students' mental health.

Academic expectations among international students from North-Western China: A case of technology use during and post COVID-19

This study examines the influence of the COVID-19 crisis on academic expectations among international students from north-western China. According to past studies, academic expectations are multifaceted, making it critical to test the methods employed to assess this fundamental trait. The outbreak of COVID-19 has resulted in various significant changes in education, which have shifted from traditional to online or mixed formats. As a result, examining international students' academic expectations along with their interactions with adopted technologies is a topic that addresses the current situation and issues. A mixed approach, comprising two different instruments (questionnaire and interview), was followed to achieve this primary objective. While a survey with a questionnaire was undertaken with 551 international students, divided into two groups, ten students were interviewed during and after the lockdowns. The findings revealed that COVID-19 had a significant impact on the academic expectations of students as well as many elements such as training for employment, personal and social development, international student mobility, motivation, social pressure, and social interaction with the help of supporting technologies. In terms of gender, men outperformed women in motivation, social interaction, training for employment, and personal and social development factors. Similarly, as per the grade variable (undergraduate, postgraduate, doctoral), the same higher trend was seen in postgraduates. Based on these findings, a set of recommendations was put forward. In the future, technology will be helpful in China's educational sector, such as online group collaboration, open education, managing student retention, and supervising teachers' recruitment.

Loneliness From the Adolescent Perspective: A Qualitative Analysis of Conversations About Loneliness Between Adolescents and Childline Counselors

There is limited qualitative research on the experience of loneliness in adolescence, meaning key facets of the loneliness experience that are important in adolescence may have been overlooked. The current study addresses that gap in the literature and explores how loneliness is experienced in the context of adolescence from the perspective of adolescents. About 67 online counseling conversations between Childline counselors and adolescents (ages 12–18 years; 70% females) who had contacted Childline to talk about loneliness were analyzed using Thematic Framework Analysis to establish commonalities and salient issues involved in adolescent experiences of loneliness. Young people considered loneliness to be an intense experience that negatively impacted their daily lives. Experiences of loneliness revolved around difficulties with peer relationships, but turmoil at home worsened those experiences. Young people often employed short-term coping strategies that distracted them from loneliness. Issues with trusting others and self-worth acted as barriers to seeking long-term help. Recommendations include (1) the training of teachers and parents to recognize and support young people experiencing loneliness and (2) further research to establish the coping strategies that are used by adolescents who successfully overcome loneliness.

Associations of Different Emotion Regulation Strategies with Coping-Efficacy, Rumination and Stress

Background

In order to investigate the relationship between stress-reactive rumination and the implementation of different emotion-regulation strategies (ERS), the pilot study at hand assessed ecological momentary assessment data twice per day from currently depressed patients (n = 21) and healthy controls (n = 23).

Methods

We analyzed differences in the implementation of ERS (body-based, behavioral, cognitive, social and multiple) and the occurrence of stress, rumination and self-efficacy between the groups as well as associations of ERS implementation at a given time-point and later levels of stress and rumination.

Results

Overall, patients reported higher subjective stress levels as well as increased ruminative thinking as a response to life stress and, in addition, a more frequent implementation of ERS. Comparing the implementation of ERS, cognitive ERS were implemented most often in the clinical group in comparison to healthy controls. All ERS were associated with increased self-efficacy at the time-point they were implemented. The implementation of cognitive ERS (e.g., reframing) at a given time-point significantly predicted reduced rumination and stress at later time-points.

Conclusions

Clinical and non-clinical groups seem to differ in their implementation of ERS. While the implementation of all investigated ERS is related to increased coping-efficacy, ERS on a cognitive level seem to be advantageous in reducing stress as well as rumination.

