Health psychology: developing biologically plausible models linking the social world and physical health

A Social Neuroscience Perspective on Stress and Health

Psychological stress is a major risk factor for the development and progression of a number of diseases, including cardiovascular disease, cancer, arthritis, and major depression. A growing body of research suggests that long-term, stress-induced activation of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis may lead to increases in inflammation, which is known to play a key role in the pathophysiology of a variety of diseases. Furthermore, the burgeoning fields of social neuroscience and health neuroscience have begun to identify the neurocognitive mechanisms by which stress may lead to these physiological changes. Here we review the literature examining the neurocognitive correlates of stress-induced SNS, HPA, and inflammatory responses. Specifically, we summarize the results of neuroimaging studies that have examined the neural correlates of stress-related increases in SNS, HPA, and inflammatory activity. A set of neural systems involved in threat processing, safety processing, and social cognition are suggested as key contributors to stress-related changes in physiology. We conclude by offering suggestions for future research in the exciting new field of health neuroscience.

Divorce and Death: A Case Study for Health Psychology

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

Associations between socioeconomic status and catecholamine levels vary by acculturation status in Mexican-American women

BACKGROUND

Lower socioeconomic status (SES) is associated with poorer health, possibly through activation of the sympathetic nervous system.

PURPOSE

This study aimed to examine the association between SES and catecholamine levels, and variations by acculturation.

METHODS

Three hundred one Mexican-American women underwent examination with a 12-h urine collection. Analyses tested associations of SES, acculturation (language and nativity), and their interaction with norepinephrine (NOREPI) and epinephrine (EPI).

RESULTS

No main effects for SES or the acculturation indicators emerged. Fully adjusted models revealed a significant SES by language interaction for NOREPI (p< .01) and EPI (p< .05), and a SES by nativity interaction approached significance for NOREPI (p= .05). Simple slope analyses revealed that higher SES related to lower catecholamine levels in Spanish-speaking women, and higher NOREPI in English-speaking women. Although nonsignificant, similar patterns were observed for nativity.

CONCLUSIONS

Associations between SES and catecholamines may vary by acculturation, and cultural factors should be considered when examining SES health effects in Hispanics.

Transcriptional modulation of the developing immune system by early life social adversity

To identify molecular mechanisms by which early life social conditions might influence adult risk of disease in rhesus macaques (Macaca mulatta), we analyze changes in basal leukocyte gene expression profiles in 4-mo-old animals reared under adverse social conditions. Compared with the basal condition of maternal rearing (MR), leukocytes from peer-reared (PR) animals and PR animals provided with an inanimate surrogate mother (surrogate/peer reared, SPR) show enhanced expression of genes involved in inflammation, cytokine signaling, and T-lymphocyte activation, and suppression of genes involved in several innate antimicrobial defenses including type I interferon (IFN) antiviral responses. Promoter-based bioinformatic analyses implicate increased activity of CREB and NF-κB transcription factors and decreased activity of IFN response factors (IRFs) in structuring the observed differences in gene expression. Transcript origin analyses identify monocytes and CD4(+) T lymphocytes as primary cellular mediators of transcriptional up-regulation and B lymphocytes as major sources of down-regulated genes. These findings show that adverse social conditions can become embedded within the basal transcriptome of primate immune cells within the first 4 mo of life, and they implicate sympathetic nervous system-linked transcription control pathways as candidate mediators of those effects and potential targets for health-protective intervention.

How neighborhood disorder increases blood pressure in youth: agonistic striving and subordination

Growing evidence links perceptions of neighborhood disorder to adverse health outcomes but little is known about psychological processes that may mediate this association. We tested the hypothesis that two psychological mechanisms-agonistic striving and subordination-mediate the link between perceived neighborhood disorder and hypertension risk in youth. Perceived neighborhood disorder, agonistic striving, subordination experiences, negative affect, obesity, and ambulatory blood pressure during daily activities (48 h) were assessed in a multiethnic sample of 167 low- to middle-income urban adolescents. Path analyses revealed that agonistic striving, subordination, and obesity each independently mediated the association between neighborhood disorder and blood pressure; these variables accounted for 73 % of the shared variance, 42 % of which was explained by agonistic striving. The direct relationship between perceived neighborhood disorder and blood pressure was no longer significant in the presence of these mediators. Negative affect was associated with neighborhood disorder and subordination, but not blood pressure. Agonistic striving proved to be a significant and substantial mediator of the association between perceived neighborhood disorder, blood pressure, and future hypertension risk. New research should seek to clarify the processes by which stressful neighborhoods induce persistent agonistic motives and perceptions of subordination in adolescents.

Epigenetic and genetic factors predict women's salivary cortisol following a threat to the social self

Evidence suggests that the reactivity of the Hypothalamus-Pituitary-Adrenal axis (HPAA) is modulated by both genetic and environmental variables. Of special interest are the underlying molecular mechanisms driving gender differences to psychosocial stressors. Epigenetic mechanisms that sculpt the genome are ideal candidates for mediating the effects of signals on the HPAA. In the current study, we analyzed by pyrosequencing, bisulfite-treated buccal DNA from male and female university students who participated in the Trier Social Stress Test (TSST). A linear regression model was used to ascertain the effects of sex, CpG methylation and genes on stress response. Total cortisol output (area under the curve, AUC) was significantly predicted by glucocorticoid receptor (NR3C1) exon 1F methylation (averaged across 39 CpG sites) solely in female subjects. A single CpG site located in the exon 1F noncanonical nerve growth factor-inducible protein A (NGFI-A) transcription factor was a highly significant predictor of AUC in female subjects. Additionally, variations in the estrogen receptor alpha (ESR1) and the serotonin transporter promoter (5-HTTLPR) genes were independent additive predictors of AUC. The full model accounted for half of the variance (50.06%) in total cortisol output. Notably, this is the first demonstration that epigenetic changes at the GR exon 1F correlate with HPAA reactivity. These findings have important implications for understanding the molecular mechanisms underlying gender differences in stress-related disorders and underscore the unique value of modeling both epigenetic and genetic information in conferring vulnerability to stress.

