Interaction Effects of Life Events and Hair Cortisol on Perceived Stress, Anxiety, and Depressive Symptoms Among Chinese Adolescents: Testing the Differential Susceptibility and Diathesis-Stress Models

The role of personal, relational, and collective self-esteem in predicting acute salivary cortisol response and perceived stress

Personal self-esteem (PSE) has been well recognized as a buffer against stress; however, the effects of other types of self-esteem, such as relational self-esteem (RSE) and collective self-esteem (CSE), on stress have not been adequately explored. This study investigated the roles of PSE, RSE, and CSE in reducing stress response. The Rosenberg, Relational, and Collective Self-Esteem Scales were adopted to assess PSE, RSE, and CSE, respectively. Participants underwent an acute social stress paradigm, and their acute stress response was assessed using subjective stress reports and salivary cortisol levels. Chronic stress level was estimated using the Perceived Stress Scale and hair cortisol concentration. The results showed that PSE was negatively correlated with salivary cortisol response during acute social stress; however, no significant associations were found between any type of self-esteem and subjective stress reports. For chronic stress, all types of self-esteem were negatively associated with perceived stress level, but not with hair cortisol concentration. Further hierarchical regression analyses suggested that only PSE negatively predicted acute salivary cortisol response and perceived stress level. Overall, the findings suggest the essential role of PSE in predicting acute salivary cortisol responses and perceived stress.

Hair cortisol as outcome parameter for psychological and neuropsychiatric interventions-a literature review

Background

Studies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic-pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing's syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems.

Aims

The aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature.

Methods

From May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias.

Results

The initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC.

Discussion

HCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health.

The moderating role of hair cortisol in the association of early and recent stress with stress-related phenotypes

Background

Increased hair cortisol concentrations (HCC) have been found in clinical samples of schizophrenia, first episode psychosis and clinical risk for psychosis, but evidence of such is scarce in schizotypy. High HCC are supposed to reflect elevated chronic stress. However, HCC were not directly associated with adversity measures and stress-related phenotypes in previous research. This study tested whether HCC moderated the association between a comprehensive range of psychosocial stressors with several stress-related phenotypes in a sample of nonclinical young adults. It was expected that stressors, either distal (i.e., early-life) or recent, would be associated with subclinical features, particularly for those with elevated HCC, reflecting the effects of a potential biological sensitization to stress.

Methods

The sample comprised 132 nonclinical young adults belonging to the Barcelona Longitudinal Investigation of Schizotypy Study (BLISS). Participants completed a questionnaire of childhood adversity and two complementary measures of recent life events, tapping threatening vs. more general life events. Both the frequency and subjective impact (positive vs. negative) of general life events were also assessed. Psychotic (i.e., schizotypy, suspiciousness) and non-psychotic (i.e., depression, anxiety) subclinical features as well as appraisals of perceived stress were examined. Hierarchical linear regressions and simple slope analyses were computed.

Results

HCC moderated the effects of both early and recent stress on suspiciousness as well as the effects of recent life events on perceived stress, such that those with higher HCC presented increased suspiciousness and perceived stress at higher levels of stress exposure. Positive, but not negative, recent life events were associated with decreased perceived stress and depression, and these associations were moderated by low HCC, indicating a buffering effect for those with a non-impaired HPA axis.

Conclusion

In line with the neural diathesis-stress model, results highlight the role of the interplay between the HPA axis and exposure to stressful experiences in exacerbating psychosis features and extend evidence to the nonclinical expression of the psychosis continuum. In addition, findings support the protective effect of positive experiences in decreasing stress appraisals and affective disturbances, which is consistent with emerging research about the relevance of positive factors in reducing the likelihood of psychopathological outcomes.

Associations between chronic stress and hair cortisol in children: A systematic review and meta-analysis

OBJECTIVES

This review systematically examined the associations between chronic stress and hair cortisol concentration (HCC) in children, and the potential modification effects of type, measurement period and scales of chronic stress, child age and sex, hair length and HCC measurement method, characteristics of study site, and congruence between time periods measured for chronic stress and HCC.

METHODS

Pubmed, Wed of Science, and APA PsycINFO were systematically searched for articles examining the association between chronic stress and HCC.

RESULTS

Thirteen studies from five countries with 1,455 participants were included in the systematic review and nine studies were included in the meta-analysis. Meta-analysis revealed that chronic stress was associated with HCC (pooled-r = 0.09, 95 % CI: 0.03, 0.16). Stratified analyses revealed that type, measurement time and scales of chronic stress, hair length and measurement method of HCC, and the congruence between time periods measured for chronic stress and HCC modified such correlations. The positive correlations between chronic stress and HCC were significant for studies measuring chronic stress as stressful life events, assessing chronic stress within the past six months, extracting HCC from 1 cm, 3 cm, or 6 cm of hair, measuring HCC by LC-MS/MS, or having congruence between time periods measured for chronic stress and HCC. The potential modifying effects of sex and country developmental status could not be concluded due to the limited number of studies included.

