Factors in the perceived stress scale differentially associate with mindfulness disposition and executive function among early adolescents

Salivary Markers as Potential Stress Descriptors for Pediatric Dental Patients: A Literature Review

Dental fear and anxiety are frequently identified as major contributing factors to non-compliance, uncooperativeness, and difficulties during dental procedures in pediatric patients. These issues can lead to avoidance of dental treatment, resulting in long-term negative consequences for oral health and overall well-being. The assessment and quantification of psychological functioning (i.e., dental fear, anxiety, and self-perceived stress) has traditionally relied on self-reported questionnaires validated for the pediatric population. While this approach is cost-effective and non-invasive, it relies on subjective self-reported data, oftentimes influenced by parental or guardian interaction, especially in young children. Salivary diagnostics has recently emerged as an objective method for the procurement of biological molecules that serve as biomarkers for a variety of oral and systemic conditions. This literature review aims to comprehensively summarize the available literature on the correlation between psychological and salivary physiological measurements assessing dental fear, dental anxiety, and self-perceived stress in pediatric dental patients, highlighting the advantages and disadvantages of each method of assessment. Four databases (PubMed®, PsycInfo, Dentistry & Oral Sciences Source, and Web of Science) were searched for published articles, in the English language, assessing the correlation between psychological and physiological distress in children undergoing dental procedures. Studies on pediatric patients reveal positive correlations between salivary cortisol and dental fear, stress, and anxiety, especially in returning patients. Conversely, findings on salivary alpha-amylase and secretory immunoglobulin A were inconsistent, with some studies suggesting correlations with dental fear and prior dental experiences.

Modeling Adolescent Disposition Development: Age-Related Changes in Psychosocial Processes Correlated with Substance Use

PURPOSE

A model is proposed in which longitudinal changes in adolescents' dispositions increase age-related risk for the onset of substance use.

METHOD

Pooled surveys from 25 longitudinal studies were examined. Disposition was calculated from eight variables: use intentions; refusal intentions; attitudes; positive consequence beliefs; beliefs about negative consequences; descriptive peer normative beliefs; injunctive peer normative beliefs; and lifestyle incongruence. Substance use onset (past 30-day alcohol, cigarette, and marijuana use) was analyzed using participants' just prior dispositional status and recent changes in their dispositions.

RESULTS

Disposition was highly correlated with each of the measured variables. The pattern of disposition changes as adolescents grow older, revealing that younger adolescents have more positive dispositions; whereas when they grew older, negative dispositions gradually emerged among a subset of adolescents. Analyses also revealed that dispositional status and recent changes in their dispositions were strong predictors of substance use onset.

IMPLICATIONS

Better understanding the development of dispositions will aid in designing effective interventions. Subordinate variables are amenable to intervention and are recommended as the primary focus of prevention programming. Because of the developmental trajectory of dispositions, multi-year interventions are highly recommended. Whenever possible, tailored approaches that take adolescents' pre-intervention dispositions into account should be considered.

Risk factor clusters for non-communicable diseases in adolescents in Eastern Cape, South Africa

Background

The increasing prevalence of non-communicable diseases (NCDs) among adolescents in South Africa is a growing public health concern.

Aim

To examine the clustering of NCD risk factors, with a focus on gender, socio-economic status (SES) and perceived stress among adolescents.

Setting

The study involved adolescents from eight schools in Buffalo City Metropolitan Municipality and Amatole district, Eastern Cape.

Methods

A stratified random sample of 266 adolescents (aged 12 years-18 years) was assessed for anthropometric, physiological, and perceived stress measures. Data included body mass index (BMI), blood pressure (BP), cholesterol, glucose levels, and perceived stress (via the Perceived Stress Scale). Analysis involved descriptive statistics, Chi-square tests, t-tests, and k-means clustering.

Results

Females (n = 155) showed a higher prevalence of NCD risk factors, with 80.2% classified as overweight or obese compared to 19.8% of males, and 77.2% had elevated cholesterol versus 22.8% of males. Perceived stress was higher in affluent schools (59.8%) despite fewer metabolic risks. K-means analysis identified four health profiles with significant SES and health differences (p < 0.001). Cluster 1 (high SES) showed elevated BP, BMI, and stress, while Clusters 2-4 (low SES) varied in risks, with Cluster 4 showing the highest BP and metabolic risks despite low stress.

Conclusion

These results highlight unique health profiles and risk factors across socio- economic contexts, with female adolescents from lower socio-economic backgrounds facing greater metabolic risks.

Contribution

This Study provides original insights into the interplay between gender, SES and perceived stress in shaping NCD risk among South African adolescents.

Association of children's electronic media use with physical activity, cognitive function, and stress

OBJECTIVE

Electronic media is constantly evolving and has become an integral part of people's lives, especially among youth. This cross-sectional observational study assessed the association between electronic media use, health behaviors and outcomes, specifically, physical activity, stress and cognitive function among youth from an under-resourced community.