An intricate dance: Life experience, multisystem resiliency, and rate of telomere decline throughout the lifespan

Accumulation of life stressors predicts accelerated development and progression of diseases of aging. Telomere length, the DNA-based biomarker indicating cellular aging, is a mechanism of disease development, and is shortened in a dose response fashion by duration and severity of life stressor exposures. Telomere length captures the interplay between genetics, life experiences and psychosocial and behavioral factors. Over the past several years, psychological stress resilience, healthy lifestyle factors, and social connections have been associated with longer telomere length and it appears that these factors can protect individuals from stress-induced telomere shortening. In the current review, we highlight these findings, and illustrate that combining these `multisystem resiliency' factors may strengthen our understanding of aging, as these powerful factors are often neglected in studies of aging. In naturalistic studies, the effects of chronic stress exposure on biological pathways are rarely main effects, but rather a complex interplay between adversity and resiliency factors. We suggest that chronic stress effects can be best understood by directly testing if the deleterious effects of stress on biological aging processes, in this case the cell allostasis measure of telomere shortening, are mitigated in individuals with high levels of multisystem resiliency. Without attending to such interactions, stress effects are often masked and missed. Taking account of the cluster of positive buffering factors that operate across the lifespan will take us a step further in understanding healthy aging. While these ideas are applied to the telomere length literature for illustration, the concept of multisystem resiliency might apply to aging broadly, from cellular to systemic health.

Associations between health-related self-protection, diurnal cortisol, and C-reactive protein in lonely older adults

OBJECTIVES

The aim of this study was to examine whether health-related self-protection (e.g., using positive reappraisals or avoiding self-blame) prevents lonely older adults from exhibiting increases in diurnal cortisol secretion and higher levels of C-reactive protein (CRP).

METHODS

This longitudinal study (n = 122) examined diurnal cortisol levels (area under the curve) at baseline and 2-year follow-up. Levels of CRP were measured at 6-year follow-up. The main predictors included baseline levels of loneliness and health-related self-protection.

RESULTS

Among lonely participants, baseline self-protection predicted an amelioration of 2-year increases in diurnal cortisol volume (β = -.34, p = .03) and lower levels of CRP at 6-year follow-up (β = -.42, p = .006). These significant associations were not found among nonlonely participants (β < .14, p = .33). In addition, mediation analyses demonstrated that the buffering effect of self-protection on lonely older adults' levels of CRP at 6-year follow-up was statistically mediated by 2-year changes in cortisol volume (β = -.16, p = .06).

CONCLUSIONS

These findings suggest that lonely older adults may ameliorate biologic disturbances if they engage in self-protection to cope with their health threats.

Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training vary widely. The additional training provided at places of employment and through continuing education after the master's degree is often inadequate for competently addressing the issues clinicians face in practice.

Tend and befriend in the intensive care unit

Stress is a common phenomenon in the intensive care unit for both patients and nurses. Critical care nurses may experience many forms of stress, including physical, psychological, and moral stress or distress. The physiological stress response traditionally associated with the hypothalamic-pituitary-adrenal axis has been expanded to include a new model, called tend and befriend, that has been linked to females of different species, including humans. Studies have shown that stress also affects immune function. Although commonly associated with adverse outcomes, stress can lead to personal growth. The tend and befriend strategy is an intervention that was developed to help nurses increase their ability to grow from stressful situations, especially those related to moral distress.

A life course model of self-rated health through adolescence and young adulthood

This paper proposes and tests a life course model of self-rated health (SRH) extending from late childhood to young adulthood, drawing on three waves of panel data from the National Longitudinal Study of Adolescent Health (Add Health). Very little research has examined SRH during the early decades, or whether and how these self-assessments reflect experiences in the family of origin. Background characteristics (parental education, income, and family structure), parental health conditions (asthma, diabetes, obesity, migraines), and early health challenges (physical abuse, presence of a disability, and parental alcoholism and smoking) predict SRH from adolescence to young adulthood. These experiences in the family-of-origin are substantially mediated by the young person's health and health behaviors (as indicated by obesity, depression, smoking, drinking, and inactivity), although direct effects remain (especially for early health challenges). Associations between SRH and these mediators (especially obesity) strengthen with age. In turn, efforts to promote healthy behaviors in young adulthood, after the completion of secondary school, may be especially strategic in the promotion of health in later adulthood.

Systematic social observation of children's neighborhoods using Google Street View: a reliable and cost-effective method

BACKGROUND

Children growing up in poor versus affluent neighborhoods are more likely to spend time in prison, develop health problems and die at an early age. The question of how neighborhood conditions influence our behavior and health has attracted the attention of public health officials and scholars for generations. Online tools are now providing new opportunities to measure neighborhood features and may provide a cost effective way to advance our understanding of neighborhood effects on child health.