CONCLUSIONS

Chronic stress was positively correlated with HCC, varying by characteristics and measurements of chronic stress and HCC. HCC could be a biomarker for chronic stress among children.

Mediating Role of Emotional Intelligence in the Relationship between Anxiety Sensitivity and Academic Burnout in Adolescents

(1) Background: Increased stress and study overload during adolescence could be related to academic burnout. Anxiety sensitivity of students seems to affect burnout levels, while emotional intelligence enables emotion management under stressful conditions. The objective of this study is to analyze the roles of anxiety sensitivity and emotional intelligence in academic burnout. (2) Methods: In this quantitative cross-sectional study conducted in Spain, the sample comprised 1287 high school students aged 14 to 18 who filled out the Maslach Burnout Inventory-General Survey, the Spanish version adapted for high school students of the Anxiety Sensitivity Index-3, and Brief Emotional Intelligence Inventory. (3) Results: Anxiety sensitivity was significantly higher in cynicism and emotional exhaustion. Furthermore, the mediation analysis showed that high anxiety sensitivity directly affected student exhaustion, cynicism, and efficacy levels. These effects were mediated mainly through stress management but also through the effect of stress management on mood, both emotional intelligence factors. (4) Conclusions: The academic changes that occur during high school hinder engagement and performance. Promoting the development of emotional skills would enable young people to manage their emotions when they become overwhelming and diminish their lack of interest and exhaustion in the classroom.

Parental support, marital conflict, and stress as predictors of depressive symptoms among African American adolescents

Given the increase of depressive symptoms among adolescents, it is essential to investigate familial and temperamental correlates of depressive symptoms such as parental support, marital conflict, and stress. Thus, using a cross-sectional design, the current study examined whether parental support, marital conflict, and stress predicted depressive symptoms. Then, using structural equation modeling, this study tested whether stress mediated the relationships among parental support, marital conflict, and depressive symptoms among African American adolescents while controlling for sex (N = 883). Results suggest that maternal support negatively related to depressive symptoms in contrast to stress and marital conflict. However, paternal support and sex were not statistically associated with depressive symptoms. Mediation results suggest that stress explained the relationships among parental support, marital conflict, and depressive symptoms. Family therapy and depression reduction implications are discussed.

Parenting in the Context of the Child: Genetic and Social Processes

The focus on the role of parenting in child development has a long-standing history. When measures of parenting precede changes in child development, researchers typically infer a causal role of parenting practices and attitudes on child development. However, this research is usually conducted with parents raising their own biological offspring. Such research designs cannot account for the effects of genes that are common to parents and children, nor for genetically influenced traits in children that influence how they are parented and how parenting affects them. The aim of this monograph is to provide a clearer view of parenting by synthesizing findings from the Early Growth and Development Study (EGDS). EGDS is a longitudinal study of adopted children, their birth parents, and their rearing parents studied across infancy and childhood. Families (N = 561) were recruited in the United States through adoption agencies between 2000 and 2010. Data collection began when adoptees were 9 months old (males = 57.2%; White 54.5%, Black 13.2%, Hispanic/Latinx 13.4%, Multiracial 17.8%, other 1.1%). The median child age at adoption placement was 2 days (M = 5.58, SD = 11.32). Adoptive parents were predominantly in their 30s, White, and coming from upper-middle- or upper-class backgrounds with high educational attainment (a mode at 4-year college or graduate degree). Most adoptive parents were heterosexual couples, and were married at the beginning of the project. The birth parent sample was more racially and ethnically diverse, but the majority (70%) were White. At the beginning of the study, most birth mothers and fathers were in their 20s, with a mode of educational attainment at high school degree, and few of them were married. We have been following these family members over time, assessing their genetic influences, prenatal environment, rearing environment, and child development. Controlling for effects of genes common to parents and children, we confirmed some previously reported associations between parenting, parent psychopathology, and marital adjustment in relation to child problematic and prosocial behavior. We also observed effects of children's heritable characteristics, characteristics thought to be transmitted from parent to child by genetic means, on their parents and how those effects contributed to subsequent child development. For example, we found that genetically influenced child impulsivity and social withdrawal both elicited harsh parenting, whereas a genetically influenced sunny disposition elicited parental warmth. We found numerous instances of children's genetically influenced characteristics that enhanced positive parental influences on child development or that protected them from harsh parenting. Integrating our findings, we propose a new, genetically informed process model of parenting. We posit that parents implicitly or explicitly detect genetically influenced liabilities and assets in their children. We also suggest future research into factors such as marital adjustment, that favor parents responding with appropriate protection or enhancement. Our findings illustrate a productive use of genetic information in prevention research: helping parents respond effectively to a profile of child strengths and challenges rather than using genetic information simply to identify some children unresponsive to current preventive interventions.