University students under lockdown, the psychosocial effects and coping strategies during COVID-19 pandemic: A cross sectional study in Egypt

Objective: This study aimed to assess the psychosocial effects and coping strategies of university students during COVID-19 pandemic. Methods: Between 30 May and 6 June 2020, an online cross-sectional survey was fulfilled by 612 university students. The University of California Los Angeles (UCLA) Loneliness Scale, version 3, the Depression Anxiety Stress Scale (DASS-21), and the Brief COPE scale were used. Results: Different degrees of depression, anxiety, and stress were reported by 74.5%, 47.1%, and 40.5% of the surveyed students, respectively. Dysfunctional coping strategies including venting, denial, and substance use had the lowest scores on Brief COPE while problem-focused coping strategies including planning and active coping strategies had the highest scores on Brief COPE. Conclusion: Undergraduate university students are very prone to experience psychosocial problems during the current pandemic. Educational institutions should work together with the authorities to promote measures to improve mental health and academic performance of their students.

Connectedness, Self-Esteem, and Prosocial Behaviors Protect Adolescent Mental Health Following Social Isolation: A Systematic Review

Societal trends and COVID-19 quarantines have increased the number of adolescents experiencing social isolation, placing them at heightened risk for mental health issues. The aim of this review is to explore protective factors that might mitigate psychological harm in the presence of social isolation. A systematic literature review was conducted using Fink's step-by-step process. Four library databases were searched, and results were reported using PRISMA. Of the 246 studies reviewed, 12 studies were retained following the quality assessment. The sample includes 14,064 participants from USA, Australia, and Europe, ranging from 10-19 years old. Social connectedness (ie., family connectedness, school connectedness, social support), self-esteem, and prosocial behaviors were the most common protective factors to social isolation. Additional factors such as self-efficacy, optimism, and ethnic identity are discussed. Implications for future research are recommended, including the need to explore spiritual, biological, and sociocultural factors influencing social connectedness and mental health in adolescents.

Loneliness: An Immunometabolic Syndrome

Loneliness has been defined as an agonizing encounter, experienced when the need for human intimacy is not met adequately, or when a person’s social network does not match their preference, either in number or attributes. This definition helps us realize that the cause of loneliness is not merely being alone, but rather not being in the company we desire. With loneliness being introduced as a measurable, distinct psychological experience, it has been found to be associated with poor health behaviors, heightened stress response, and inadequate physiological repairing activity. With these three major pathways of pathogenesis, loneliness can do much harm; as it impacts both immune and metabolic regulation, altering the levels of inflammatory cytokines, growth factors, acute-phase reactants, chemokines, immunoglobulins, antibody response against viruses and vaccines, and immune cell activity; and affecting stress circuitry, glycemic control, lipid metabolism, body composition, metabolic syndrome, cardiovascular function, cognitive function and mental health, respectively. Taken together, there are too many immunologic and metabolic manifestations associated with the construct of loneliness, and with previous literature showcasing loneliness as a distinct psychological experience and a health determinant, we propose that loneliness, in and of itself, is not just a psychosocial phenomenon. It is also an all-encompassing complex of systemic alterations that occur with it, expanding it into a syndrome of events, linked through a shared network of immunometabolic pathology. This review aims to portray a detailed picture of loneliness as an “immunometabolic syndrome”, with its multifaceted pathology.

Mental Resilience and Coping With Stress: A Comprehensive, Multi-level Model of Cognitive Processing, Decision Making, and Behavior

Aversive events can evoke strong emotions that trigger cerebral neuroactivity to facilitate behavioral and cognitive shifts to secure physiological stability. However, upon intense and/or chronic exposure to such events, the neural coping processes can be maladaptive and disrupt mental well-being. This maladaptation denotes a pivotal point when psychological stress occurs, which can trigger subconscious, "automatic" neuroreactivity as a defence mechanism to protect the individual from potential danger including overwhelming unpleasant feelings and disturbing or threatening thoughts.The outcomes of maladaptive neural activity are cognitive dysfunctions such as altered memory, decision making, and behavior that impose a risk for mental disorders. Although the neurocognitive phenomena associated with psychological stress are well documented, the complex neural activity and pathways related to stressor detection and stress coping have not been outlined in detail. Accordingly, we define acute and chronic stress-induced pathways, phases, and stages in relation to novel/unpredicted, uncontrollable, and ambiguous stressors. We offer a comprehensive model of the stress-induced alterations associated with multifaceted pathophysiology related to cognitive appraisal and executive functioning in stress.