METHODS

Participants ages six-sixteen were recruited from a Federally Qualified Health Center to participate in a study to promote park prescriptions with data collection between 2020 and 2024. At baseline, both intervention and control participants were asked to wear an accelerometer for one week and complete surveys about their electronic media time, stress, and cognitive function. We estimated the associations between electronic media use and health outcomes using cross-sectional multiple regressions.

RESULTS

Among the 441 participants, the average amount of electronic media use was 48.6 h per week (95 % CI: 46.0, 51.1), with children ages 6-9 engaging in 37.3 h per week (95 % CI: 34.5, 40.2) and youth ages 10-16 engaging in 56.4 h per week of electronic media time (95 % CI: 52.9, 59.9). Average daily MVPA was 16.6 min (95 % CI: 15.4, 17.8). Electronic media use time was negatively associated with MVPA and with cognitive function for all age groups. Electronic media time was only associated with stress for youth over age 10.

CONCLUSION

The associations among electronic media, MVPA, cognitive function and stress were statistically significant, but relatively modest. Future research should examine whether reducing time on electronic media will have a positive impact on physical activity and mental health outcomes.

CLINICAL TRIALS REGISTRY NUMBER

#NCT04114734.

Greater perceived stress and lower cortisol concentration increase the odds of depressive symptoms among adolescents

BACKGROUND

Adolescent depression is a major public health concern. Although stress has been linked to more severe depression, its association with mild depression among adolescents is not understood. This study assesses the relationship between perceived stress and cortisol (a physiologic measure of stress) and examines the relationships between these stress measures and depressive symptoms among adolescents 13-19 years of age.

METHODS

Stress was measured with the Perceived Stress Scale-10 and through salivary sampling for cortisol four times throughout the day. The Patient Health Questionnaire-9 was used to measure depressive symptoms (range 0-27), where ≥5 indicated the threshold for experiencing at least mild depressive symptoms. Spearman coefficients and multiple logistic regression models were used to examine the relationships between our variables of interest.

RESULTS

The mean age of the 73 participants in our study was 15.82 years. 49 % of the participants reported depressive symptoms (PHQ-9 score ≥ 5). Both higher perceived stress (odds ratio [OR] = 1.11, p = 0.022) and lower cortisol (area-under-the curve; AUCG) (OR = 0.99, p = 0.009) were associated with increased odds of having depressive symptoms.

LIMITATIONS

Few participants had moderate to severe PHQ-9 depression, therefore our study reported findings on mild depression or greater.

CONCLUSIONS

Perceived stress and cortisol appear to reflect distinct, independent components of the stress experience. However, both greater perceived stress and less circulating cortisol may indicate difficulties in regulating stress as potential factors underlying depressive symptoms. Future research should focus on the different types of adolescent stressors and the importance of routine screening of stress and depression, including mild depression.

Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study

BACKGROUND

Stress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA.

METHODS

This is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors.

RESULTS

Change in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function.

CONCLUSIONS

This study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.

The Association of Quality of Life with Psychosocial Factors in Adolescents with Tourette Syndrome

Individuals with Tourette syndrome (TS) have poorer quality of life (QoL) than their peers, yet factors contributing to poor QoL in this population remain unclear. Research to date has predominantly focused on the impact of tics and psychiatric symptoms on QoL in TS samples. The aim of this cross-sectional, multi-informant study was to identify psychosocial variables that may impact adolescent QoL in TS. Thirty-eight adolescents aged 13 to 17 with TS and 28 age-matched controls participated with a caregiver. No group differences were found on QoL, although the TS group reported reduced QoL compared to population normative data. In the TS group, reduced QoL was associated with lower self-esteem, poorer family functioning, higher stress, and greater depression and anxiety; QoL was unrelated to tic severity. In regression analyses, after adjusting for covariates, family functioning was the strongest predictor of QoL. These results emphasize the need to further explore the influence of psychosocial factors, particularly family functioning, on QoL in adolescents with TS.

Factor structure and psychometric properties of the Perceived Stress Scale in Russian adolescents

This study involved a psychometric analysis of the 10-item Perceived Stress Scale (PSS-10). To investigate the Russian version of the PSS-10 for adolescents, 3530 adolescents aged 13-17 years were recruited. Confirmatory factor analysis revealed that the data corresponded to the expected two-factor configuration. Psychometric properties and factor structure were evaluated. As expected, the PSS-10 included two factors: perceived helplessness and perceived self-efficacy. Internal consistency demonstrated acceptable values (Cronbach's alpha was 0.82 for perceived helplessness, 0.77 for perceived self-efficacy, and 0.80 for the overall PSS score). Measurement invariance across sexes was assessed, and configural and metric invariance were confirmed. The developed diagnostic tool can be used both in the school system to alleviate the negative consequences of academic stress in adolescents and, in the future, in other areas, particularly in clinical practice.