METHOD

A virtual systematic social observation (SSO) study was conducted to test whether Google Street View could be used to reliably capture the neighborhood conditions of families participating in the Environmental-Risk (E-Risk) Longitudinal Twin Study. Multiple raters coded a subsample of 120 neighborhoods and convergent and discriminant validity was evaluated on the full sample of over 1,000 neighborhoods by linking virtual SSO measures to: (a) consumer based geo-demographic classifications of deprivation and health, (b) local resident surveys of disorder and safety, and (c) parent and teacher assessments of children's antisocial behavior, prosocial behavior, and body mass index.

RESULTS

High levels of observed agreement were documented for signs of physical disorder, physical decay, dangerousness and street safety. Inter-rater agreement estimates fell within the moderate to substantial range for all of the scales (ICCs ranged from .48 to .91). Negative neighborhood features, including SSO-rated disorder and decay and dangerousness corresponded with local resident reports, demonstrated a graded relationship with census-defined indices of socioeconomic status, and predicted higher levels of antisocial behavior among local children. In addition, positive neighborhood features, including SSO-rated street safety and the percentage of green space, were associated with higher prosocial behavior and healthy weight status among children.

CONCLUSIONS

Our results support the use of Google Street View as a reliable and cost effective tool for measuring both negative and positive features of local neighborhoods.

The Biology of Caring

Caring, a core tenet of nursing practice, grew out of a holistic approach. Nurse theorists often note the establishment of a therapeutic relationship as the beginning point of caring, with subsequent nursing interventions reliant upon this relationship for effectiveness. Relational exchange serves as a source of either stress or healing between participants, and rarely is its impact neutral. Relational stress, in fact, has become a primary contributor to many disease processes in terms of promotion and progression and perhaps even initiation. Patient–provider relationships have a long history in medical and nursing literature as critical to providing effective interventions, but our understanding of relational dynamics between patients and providers remains fairly superficial. This theoretical article adapts a previously described biobehavioral model to illustrate the nature and centrality of caring relationships in nursing practice. The dynamic process of face-to-face engagement is deconstructed from a psychobiological standpoint in order to understand the physiological, emotional, cognitive, and behavioral impacts of relational interaction. This understanding is then applied to the patient–provider relationship. Finally, the utility of biomarkers of stress, positive emotion and resonance, and of disease is discussed relative to the patient-provider relationship. Methodological and interpretive challenges inherent in this line of research, along with suggestions to address such challenges, are also presented.

Inflammatory pathways link socioeconomic inequalities to white matter architecture

Socioeconomic disadvantage confers risk for aspects of ill health that may be mediated by systemic inflammatory influences on the integrity of distributed brain networks. Following this hypothesis, we tested whether socioeconomic disadvantage related to the structural integrity of white matter tracts connecting brain regions of distributed networks, and whether such a relationship would be mediated by anthropometric, behavioral, and molecular risk factors associated with systemic inflammation. Otherwise healthy adults (N= 155, aged 30-50 years, 78 men) completed protocols assessing multilevel indicators of socioeconomic position (SEP), anthropometric and behavioral measures of adiposity and cigarette smoking, circulating levels of C-reactive protein (CRP), and white matter integrity by diffusion tensor imaging. Mediation modeling was used to test associations between SEP indicators and measures of white matter tract integrity, as well as indirect mediating paths. Measures of tract integrity followed a socioeconomic gradient: individuals completing more schooling, earning higher incomes, and residing in advantaged neighborhoods exhibited increases in white matter fractional anisotropy and decreases in radial diffusivity, relative to disadvantaged individuals. Moreover, analysis of indirect paths showed that adiposity, cigarette smoking, and CRP partially mediated these effects. Socioeconomic inequalities may relate to diverse health disparities via inflammatory pathways impacting the structural integrity of brain networks.

Social subordination produces distinct stress-related phenotypes in female rhesus monkeys

Social subordination in female macaques is imposed by harassment and the threat of aggression and produces reduced control over one's social and physical environment and a dysregulation of the limbic-hypothalamic-pituitary-adrenal axis resembling that observed in people suffering from psychopathologies. These effects support the contention that this particular animal model is an ethologically relevant paradigm in which to investigate the etiology of stress-induced psychological illness related to women. Here, we sought to expand this model by performing a discriminate analysis (DA) on 33 variables within three domains; behavioral, metabolic/anthropomorphic, and neuroendocrine, collected from socially housed female rhesus monkeys in order to assess whether exposure to social subordination produces a distinct phenotype. A receiver operating characteristic (ROC) curve was also calculated to determine each domain's classification accuracy. DA found significant markers within each domain that differentiated dominant and subordinate females. Subordinate females received more aggression, showed more submissive behavior, and received less of affiliation from others than did dominant females. Metabolic differences included increased leptin, and reduced adiponectin in dominant compared to subordinate females. Dominant females exhibited increased sensitivity to hormonal stimulation with higher serum LH in response to estradiol, cortisol in response to ACTH, and increased glucocorticoid negative feedback. Serum oxytocin, CSF DOPAC and serum PACAP were all significantly higher in dominant females. ROC curve analysis accurately predicted social status in all three domains. Results suggest that socially house rhesus monkeys represent a cogent animal model in which to study the physiology and behavioral consequences of chronic psychosocial stress in humans.