Examining the Relationship Between Hair Cortisol With Stress-Related and Transdiagnostic Subclinical Measures

Background: Hair cortisol concentrations (HCC) provide a retrospective examination of long-term cortisol production as a measure of the hypothalamic-pituitary-adrenal (HPA) axis functioning, one of the major neural systems implicated in mediating the effects of stress on mental illness. However, evidence about the relationship between HCC with stressors and symptoms is scattered. In the present study, we aimed to examine the association between HCC and a wide range of stress-related and transdiagnostic subclinical measures in a sample of non-clinical young adults with a wide distribution of schizotypy. Methods: A total sample of 132 non-clinical young adults recruited at college and technical schools oversampled for schizotypy scores were assessed on distal and proximal stressful experiences, appraisals of stress, traits and symptoms of the affective, psychosis and dissociation spectrums, as well as stress-buffering measures, and provided 3 cm-hair samples. Results: No significant associations were found between HCC and any of the stress-related and subclinical measures. Only suspiciousness and disorganization showed a trend for a positive association with HCC but the magnitude was small. Conclusions: The present findings support previous studies indicating an overall lack of concordance between a broad range of stress-related and (sub)clinical phenotypic measures with hair cortisol. This study examined for the first time the relationship of HCC with the non-clinical expression of the psychosis spectrum, that is, schizotypy, which complements previous studies on clinical high risk and established psychosis and offers a promising strategy for studying possible HPA dysfunctions characterizing the subclinical psychosis continuum without the confounds associated to clinical psychosis.

Evidence of the moderating role of hair cortisol and hair cortisone in the relationship between work stress and depression symptoms among Chinese fishermen

BACKGROUND

Stress plays an important role in the pathogenesis of depression through functional changes to the hypothalamic-pituitary-adrenal (HPA) axis, a key output of which is the stress hormone cortisol. But the precise relationship between HPA axis activity and depression remains unclear, in part because mostly cortisol measurement only provides reflect acute or short-term fluctuations. In this study, hair cortisol and its metabolite cortisone were measured in a prospective, pre and post follow-up study of working stress and depressive symptoms in Chinese fishermen. We evaluated HPA activity, work stress, and depression symptoms before and after fishing to determine whether cortisol and cortisone in hair can moderate the work stress and depression symptoms of Chinese fishermen.

METHODS

Hair cortisol, hair cortisone, work stress, and depression were measured in Chinese fishermen (n=229; age 16-65) before and after 1-3 months at sea. A week after the fishermen returned, they provided 2-4 cm hair segments closest to the scalp. We measured hair cortisol and hair cortisone using high-performance liquid chromatography-tandem mass spectrometry.

RESULTS

The work stress and hair cortisol of fishermen before fishing were significantly higher than those after fishing, while hair cortisone was lower. There was no significant difference in depressive symptoms. Fishermen with low hair cortisol or high hair cortisone were more likely to show depressive symptoms after experiencing stress, and were less likely to show depressive symptoms when faced with lower levels of work stress, consistent with the differential susceptibility model.

LIMITATIONS

The assumption of an average hair growth of 1 cm/month may cause time overlap between pre- and post-fishing, and time error between the hormone data and questionnaire collection. The present study evaluated only two observation points. The use of self-report scales may affect interpretability of the results. Finally, the study used a limited sample of marine fishermen working out of a single location in Hainan province, China.

CONCLUSIONS

Hair cortisol and hair cortisone appear to have a moderating role in the relationship between work stress and depressive symptoms among fishermen, which fits with the differential susceptibility model of depression. However, their mechanisms of moderation are not the same, which may reflect the complexity of physiological indicators.

Urinary Polycyclic Aromatic Hydrocarbon Metabolites Are Associated with Biomarkers of Chronic Endocrine Stress, Oxidative Stress, and Inflammation in Adolescents: FLEHS-4 (2016-2020)