Personality or pathology? Predictors of early substance use in first-year college students

OBJECTIVE

The aim of the current study was to examine the dual role of personality and psychopathology in predicting substance use among first-year students.

PARTICIPANTS

103 first-semester undergraduate students were recruited via the university subject pool.

METHODS

Participants completed personality questionnaires, structured clinical interviews, followed by the completion of diary entries each week reporting on substance use throughout their first semester.

RESULTS

Results indicated that a past diagnosis of an affective (mood/anxiety/stress) disorder was the most significant predictor of substance use. Personality and current psychopathology had no association to substance use.

CONCLUSION

This finding is consistent with developmental models of substance use relating to emotion-related disease and suggests that greater nuance is needed in understanding substance use risk in college students.

Curvilinear associations between family income in early childhood and the cortisol awakening response in adolescence

Previous evidence on cortisol output and socioeconomic status (SES) has been mixed, with studies finding that lower SES can be associated with higher or lower cortisol output, and null associations have also been reported. We hypothesized that these inconsistencies may be due to an underlying curvilinear, inverted-U pattern of association, such that low income is related to increased likelihood of both low and high cortisol output. We tested these curvilinear links among family income and cortisol indices in the Avon Longitudinal Study of Parents and Children (N = 803). Maternal reports of family income when the study children were 33 and 47 months of age were averaged to estimate early-childhood family income. Three cortisol indices were derived from samples collected in adolescence (15.5 years of age): the cortisol awakening response (CAR), area under the curve (AUC) cortisol, and the diurnal cortisol slope. As hypothesized, the CAR exhibited a curvilinear, inverted-U relation with childhood income, with low childhood income being associated with both the lowest and the highest CARs. These findings suggest that discrepancies in prior findings on low SES and the CAR may be due to curvilinear patterns of association. However, childhood income was not significantly associated with adolescent cortisol diurnal slope or AUC. Future work should clarify the factors that might predispose to high versus low CAR given equivalent low SES in childhood.

A longitudinal study of perceived stress and cortisol responses in an undergraduate student population from India

Young adults entering college experience immense shifts in personal and professional environments. Such a potentially stressful event may trigger multiple psychological and physiological effects. In a repeated-measures longitudinal survey (N = 6 time-points) of first year cohort of residential undergraduate students in India, this study evaluates multiple psychological parameters: PSS14 (Perceived Stress Scale), K10 (distress scale) and positive mood measures, along with salivary cortisol levels. We find that compared to women, men showed significantly lower levels of salivary cortisol and also a decrease in perceived stress (PSS14) and distress (K10) with time. By contrast, women reported similar perceived stress and distress levels over time but had higher cortisol levels at the end of the academic year. Academic stress was reported by the students to be the most important stressor. This study highlights notable gender-/sex-differences in psychological and physiological stress responses and adds a valuable longitudinal dataset from the Indian undergraduate student cohort which is lacking in literature.

Loneliness and Risk for Cardiovascular Disease: Mechanisms and Future Directions

Purpose of review

In this review, we synthesise recent research on the association between loneliness and cardiovascular disease (CVD). We present evidence for mechanisms underlying this association and propose directions for future research.

Recent findings

Loneliness is related to increased risk of early mortality and CVD comparable to other well-established risk factors such as obesity or smoking.

Summary

Loneliness has been linked to higher rates of incident CVD, poorer CVD patient outcomes, and early mortality from CVD. Loneliness likely affects risk for these outcomes via health-related behaviours (e.g. physical inactivity and smoking), biological mechanisms (e.g. inflammation, stress reactivity), and psychological factors (e.g. depression) to indirectly damage health.