Mediated effects of physical risk factors, leader-member exchange and empowerment in predicting perceived injury risk

In the context of conservation of resources theory, we examine the indirect (mediated) effects of physical risk factors, leader-member exchange (LMX) and empowerment on perceived injury risk in a heterogeneous sample (N = 226) of individuals employed in occupations related to production, construction and installation/maintenance. Positioning work role stressors and upward safety communications as two important mediating variables, as predicted, LMX and empowerment demonstrated significant indirect effects on perceived injury risk. Results from our model also provide preliminary evidence that an asymmetrical dualistic process exists in terms of the effect physical risk factors have on perceived injury risk via depletion of both psychological (i.e. role stressors) and physical resources (i.e. physical symptoms). Theoretical and practical implications based on the results of our model are also discussed.

"Shift-and-Persist" Strategies: Why Low Socioeconomic Status Isn't Always Bad for Health

Some individuals, despite facing recurrent, severe adversities in life such as low socioeconomic status (SES), are nonetheless able to maintain good physical health. This article explores why these individuals deviate from the expected association of low SES and poor health and outlines a "shift-and-persist" model to explain the psychobiological mechanisms involved. This model proposes that, in the midst of adversity, some children find role models who teach them to trust others, better regulate their emotions, and focus on their futures. Over a lifetime, these low-SES children develop an approach to life that prioritizes shifting oneself (accepting stress for what it is and adapting the self through reappraisals) in combination with persisting (enduring life with strength by holding on to meaning and optimism). This combination of shift-and-persist strategies mitigates sympathetic-nervous-system and hypothalamic-pituitary-adrenocortical responses to the barrage of stressors that low-SES individuals confront. This tendency vectors individuals off the trajectory to chronic disease by forestalling pathogenic sequelae of stress reactivity, like insulin resistance, high blood pressure, and systemic inflammation. We outline evidence for the model and argue that efforts to identify resilience-promoting processes are important in this economic climate, given limited resources for improving the financial circumstances of disadvantaged individuals.

Conscientiousness and stress exposure and reactivity: a prospective study of adolescent females

Conscientiousness is associated with health, but the mechanisms remain poorly understood. To explore the role that stress might play, this study examined whether conscientiousness was associated with exposure and reactivity to life stress. This study followed 133 adolescent women every 6 months for 2.5 years. Participants completed a baseline measure of conscientiousness, and at each visit underwent a structured interview to catalogue episodic and chronic stress and had blood drawn to assess inflammatory processes. Participants higher in conscientiousness experienced fewer self-dependent episodic stressors and less academic and interpersonal chronic stress throughout the study. However, at times when they experienced higher levels of chronic interpersonal stress, they became more resistant to glucocorticoids. Higher levels of conscientiousness may protect adolescent women from exposure to certain stressors. However, when stress occurs, highly conscientious individuals may become more resistant to glucocorticoids, increasing their risk for processes that influence inflammatory conditions.

Associations among depression, perceived self-efficacy, and immune function and health in preadolescent children

Experimental animal studies and adult research consistently show that stress exposure and/or psychological symptoms are associated with poorer health and immune functioning. The application to children is not yet clear, however, and we lack developmental models for studies in this area. The objective of this paper was to test the hypothesis that self-reported self-efficacy and depression, two markers of psychological well-being in children, would predict immunity and rate of illnesses. The data are based on a prospective study of 141 healthy, normally developing children aged 7-13 years who were recruited from an ambulatory pediatric setting. Children completed self-efficacy and depression measures and had blood obtained for IL-6 plasma levels and natural killer cell functional assays on three occasions, 6 months apart. Parents maintained weekly child illness diaries over 1 year using a thermometer to record fever. Parent psychiatric symptoms and income were used as covariates. Results indicated that, across the three occasions of measurement collected over the 1-year period, higher perceived self-efficacy was significantly associated with lower plasma interleukin 6 concentrations. There was no overall main effect of depressive symptoms on immune measures; however, for older girls, higher depression was associated with elevated natural killer cell cytotoxicity and an increased rate of total illnesses and febrile illnesses. The findings provide some of the first evidence that psychological processes are associated with immunity and health in a normally developing sample of preadolescents. Furthermore, the pattern of results suggests a modified model of a link between psychological well-being and immunological processes in children. These results build on and expand research on the notion of allostatic load and develop a groundwork for developmental studies in this area.

Cognitive-behavioral stress management reverses anxiety-related leukocyte transcriptional dynamics

BACKGROUND

Chronic threat and anxiety are associated with pro-inflammatory transcriptional profiles in circulating leukocytes, but the causal direction of that relationship has not been established. This study tested whether a cognitive-behavioral stress management (CBSM) intervention targeting negative affect and cognition might counteract anxiety-related transcriptional alterations in people confronting a major medical threat.

METHODS

One hundred ninety-nine women undergoing primary treatment of stage 0-III breast cancer were randomized to a 10-week CBSM protocol or an active control condition. Seventy-nine provided peripheral blood leukocyte samples for genome-wide transcriptional profiling and bioinformatic analyses at baseline, 6-month, and 12-month follow-ups.

RESULTS

Baseline negative affect was associated with >50% differential expression of 201 leukocyte transcripts, including upregulated expression of pro-inflammatory and metastasis-related genes. CBSM altered leukocyte expression of 91 genes by >50% at follow-up (group × time interaction), including downregulation of pro-inflammatory and metastasis-related genes and upregulation of type I interferon response genes. Promoter-based bioinformatic analyses implicated decreased activity of NF-κB/Rel and GATA family transcription factors and increased activity of interferon response factors and the glucocorticoid receptor as potential mediators of CBSM-induced transcriptional alterations.

CONCLUSIONS

In early-stage breast cancer patients, a 10-week CBSM intervention can reverse anxiety-related upregulation of pro-inflammatory gene expression in circulating leukocytes. These findings clarify the molecular signaling pathways by which behavioral interventions can influence physical health and alter peripheral inflammatory processes that may reciprocally affect brain affective and cognitive processes.