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants of public health concern. Multiple biological mechanisms have been hypothesized to contribute to PAHs-associated adverse health effects. Little is known about the impact of PAHs on endocrine stress and inflammation in adolescence. We examined 393 Flemish adolescents (14-15 years) cross-sectionally, measured urinary concentrations of hydroxylated naphthalene, fluorene, phenanthrene and pyrene metabolites, and calculated the sum of all measured metabolites. We determined hair cortisol concentration (HCC) as endocrine stress biomarker, leucocyte counts and neutrophil-lymphocyte ratio (NLR) in peripheral blood as inflammatory biomarkers, and urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) concentration as oxidative stress biomarker. Exposure-response associations were analyzed by multiple regression, adjusted for a priori selected covariates. A doubling of 1-hydroxypyrene concentration was associated with a factor of 1.13 (95% CI: 1.03, 1.24) increase in HCC and a factor of 1.07 (95% CI: 1.02, 1.13) increase in 8-oxodG. Doublings of 2- and 3-hydroxyphenanthrene concentrations were associated with a factor of 1.08 (95% CI: 1.02, 1.14) and 1.06 (95% CI: 1.00, 1.12) increase in 8-oxodG, respectively. Doubling of 2-hydroxyphenanthrene and of the sum of 2- and 3-hydroxyfluorene was associated with, respectively, a factor of 1.08 (95% CI: 1.02, 1.14) and 1.06 (95% CI: 1.01, 1.13) increase in NLR. Our results indicate the glucocorticoid pathway as a potential target for PAH exposure in adolescents and suggest oxidative stress, endocrine stress, and inflammation in adolescence as underlying mechanisms and early markers for PAH-related adverse health effects.

The Role of Personal Biological Resource in the Job Demands-Control-Support Model: Evidence From Stress Reactivity

Job resources can buffer the deleterious effect of adverse work environments. Extant studies on the interaction pattern between job resources and adverse environments were confined to the diathesis stress model. This traditional perspective has received the challenge from the differential susceptibility model and the vantage sensitivity model. Additionally, stress reactivity may be one of the important job resources at the personal biological level, but its moderating role was short of empirical research. This study aimed to examine how stress reactivity interacts with work environments in predicting job burnouts among 341 Chinese hospital female nurses. This study selected job control and job support representative of supportive environments and psychological demands representative of an adverse environment and the cortisol content in 1-cm hair segment as a biomarker to assess individual's stress reactivity in 1 month. The nurses self-reported their work environments and job burnouts and provided 1-cm hair segments closest to the scalp. Hair cortisol content was measured with high-performance liquid chromatography-tandem mass spectrometry. The interaction pattern was examined with multiple linear regressions and the analysis of region of significance (RoS). The regression revealed that the interaction of hair cortisol content with job control could positively predict professional efficiency among nurses, with psychological demands could negatively predict emotional exhaustion, and with coworker support could negatively predict professional efficiency. The RoS analysis revealed that nurses with high cortisol levels had not only significantly higher professional efficiency than those with low cortisol levels in high job control but also significantly lower professional efficiency in low job control. Nurses with high cortisol levels had significantly higher emotional exhaustion than those with low cortisol levels in low psychological demands. Nurses with low cortisol levels had not only significantly higher professional efficiency than those with high cortisol levels in high coworker support but also significantly lower professional efficiency in low coworker support. The interaction patterns of stress reactivity with both job control and coworker support were consistent with the differential susceptibility model, but the interaction between stress reactivity and psychological demands supported the vantage sensitivity model.

Stress Reactivity Influences the Relationship between Emotional Labor Strategies and Job Burnouts among Chinese Hospital Nurses

Extant studies mostly focused on the buffering role of social and external organizational resources and personal mental resources. However, there is no research exploring the moderating role of personal physiological resources (e.g., stress reactivity). The present study is aimed at examining the interactive effect of emotional labor and stress reactivity on job burnout. The present study utilized cortisol content in a 1 cm hair segment as the biomarker of total stress reactivity in one month. The participants were 229 female hospital nurses randomly recruited from city hospitals, China. They self-reported their emotional labor strategies and job burnout syndromes and provided 1 cm hair segments closest to the scalp two weeks later after the survey. Hair cortisol content was determined with high-performance liquid chromatography-tandem mass spectrometry. The results revealed that hair cortisol can moderate the associations of surface acting with emotional exhaustion and personal burnout; of deep acting with emotional exhaustion, depersonalization, and personal burnout; and of expression of naturally felt emotions with professional inefficacy. In particular, nurses with high cortisol levels not only showed higher emotional exhaustion than those with low cortisol levels under high surface acting but also showed lower emotional exhaustion under low surface acting. A similar situation was true for nurses' emotional exhaustion and depersonalization in the context of deep acting. Nurses with low hair cortisol levels not only showed higher professional inefficacy than those with high hair cortisol levels under low expression of naturally felt emotions but also showed lower professional inefficacy under high expression of naturally felt emotions. Additionally, nurses with high hair cortisol levels showed lower personal burnout than those with low hair cortisol levels under low surface acting or high deep acting. In summary, the interaction pattern between stress reactivity and emotional labor was varied with the nature of emotional labor strategy and job burnout.