Perceived Stress and Perceived Lack of Control of Spanish Education-Degree University Students: Differences Dependent on Degree Year, Basis for Admission and Gender

Stress in higher education students is an issue of growing concern, as stress impacts quality of life and has been linked to drop-out from higher education. The aim was to investigate how stress was related to how far along students were in their degree program, using the Spanish Perceived Stress Scale (PSS10). We expected 1) first-year education students to experience more perceived lack of control than second-year students, 2) second-year students to experience more perceived stress than first-year students. Participants were students in three university education-degree programs (N = 399). The psychometric properties of the Perceived Stress (PS) and Perceived Lack of Control (PLC) subscales were investigated using Rasch models. One item was eliminated from each subscale. The estimated interval-level Rasch scores were utilized for testing hypotheses with general linear models. Results showed a somewhat more complex pattern than predicted as interaction effects between degree year and gender and between degree year and basis for admission were found.

Stress coping strategies and stress reactivity in adolescents with overweight/obesity

This study explored the associations between the frequency and effectiveness of habitual stress coping strategies on physiological and psychological stress responses to an acute laboratory stressor in adolescents with overweight/obesity (51 adolescents; 47% female; ages 14-19 years). Coping strategies were assessed using the Schoolager's Coping Strategies Inventory. Acute physiological stress responses were measured as salivary cortisol and α-amylase output during the Trier Social Stress Test and during a control condition. Acute psychological stress was measured using a Likert-type scale, and systolic blood pressure (SBP) and heart rate were measured at baseline. Results revealed that higher coping effectiveness was associated with lower log-based α-amylase during the stress (β = -0.025, p = 0.018) and control (β = -0.030, p = 0.005) conditions, but not with cortisol across either condition (all ps > 0.05). SBP moderated the association between coping effectiveness and α-amylase during the stress condition, with higher coping effectiveness associated with lower α-amylase only among individuals with lower SBP (β = 0.002, p = 0.027). Coping frequency was not associated with cortisol responses, neither was habitual stress coping strategies associated with psychological stress (all ps > 0.05). These findings provide preliminary evidence that effective use of stress coping strategies may provide a dampening effect on sympathetic activity in an at-risk adolescent population.

Classification of loneliness using the T-ILS: Is it as simple as it seems?

Student well-being is a growing issue in higher education, and assessment of the prevalence of conditions as loneliness is therefore important. In higher education and population surveys the Three-Item Loneliness Scale (T-ILS) is used increasingly. The T-ILS is attractive for large multi-subject surveys, as it consists of only three items (derived from the UCLA Loneliness Scale). Several ways of classifying persons as lonely based on T-ILS scores exist: dichotomous and trichotomous classification schemes and use of sum scores with rising levels indicating more loneliness. The question remains whether T-ILS scores are comparable across the different population groups where they are used or across groups of students in the higher education system. The aim was to investigate whether the T-ILS suffers from differential item functioning (DIF) that might change the loneliness classification among higher education students, using a large sample just admitted to 22 different academy profession degree programs in Denmark (N = 3,757). DIF was tested relative to degree program, age groups and gender. The framework of graphical loglinear Rasch models was applied, as this allows for adjustment of sum scores for uniform DIF, and thus for assessment of whether DIF might change the classification. Two items showed DIF relative to degree program and gender, and adjusting for this DIF changed the classification for some subgroups. The consequences were negligible when using a dichotomous classification and larger when using a trichotomous classification. Therefore, trichotomous classification should be used with caution unless suitable adjustments for DIF are done prior to classification.

Effects of psychosocial and socio-environmental factors on anxiety disorder among adolescents in Bangladesh

BACKGROUND

Anxiety is a common psychiatric disorder among adolescents in developing countries. This study aimed to examine the risk factors of anxiety disorder and the adverse consequences of anxiety disorder among adolescents in Bangladesh.

METHODS

A total of 2,989 adolescent data of the 2014 Global School-based Student Health Survey (GSHS), Bangladesh, was analyzed WHO. The prevalence of anxiety disorder across psychosocial and socio-environmental factors was calculated as descriptive statistics, whereas their effects on occurring anxiety disorder were determined using the unadjusted and adjusted multivariable binary logistic regression model. The consequences of anxiety disorder were also determined using the multivariable binary logistic regression model.