Hostile behavior links negative childhood family relationships to heart rate reactivity and recovery in young adulthood

Prior research has demonstrated that vulnerability to stress is influenced by early life experiences. This study evaluates the impact of negative childhood family relationships on cardiovascular stress reactivity in young adulthood. Participants (age 18-22) from families characterized by negative (n=39) or positive relationships (n=36) engaged in a role-play conflict task. Hostile/aggressive verbal behaviors during the task were observed, and blood pressure (BP) and heart rate (HR) responses were measured before, during, and after the task. Participants from negative families engaged in more hostile/aggressive verbal behavior during the task and showed attenuated HR reactivity. Hostile/aggressive verbal behavior predicted attenuated HR reactivity and recovery. Path analyses linked negative family relationships to more hostile verbal behavior during the task, and attenuated HR reactivity and recovery. These results support the development of hostile/aggressive behavior in social situations as a pathway linking childhood adversity to stress vulnerability across the lifespan.

Diurnal cortisol rhythms in Tsimane' Amazonian foragers: new insights into ecological HPA axis research

Although a growing body of research has documented important pathways by which the HPA axis mediates the interface between the psychosocial world and individual health, there is a paucity of data from nonwestern populations, particularly from those populations with distinct nutritional and infectious disease ecologies. The specific objectives of this study are: (1) to document variation in diurnal cortisol rhythms among the Tsimane', a remote population in the Bolivian Amazon, (2) to explore this variation by age and by gender, and (3) to compare diurnal rhythms from this study to other population based studies of cortisol conducted in industrialized nations. Salivary cortisol samples were collected twice daily, immediately upon waking and before bed, for three consecutive days from 303 participants (age 1.6-82 years, 1564 samples) in conjunction with the Tsimane' Amazonian Panel Study (TAPS). Cortisol rhythms showed strong age effects across the developmental span, with basal levels and slopes increasing into adulthood, although individuals older than 60 years demonstrated a precipitous flattening of the diurnal slope. Cortisol profiles were elevated in adult females compared to their age-matched male counterparts, and diurnal slopes, as well as mean cortisol concentrations among the Tsimane' were the lowest reported in any population based study of HPA axis function. Although the within-population variation in cortisol profiles was consistent with the established correlates of time of day, age, and sex, the between-population comparisons revealed dramatically lower levels of HPA activity among the Tsimane'. This study provides a benchmark against which to reference cortisol levels from industrialized populations, and expands the range of documented variation in HPA axis function in a nonwestern context.

Test anxiety and cardiovascular responses to daily academic stressors

Routine academic events may cause stress and produce temporary elevations in blood pressure. Students who experience test anxiety may be especially prone to cardiovascular activation in response to academic stress. This study drew on self-reported stress and ambulatory blood pressure measurements provided by 99 undergraduate participants (30% men, mean age=21 years) who participated over 4 days. Posture, activity level, recent consumption and the previous same-day reading were considered as covariates in a series of hierarchical linear models. Results indicate elevations in systolic blood pressure at times of acute academic stressors; neither diastolic blood pressure nor heart rate was linked with academic stress. In addition, those participants higher in test anxiety exhibited especially pronounced elevations in systolic blood pressure during times of acute academic stress. This research suggests that everyday academic stressors are linked with temporary increases in blood pressure and that test anxiety may contribute to these elevations. Test anxiety has implications for future academic and job success, and cardiovascular responses to everyday stress may contribute to health problems later in life.

Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load

OBJECTIVE

Low socioeconomic status (SES) early in life is one of the most well-established social predictors of poor health. However, little is understood about why some adults who grew up in low-SES environments do not have poor health outcomes. This study examined whether the psychological characteristic of "shift-and-persist" protects adults from the physiological risks of growing up in low-SES households. Shift-and-persist consists of reframing appraisals of current stressors more positively (shifting), while simultaneously persisting with a focus on the future. We hypothesized that this characteristic would be associated with reduced physiological risk in low-childhood SES individuals.

METHODS

A national sample of 1207 adults (aged 25-74 years) from the Survey of Midlife Development in the United States completed psychological questionnaires and were queried about parent education. Biologic assessments consisted of 24 different measures across seven physiological systems, from which a composite measure representing cumulative physiological risk (allostatic load) was derived.

RESULTS

Among adults who grew up in low-SES households, those who engaged in high-shift-and-high-persist strategies had the lowest allostatic load (b = -0.15, p = .04). No benefit of shift-and-persist was found for those from higher-childhood SES backgrounds (p = .36).

CONCLUSIONS

Identifying the health-related protective qualities that naturally occur in some low-SES individuals represents one important approach for developing future health improvement interventions for those who start out life low in SES. Moreover, the psychological qualities that are protective from future disease risk for those from low-SES backgrounds are different from those beneficial to high-SES individuals.

Childhood adversity and immune and inflammatory biomarkers associated with cardiovascular risk in youth: a systematic review

BACKGROUND

Research suggests that adverse experiences in childhood affect the development of cardiovascular disease (CVD), and immune and inflammation dysregulation has been postulated to play role. However, it is unclear whether the effects of social adversity on immune-related biomarkers are evident in early life, and if these biomarkers may provide an early risk marker for targeting prevention and intervention. The purpose of this review is to evaluate research on the relationship between adversity and CVD-relevant immune biomarkers in youth, assess the consistency of the findings, and consider what additional research is needed.

METHODS

PubMed and PsycINFO searches were conducted through September 2011. Studies were selected using criteria related to the childhood exposure, biomarker outcome, age range, and sample selection. Twenty articles were identified, examining associations between childhood adversity and immune biomarkers (assessed during childhood) that are potential risk markers for CVD later in life.

RESULTS

Although childhood adversity was not consistently related to youth levels of inflammatory and other immune markers relevant to CVD, a trend toward positive findings was observed. No detectable patterns were evident based on measure of adversity, biomarker, study design, or sample size.

CONCLUSIONS

Overall, our findings suggest this avenue of research is worth continued investigation. We offer recommendations for future research related to (1) study design and sample, (2) definition and measurement of adversity, (3) statistical analysis, and (4) outcomes that will help distinguish whether there are immunologic alterations related to adversity and subsequent CVD risk that can be reliably detected in childhood.

Coping with chronic illness in childhood and adolescence

Chronic illnesses and medical conditions present millions of children and adolescents with significant stress that is associated with risk for emotional and behavioral problems and interferes with adherence to treatment regimens. We review research on the role of child and adolescent coping with stress as an important feature of the process of adaptation to illness. Recent findings support a control-based model of coping that includes primary control or active coping (efforts to act on the source of stress or one's emotions), secondary control or accommodative coping (efforts to adapt to the source of stress), and disengagement or passive coping (efforts to avoid or deny the stressor). Evidence suggests the efficacy of secondary control coping in successful adaptation to chronic illness in children and adolescents, disengagement coping is associated with poorer adjustment, and findings for primary control coping are mixed. Avenues for future research are highlighted.

The need to belong and symptoms of acute physical health in early adolescence

This study examined the role of social belonging and self-esteem in acute physical health and mood in 159 young adolescents (aged 11 to 14 years). Standardized self-report measures of belongingness (school, home and community), self-esteem, acute physical symptoms, and affect, were completed for the previous month. Higher levels of inclusive belonging were associated with fewer physical symptoms and better affect. Domain specific belonging was independently linked to acute physical symptoms and level of affect, with pathways between belonging and outcome mediated by self-esteem. Findings emphasize the need for greater recognition of the role of belonging in physical health outcomes.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Antagonistic pleiotropy at the human IL6 promoter confers genetic resilience to the pro-inflammatory effects of adverse social conditions in adolescence

The authors tested the evolutionary genetic hypothesis that the functional form of an asymmetrically risky Gene × Environment interaction will differ as a function of age-related antagonistic pleiotropy (i.e., show opposite effects in young vs. old individuals). Previous studies have identified a polymorphism in the human IL6 promoter (rs1800795; IL6-74 G/C) that interacts with adverse socioenvironmental conditions to promote chronic inflammation in older adults (elevated C-reactive protein). This study identifies a protective effect of the same polymorphism in 17- to 19-year-old adolescents confronting socioeconomic adversity. Over 60% of the environmental risk contribution to the IL6 × Socioeconomic Status interaction could be accounted for by interpersonal stress and adult role burden. Thus, the IL6-174G allele does not represent an undifferentiated risk factor but instead sensitizes inflammatory biology to socioenvironmental conditions, conferring either genetic vulnerability or resilience depending on the developmental "somatic environment" that interacts with social conditions to influence gene expression.

Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms

Among people exposed to major psychological stressors in early life, there are elevated rates of morbidity and mortality from chronic diseases of aging. The most compelling data come from studies of children raised in poverty or maltreated by their parents, who show heightened vulnerability to vascular disease, autoimmune disorders, and premature mortality. These findings raise challenging theoretical questions. How does childhood stress get under the skin, at the molecular level, to affect risk for later diseases? And how does it incubate there, giving rise to diseases several decades later? Here we present a biological embedding model, which attempts to address these questions by synthesizing knowledge across several behavioral and biomedical literatures. This model maintains that childhood stress gets "programmed" into macrophages through epigenetic markings, posttranslational modifications, and tissue remodeling. As a consequence these cells are endowed with proinflammatory tendencies, manifest in exaggerated cytokine responses to challenge and decreased sensitivity to inhibitory hormonal signals. The model goes on to propose that over the life course, these proinflammatory tendencies are exacerbated by behavioral proclivities and hormonal dysregulation, themselves the products of exposure to early stress. Behaviorally, the model posits that childhood stress gives rise to excessive threat vigilance, mistrust of others, poor social relationships, impaired self-regulation, and unhealthy lifestyle choices. Hormonally, early stress confers altered patterns of endocrine and autonomic discharge. This milieu amplifies the proinflammatory environment already instantiated by macrophages. Acting in concert with other exposures and genetic liabilities, the resulting inflammation drives forward pathogenic mechanisms that ultimately foster chronic disease.

Child development in the context of disaster, war, and terrorism: pathways of risk and resilience

This review highlights progress over the past decade in research on the effects of mass trauma experiences on children and youth, focusing on natural disasters, war, and terrorism. Conceptual advances are reviewed in terms of prevailing risk and resilience frameworks that guide basic and translational research. Recent evidence on common components of these models is evaluated, including dose effects, mediators and moderators, and the individual or contextual differences that predict risk or resilience. New research horizons with profound implications for health and well-being are discussed, particularly in relation to plausible models for biological embedding of extreme stress. Strong consistencies are noted in this literature, suggesting guidelines for disaster preparedness and response. At the same time, there is a notable shortage of evidence on effective interventions for child and youth victims. Practical and theory-informative research on strategies to protect children and youth victims and promote their resilience is a global priority.