RESULTS

The prevalence of anxiety disorder was 4.7%, which was found higher among female than their male counterparts. The psychosocial factors were found associated with the anxiety disorder are loneliness (AOR: 2.26, 95% CI: 1.08-4.72), being bullied (AOR: 6.00, 95% CI: 3.14-11.47), and physical abuse (AOR: 2.12, 95% CI: 1.07-4.21). Moreover, poor understandings with parents (AOR: 1.75, 95% CI: 1.02-3.01) and lack of peer support (AOR: 2.23, 95% CI: 1.18-4.23) were the socio-environmental factors that found associated with the anxiety disorder. Subgroup analysis across gender found these associations were consistent for adolescent male and female. Moreover, the likelihood increased with the increasing number of the adverse psychosocial, or socio-environmental factors.

CONCLUSIONS

Around 5% of school-going adolescents in Bangladesh reported anxiety associated with the exposure of single or multiple adverse psychosocial and socio-environmental factors including bullying and physical abuse. Early screening and interventions are essential, targeted to adolescent at risk, which could reduce the rate of anxiety disorder among adolescent in Bangladesh.

Promoting Mental Health and Psychological Thriving in University Students: A Randomized Controlled Trial of Three Well-Being Interventions

This study aimed to address the decline in mental health on U.S. university campuses by examining the effects of three interventions. University students suffer from high levels of anxiety, depression, and suicide. Counseling centers on university campuses are struggling to meet increased demand. The cost to students and universities could be buffered by offering preventative, psychoeducational, and skill-building training programs that promote mental health and psychological thriving. To date, the research literature has not yielded systematically evaluated and recommendable preventative mental health and well-being programs for university students. In a registered, randomized controlled trial, 131 university students were either placed in a non-intervention control group (N = 47) or received training in one of three 30-hour, eight-week semester-long well-being programs: SKY Campus Happiness ("SKY"; N = 29), Foundations of Emotional Intelligence ("EI"; N = 21) or Mindfulness-Based Stress Reduction ("MBSR"; N = 34). Compared to the control group and controlling for variance of baseline measurements and multiple comparisons, SKY Campus Happiness showed the greatest impact, benefiting six outcomes: depression, stress, mental health, mindfulness, positive affect and social connectedness. EI benefited one outcome: mindfulness. The MBSR group showed no change. Delivering SKY or EI to university students may be a cost-effective and efficient way to proactively and preventatively address mental health for university students and reduce the financial strain on universities.

The Impact of COVID-19 on Anxiety in Chinese University Students

COVID-19 had become a pandemic raising concerns of widespread panic and increasing anxiety and stress in individuals all over the world (World Health Organization, 2020a). Lots of countries had closed their schools. As the first country to do so, Chinese colleges and universities were making use of different modes of learning, including online-learning based on different platforms to achieve the goal suggested by Ministry of Education in China, "suspending classes without suspending learning," since middle February. This paper is the first one which aims to investigate the anxiety of Chinese university students after the outbreak of COVID-19 right before the start of new spring term. 3611 university students (female: male = 1.48:1) aged between 18 to 24 from all over China were enrolled to this study from a top university in China. The Self-Rating Anxiety Scale - SAS (Zung, 1971) was used to assess anxiety 2 days before the start of new spring term in middle February. All four-year undergraduate students were included in the study. The mean SAS score was 40.53 (SD = 10.15), significantly higher than the national norm (Mean = 29.78, SD = 10.07, and p ≤ .001), and there were still 557 (15.43%, Mean = 58.75, and SD = 8.9) students met the cutoff of 50 and were screened positive. Comparisons among sexes, grades and majors were also conducted. Significant differences were found between all males and all female (p ≤ .001), and between all students majoring arts and sciences in the anxiety sample (n = 557, p = 0.05). The results also showed that the mean SAS scores were not correlated with the regions they came from/lived in. This study concluded that the Chinese university students showed higher anxiety for COVID-19.

Risk factors for loneliness: The high relative importance of age versus other factors

Loneliness is a potent predictor of negative health outcomes, making it important to identify risk factors for loneliness. Though extant studies have identified characteristics associated with loneliness, less is known about the cumulative and relative importance of these factors, and how their interaction may impact loneliness. Here, 4,885 individuals ages 10-97 years from the US completed the three-item UCLA Loneliness Survey on TestMyBrain.org. Using census data, we calculated the population and community household income of participants' census area, and the proportion of individuals in the participant's census area that shared the participant's demographic characteristics (i.e., sociodemographic density). We evaluated the relative importance of three classes of variables for loneliness risk: those related to the person (e.g., age), place (e.g., community household income), and the interaction of person X place (sociodemographic density). We find that loneliness is highly prevalent and best explained by person (age) and place (community household income) characteristics. Of the variance in loneliness accounted for, the overwhelming majority was explained by age with loneliness peaking at 19 years and declining thereafter. The congruence between one's sociodemographic characteristics and that of one's neighborhood had no impact on loneliness. These data may have important implications for public health interventions.

A systematic review of prevention programs targeting depression, anxiety, and stress in university students

BACKGROUND

Given the prevalence of anxiety, depression, and stress among university students, it is important to assess the effectiveness of prevention programs for these problems. Beyond examining effect sizes, applying a common elements approach can enhance our understanding of which practice elements are most frequently included in symptom-reducing programs.

METHOD

This review examined effective (i.e., outcome-producing) prevention programs targeting depression, anxiety, and/or stress in university students. Programs could be delivered in a group-based, online/computer-delivered, or self-administered format and at the universal, selective, or indicated prevention level.

RESULTS

The resulting sample of 62 articles covered 68 prevention programs for college, graduate, or professional students across 15 countries. Average effect sizes for programs were moderate (overall g = 0.65), regardless of delivery format or prevention level. The most common practice elements (overall and for programs producing large effects) were: psychoeducation (72%), relaxation (69%), and cognitive monitoring/restructuring (47%). Many programs were limited by: (a) symptom target-outcome mismatches, (b) disproportionately female samples, and (c) inconsistently reported adherence data.

LIMITATIONS

Commonness of practice elements across outcome-producing interventions does not imply their extensiveness nor unique contribution to effectiveness. Coding was based on information in articles rather than manuals, and inter-rater reliability was moderate for some practice elements.

CONCLUSION

The outcome-producing prevention programs in our sample had common practice elements and produced moderate reduction in symptoms overall. Future research of depression, anxiety, and stress prevention programs for university students can investigate practice elements' unique and combined impact on outcomes, further explore under-tested practice elements, and use findings to inform intervention design.

Daily hassles, loneliness, and diurnal salivary cortisol in emerging adults

This study used an intensive protocol to examine the effects of daily hassles and loneliness on diurnal salivary cortisol levels. Fifty Chinese undergraduates (28 females) provided six saliva samples each day for two consecutive days (at 0, 0.5, 3, 6, and 12 h after waking and at bedtime) and completed a questionnaire that included scales to measure daily hassles experienced over the previous month, trait loneliness, and depression. Cortisol data were aggregated over two days and used in subsequent analyses, focusing on the cortisol awakening response, diurnal slope, and overall cortisol output operationalized as the area under the curve with reference to the ground (AUC_G). Multiple regression analysis showed that an increase in loneliness had a significant association with an increase in the AUC_G and with a steeper diurnal slope. Loneliness also showed a significant interaction with daily hassles in that the positive association between daily hassles and AUC_G was accentuated in the participants who reported a greater degree of loneliness. Our findings demonstrate for the first time the importance of trait loneliness in modulating the association between daily hassles and diurnal cortisol levels, which has significant clinical implications. Interventions to reduce loneliness should help college students to better cope with daily stressors. Increased attention should also be paid to the health implications of an elevated cortisol level in this relatively young and healthy population.