The different roles of perceived stress in the association between older adults' physical activity and physical health

OBJECTIVE

This 4-year longitudinal study examined the different roles of perceived stress in the association between older adults' physical activities and physical health. We hypothesized that physical activities would exert beneficial effects on physical health by preventing chronically high levels of perceived stress.

METHODS

We assessed baseline levels of physical activities and repeated measures of perceived stress and physical symptoms in 3 waves of data from a sample of 157 older adults.

RESULTS

Among participants with high (but not low) baseline levels of perceived stress, physical activity predicted a 2-year reduction of perceived stress and a 4-year prevention of physical health symptoms. Moreover, the interaction effect on 4-year changes in physical symptoms was mediated by 2-year changes in perceived stress.

CONCLUSIONS

Physical health benefits of physical activity are particularly pronounced among older adults who perceive high levels of stress, and this effect is mediated by a prevention of chronically high perceptions of stress.

Restorative biological processes and health

Research on psychological influences on physiology primarily focuses on biological responses during stressful challenges, and how those responses can become dysregulated with prolonged or repeated exposure to stressful circumstances. At the same time, humans spend considerable time recovering from those challenges, and a host of biological processes involved in restoration and repair take place during normal, non-stressed activities. We review restorative biological processes and evidence for links between psychosocial factors and several restorative processes including sleep, wound healing, antioxidant production, DNA repair, and telomerase function. Across these biological processes, a growing body of evidence suggests that experiencing negative emotional states, including acute and chronic stress, depressive symptoms, and individual differences in negative affectivity and hostility, can influence these restorative processes. This review calls attention to restorative processes as fruitful mechanisms and outcomes for future biobehavioral research.

Individual vulnerability to addiction

The process of addiction is often studied in the neurosciences as a function of the quantity or type of substance consumed, with the ultimate goal of counteracting these effects by other pharmacological means. However, epidemiology and clinical research have extensively demonstrated that most individuals who use drugs do not develop dependence. Numerous factors may explain an individual's propensity to addiction. This review discusses these paradigms and summarizes research on individual differences that encompass cultural and sociodemographic factors, psychiatric or psychological vulnerability, and biological or genetic propensity to addiction. Although these different factors often interact in the expression of vulnerable phenotypes, it is possible to alter or control specific sources of vulnerability. For these reasons, integrating individual vulnerability to addiction across different research disciplines is likely to provide the greatest advances for intervention and prevention efforts.

Risk and Resilience in Coping With Chronic Life Stress

This review discusses evidence-based perspectives on risk and resilience in coping with chronic life stress. Future directions for inquiry and practice also are addressed.

Intensive meditation training, immune cell telomerase activity, and psychological mediators

BACKGROUND

Telomerase activity is a predictor of long-term cellular viability, which decreases with chronic psychological distress (Epel et al., 2004). Buddhist traditions claim that meditation decreases psychological distress and promotes well-being (e.g., Dalai Lama and Cutler, 2009). Therefore, we investigated the effects of a 3-month meditation retreat on telomerase activity and two major contributors to the experience of stress: Perceived Control (associated with decreased stress) and Neuroticism (associated with increased subjective distress). We used mediation models to test whether changes in Perceived Control and Neuroticism explained meditation retreat effects on telomerase activity. In addition, we investigated whether two qualities developed by meditative practice, increased Mindfulness and Purpose in Life, accounted for retreat-related changes in the two stress-related variables and in telomerase activity.

METHODS

Retreat participants (n=30) meditated for ∼6 h daily for 3 months and were compared with a wait-list control group (n=30) matched for age, sex, body mass index, and prior meditation experience. Retreat participants received instruction in concentrative meditation techniques and complementary practices used to cultivate benevolent states of mind (Wallace, 2006). Psychological measures were assessed pre- and post-retreat. Peripheral blood mononuclear cell samples were collected post-retreat for telomerase activity. Because there were clear, a priori hypotheses, 1-tailed significance criteria were used throughout.

RESULTS

Telomerase activity was significantly greater in retreat participants than in controls at the end of the retreat (p<0.05). Increases in Perceived Control, decreases in Neuroticism, and increases in both Mindfulness and Purpose in Life were greater in the retreat group (p<0.01). Mediation analyses indicated that the effect of the retreat on telomerase was mediated by increased Perceived Control and decreased Neuroticism. In turn, changes in Perceived Control and Neuroticism were both partially mediated by increased Mindfulness and Purpose in Life. Additionally, increases in Purpose in Life directly mediated the telomerase group difference, whereas increases in Mindfulness did not.

CONCLUSIONS

This is the first study to link meditation and positive psychological change with telomerase activity. Although we did not measure baseline telomerase activity, the data suggest that increases in perceived control and decreases in negative affectivity contributed to an increase in telomerase activity, with implications for telomere length and immune cell longevity. Further, Purpose in Life is influenced by meditative practice and directly affects both perceived control and negative emotionality, affecting telomerase activity directly as well as indirectly.