The relationship between loneliness and cognition in healthy older men and women: The role of cortisol

Loneliness has been associated with an increased risk of cognitive decline and dementia in older people, as well as a dysregulation of Hypothalamic-Pituitary-Adrenal (HPA) axis functioning. In addition, it has been suggested that women are more vulnerable to the negative effects of loneliness on health. Our aim was to analyze the effect of HPA-axis functioning as a mediator in the relationship between loneliness and cognitive function, and interactions depending on sex, in healthy older people. To do so, 86 healthy older people (52.3% female) from 60 to 80 years old (M = 67.44, SD = 4.37) completed the revised UCLA loneliness scale. A neuropsychological battery was administered to assess global cognition, processing speed, attention and executive function, working memory, and verbal memory immediate and delayed recall. Saliva samples were provided on two consecutive weekdays to obtain awakening and bedtime cortisol levels, the diurnal cortisol slope (DCS), and the area under the curve with respect to the ground (AUCg). Our results showed that loneliness was not directly associated with cognitive performance. Furthermore, loneliness was related to higher bedtime cortisol levels, but not to awakening cortisol, the DCS, or the AUCg. In addition, loneliness was associated with worse performance on attention and processing speed, executive function, and verbal memory immediate recall, via bedtime cortisol levels. Therefore, we suggest that HPA-axis functioning is one of the biological mechanisms that mediate the relationship between loneliness and poorer cognitive function. No sex differences were observed in these associations.

Measuring the Psychobiological Correlates of Daily Experience in Adolescents

Mapping the psychobiological correlates of social contexts, experiences, and emotional responses of adolescents in their daily lives provides insight into how adolescent well-being shapes, and is shaped by, experience. Measures of these psychobiological correlates are enabled by devices and technologies that must be precise and suitable for adolescent participants. The present report reviews the most often used research measures, and suggests strategies for best practice, drawn from practical experience. The rapid advances in technological methods to collect attuned measures of psychological processes, social context, and biological function indicate the promise for multimodal measures in ecological settings. Attaining these methodological goals will support research to secure comprehensive, quality data, and advance the understanding of psychobiological function in ambulatory settings.

Transitional Instability Predicts Polymorphous Distress in Emerging Adults

The primary aim of this investigation is to determine the extent to which transitional instability can predict diverse markers of distress in emerging adults. Participants were 210 emerging adults, aged 18-25 who completed measures of distress that included loneliness, stress, problem drinking, and prescription medication use. One year later, they returned to complete these same measures of distress along with a measure of significant life transitions that they encountered during the past year in such domains as education, employment, residence, and relationships. Results of a structural equation modeling analysis showed that even after controlling for the potential reciprocal association between transitional instability and distress, the more transitional instability emerging adults experienced over the year, the higher their distress was at time 2. The results are consistent with models of transitional instability as a precipitant of distress in emerging adulthood.

Loneliness and Diurnal Salivary Cortisol in Emerging Adults

This study aimed to examine the relationship between trait loneliness and diurnal rhythms of salivary cortisol. Fifty-One Chinese undergraduates provided six saliva samples on a weekday at immediately, 0.5, 3, 6, and 12 h after waking, and at bedtime. Saliva collection times were monitored using electronic devices (MEMS TrackCaps). Participants were also administered a questionnaire consisting of scales measuring, trait loneliness, depression, and demographics. Relationships between loneliness and the cortisol awakening response (CAR), diurnal slope (DS), and area under the curve with respect to ground (AUC_G) were examined using multiple regression analyses. Results showed that a higher loneliness score was associated with an attenuated CAR, a large AUC_G, and a steeper DS, with the effects of compliance, waking time, and depression being controlled. As a blunted CAR and a higher diurnal cortisol level have been shown to be associated with poorer health in prior studies, increased attention to the mechanisms translating loneliness into disease endpoints via elevated cortisol is warranted.