Vasopressin needs an audience: neuropeptide elicited stress responses are contingent upon perceived social evaluative threats

The nonapeptide arginine vasopressin (AVP) plays an important role in hypothalamus-pituitary-adrenal axis regulation and also functions as a social hormone in a wide variety of species, from voles to humans. In the current report we use a variety of stress inducing tasks, including the Trier Social Stress Test (TSST) and intranasal administration of AVP to show that intranasal administration of this neuropeptide leads to a significant increase in salivary cortisol and pulse rate, specifically in conditions where subjects perform tasks in the presence of a social evaluative threat (task performance could be negatively judged by others). In contrast, in conditions without a social evaluative threat (no task condition, modified TSST without audience and bike ergometry), subjects receiving AVP did not differ from subjects receiving placebo. Thus exogenous AVP's influence is contingent upon a circumscribed set of initial conditions that constitute a direct threat to the maintenance of our social selves. Stress evoked by social threat is an integral part of social life and is related to self-esteem and in extreme forms, to poor mental health (e.g., social phobia). Our findings suggest that AVP is a key component in the circuit that interlaces stress and social threat and findings offer inroads to our understanding of individual differences in sociability and in stress response elicited in threatening social situations.

Emotional functioning at age 7 years is associated with C-reactive protein in middle adulthood

OBJECTIVE

Few have considered whether and how child emotional functioning is associated with inflammation later in life. Therefore, we evaluated whether child emotional functioning at age 7 years is associated with C-reactive protein (CRP), an indicator of systemic inflammation, in middle adulthood.

METHODS

We studied adult offspring (mean age 42.2 years) of participants in the National Collaborative Perinatal Project, a national cohort of pregnant women enrolled between 1959 and 1966. Three measures of child emotional functioning were derived from psychologist ratings of child behavior at age 7 years: inappropriate self-regulation (ISR), distress proneness, and behavioral inhibition. Multiple linear regression models were fit to investigate the association between childhood emotional functioning and adulthood CRP and also to evaluate potential mediators of this association. Model n's were from 400 for Model 1 to 379 for Model 4 depending on covariates included and missing data on those covariates.

RESULTS

Children with high ISR and distress proneness at age 7 years had significantly higher CRP as adults (ISR: β = 0.86; standard error [SE] = 0.28; p = .002; distress proneness: β = 1.23; SE = 0.57; p = .03). In contrast, children with high levels of behavioral inhibition had lower CRP as adults (β = -0.58; SE = 0.38; p = .04). Furthermore, there was evidence that associations of ISR and distress proneness with CRP may be mediated in part by adulthood body mass index (Sobel significance tests of mediation: ISR: p = .003; distress proneness: p = .07).

CONCLUSIONS

Findings suggest that poor childhood emotional functioning is associated with inflammation in adulthood. These results suggest a potential childhood origin of adult inflammatory risk.

Abuse in childhood and risk of uterine leiomyoma: the role of emotional support in biologic resilience

BACKGROUND

Childhood adversities are associated with adult health. We hypothesize that exposure to physical and sexual abuse in childhood and adolescence will be associated with incidence of clinically symptomatic uterine leiomyomas (fibroids) through influences on health behaviors and reproductive hormone regulation.

METHODS

Participants included 68,505 women enrolled in the Nurses' Health Study II, an ongoing prospective cohort study of premenopausal women from 14 US states aged 25-42 years at enrollment (1989), who completed a retrospective questionnaire on childhood violence exposure (2001). A cumulative indicator of severity and chronicity of child/teen violence exposure was derived using factor analysis. We used a Cox proportional-hazards model to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs).

RESULTS

During the 728,865 woman-years of follow-up (1989-2005), 9823 incident diagnoses of ultrasound- or hysterectomy-confirmed uterine leiomyomas were reported; 65% reported any physical or sexual abuse. A dose-response association between cumulative abuse and fibroid risk was found. Compared with those who reported no abuse, multivariable IRRs for ultrasound or hysterectomy-confirmed uterine leiomyomas were 1.08 (95% CI = 1.03-1.13), 1.17 (1.10-1.24), 1.23 (1.14-1.33), 1.24 (1.10-1.39), and 1.36 (1.18-1.54), for cumulative exposures ranging from mildest to most severe. Increased emotional support in childhood also attenuated associations.

CONCLUSIONS

Severity and chronicity of child/teen sexual and physical abuse was associated with increasing risk of clinically detected fibroids among premenopausal women.

Morphological and receptorial changes in the epididymal adipose tissue of rats subjected to a stressful stimulus

Obesity is nowadays related to other pathological conditions such as inflammation, insulin resistance, and diabetes, but little is known about the relationship between psychological stress and adipocytes. We decided to study the expression of the translocator protein (TSPO) 18-kDa, peroxisome proliferator-activated receptor-γ (PPAR-γ), mitochondrial uncoupling protein-1 (UCP-1), and adipocyte morphology in the adipose tissue of rats subjected to stress conditions. In our model of stress, rats fasted for 24 h were placed in a restraint cage and then immersed vertically to the level of the xiphoid process in a water bath at 23 °C for 7 h. After that period, we removed the epididymal adipose tissues for the subsequent analysis. The optical and electron microscopy revealed that adipocytes of control rats formed a continuous epithelial-like cell layer; on the contrary in the adipocytes of stressed rats some cells have merged together and the number of vessels formed seems to increase. Stressed adipocytes presented unilocular cells with numerous mitochondria with a morphology ranging between that of brown adipose tissue (BAT) and white adipose tissue (WAT). Interestingly, when we investigated the subcellular distribution of UCP-1 by immunogold electron microscopy, the adipose tissue of stressed rats was positive for UCP-1. From the immunoblot analysis with anti-PPAR-γ antibody, we observed an increased expression of PPAR-γ in the adipocytes of stressed group compared with control group (P < 0.05). Stress induced the expression of TSPO 18-kDa receptor (B(max) = 106.45 ± 5.87 fmol/mg proteins), which is undetectable by saturation-binding assay with [(3)H]PK 11195 in the control group.