People who need people: Trait loneliness influences positive affect as a function of interpersonal context

Trait loneliness is associated with negative health consequences; understanding involved processes may elucidate its contributory role. Evolutionary and reaffiliative models associate loneliness with negative affect and dysregulated cortisol responding, while the social monitoring system model associates loneliness with heightened salience of social cues. We hypothesized that loneliness would be associated with greater negative affect and cortisol reactivity, comparing a negative-evaluative audience Trier Social Stress Test ("audience condition;" n = 55) versus a no-audience control condition (n = 69) in non-depressed young adults. Opposing hypotheses, multilevel growth curve models indicated that loneliness was not associated with negative affect or cortisol reactivity in the audience versus no-audience condition. Loneliness was, however, associated with greater positive affect reactivity in the audience versus no-audience condition. In particular, the positive affect subfacet "Interest" was heightened in the audience condition but blunted in the no-audience condition as a function of loneliness, echoing a social monitoring system model of loneliness.

Loneliness and acute stress reactivity: A systematic review of psychophysiological studies

Physiological reactivity to acute stress has been proposed as a potential biological mechanism by which loneliness may lead to negative health outcomes such as cardiovascular disease. This review was conducted to investigate the association between loneliness and physiological responses to acute stress. A series of electronic databases were systematically searched (PsycARTICLES, PsycINFO, Medline, CINAHL Plus, EBSCOhost, PubMed, SCOPUS, Web of Science, Science Direct) for relevant studies, published up to October 2016. Eleven studies were included in the review. Overall, the majority of studies reported positive associations between loneliness and acute stress responses, such that higher levels of loneliness were predictive of exaggerated physiological reactions. However, in a few studies, loneliness was also linked with decreased stress responses for particular physiological outcomes, indicating the possible existence of blunted relationships. There was no clear pattern suggesting any sex- or stressor-based differences in these associations. The available evidence supports a link between loneliness and atypical physiological reactivity to acute stress. A key finding of this review was that greater levels of loneliness are associated with exaggerated blood pressure and inflammatory reactivity to acute stress. However, there was some indication that loneliness may also be related to blunted cardiac, cortisol, and immune responses. Overall, this suggests that stress reactivity could be one of the biological mechanisms through which loneliness impacts upon health.

Psychosocial functioning and the cortisol awakening response: Meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies

Cortisol levels rise immediately after awakening and peak approximately 30-45min thereafter. Psychosocial functioning influences this cortisol awakening response (CAR), but there is considerable heterogeneity in the literature. The current study used p-curve and meta-analysis on 709 findings from 212 studies to test the evidential value and estimate effect sizes of four sets of findings: those associating worse psychosocial functioning with higher or lower cortisol increase relative to the waking period (CARi) and to the output of the waking period (AUCw). All four sets of findings demonstrated evidential value. Psychosocial predictors explained 1%-3.6% of variance in CARi and AUCw responses. Based on these effect sizes, cross-sectional studies assessing CAR would need a minimum sample size of 617-783 to detect true effects with 80% power. Depression was linked to higher AUCw and posttraumatic stress to lower AUCw, whereas inconclusive results were obtained for predictor-specific effects on CARi. Suggestions for future CAR research are discussed.

Perceived stress, coping, and cortisol reactivity in daily life: A study of adolescents during the first year of college

Adolescents change how they cope with stress across different situations, but also differ from one another in their general capacity to cope. The current study examined whether cortisol reactivity to perceived daily stress varies with both situational (within-person) and individual (between-person) differences in coping. First-year college students (N=63; Mage=18.85) provided 15 stress-coping diaries and 15 corresponding saliva samples across 3 weekdays. Results from hierarchical linear growth models revealed that perceiving greater stress than usual in the last hour was significantly associated with elevations in cortisol (relative to diurnal patterning) only during situations characterized by greater than usual diary-reported engagement coping. Regarding individual differences, perceiving greater stress than usual was significantly associated with elevations in cortisol only for adolescents below average on trait measures of engagement coping or belief in their ability to handle stress. Findings indicate that cortisol reactivity to daily stress varies with both situational variation and individual differences in coping.