Beyond the RewP: The reward feedback-elicited LPP and its potential associations with perceived stress and internalizing symptoms in late childhood

Internalizing problems increase substantially during late childhood and early adolescence, which are known to be associated with elevated perceived stress as children transition into adolescence. One risk factor that may moderate the stress-symptom association is reward processing. While neurophysiological research in this field has focused on the reward positivity component (RewP) elicited during reward processing, little work has examined the reward feedback-elicited late positive potential (LPP) and its association with internalizing psychopathology. The present study examined the moderating roles of the RewP and feedback-elicited LPP in the relationship between perceived stress and internalizing symptoms in late childhood. A community sample of 115 nine-to-12-year-old children (66 girls, Mean age = 11.00 years, SD = 1.16) completed an EEG version of the reward feedback paradigm, the Doors task, and completed questionnaires on perceived stress and internalizing symptoms. A principal component analysis revealed three temporo-spatial factors that were temporally and spatially analogous to the RewP, anterior LPP, and posterior LPP, respectively. As expected, an enlarged RewP was found towards the win condition compared to the loss condition. We also observed a potentiated LPP towards loss relative to win feedback, which may reflect the evaluation and reappraisal processes following unsuccessful performance (i.e., loss). We did not, however, find significant moderating effects of any ERP components on the stress-symptom association. Our study was first to isolate the feedback-elicited LPP in a reward processing paradigm in children and provide initial evidence on the modulation of the ERP component by task conditions. Future research is warranted to further explore the functional significance of the reward feedback-elicited LPP in association with perceived stress and internalizing psychopathology in youths.

Study protocol of the Our Futures Vaping Trial: a cluster randomised controlled trial of a school-based eHealth intervention to prevent e-cigarette use among adolescents

BACKGROUND

Effective and scalable prevention approaches are urgently needed to address the rapidly increasing rates of e-cigarette use among adolescents. School-based eHealth interventions can be an efficient, effective, and economical approach, yet there are none targeting e-cigarettes within Australia. This paper describes the protocol of the OurFutures Vaping Trial which aims to evaluate the efficacy and cost-effectiveness of the first school-based eHealth intervention targeting e-cigarettes in Australia.

METHODS

A two-arm cluster randomised controlled trial will be conducted among Year 7 and 8 students (aged 12-14 years) in 42 secondary schools across New South Wales, Western Australia and Queensland, Australia. Using stratified block randomisation, schools will be assigned to either the OurFutures Vaping Program intervention group or an active control group (health education as usual). The intervention consists of four web-based cartoon lessons and accompanying activities delivered during health education over a four-week period. Whilst primarily focused on e-cigarette use, the program simultaneously addresses tobacco cigarette use. Students will complete online self-report surveys at baseline, post-intervention, 6-, 12-, 24-, and 36-months after baseline. The primary outcome is the uptake of e-cigarette use at 12-month follow-up. Secondary outcomes include the uptake of tobacco smoking, frequency/quantity of e-cigarettes use and tobacco smoking, intentions to use e-cigarettes/tobacco cigarettes, knowledge about e-cigarettes/tobacco cigarettes, motives and attitudes relating to e-cigarettes, self-efficacy to resist peer pressure and refuse e-cigarettes, mental health, quality of life, and resource utilisation. Generalized mixed effects regression will investigate whether receiving the intervention reduces the likelihood of primary and secondary outcomes. Cost-effectiveness and the effect on primary and secondary outcomes will also be examined over the longer-term.

DISCUSSION

If effective, the intervention will be readily accessible to schools via the OurFutures platform and has the potential to make substantial health and economic impact. Without such intervention, young Australians will be the first generation to use nicotine at higher rates than previous generations, thereby undoing decades of effective tobacco control.

TRIAL REGISTRATION

The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662; date registered: 10/01/2023).

Interactions between perceived stress and microbial-host immune components: two demographically and geographically distinct pregnancy cohorts

Higher stress during pregnancy associates with negative outcomes and elevated inflammation. The gut microbiota, reflecting environment and social interactions, alongside host immune responses have the potential to better understand perceived stress and identify when stress is excessive in pregnancy. Two U.S. cohorts of 84 pregnant individuals, composed of urban women of color and suburban white women, completed the Perceived Stress Scale-10 (PSS-10) and provided fecal and blood samples at two time points. Confirmatory Factor Analysis assessed the robustness of a two-factor PSS-10 model (Emotional Distress/ED and Self-Efficacy/SE). Gut microbiota composition was measured by 16 S rRNA amplicon sequencing and the immune system activity was assessed with a panel of 21 T-cell related cytokines and chemokines. ED levels were higher in the suburban compared to the urban cohort, but levels of SE were similar. ED and SE levels were associated with distinct taxonomical signatures and the gut microbiota data improved the prediction of SE levels compared with models based on socio-demographic characteristics alone. Integration of self-reported symptoms, microbial and immune information revealed a possible mediation effect of Bacteroides uniformis between the immune system (through CXCL11) and SE. The study identified links between distinct taxonomical and immunological signatures with perceived stress. The data are congruent with a model where gut microbiome and immune factors, both impacting and reflecting factors such as close social relationships and dietary fiber, may modulate neural plasticity resulting in increased SE during pregnancy. The predictive value of these peripheral markers merit further study.

Hair glucocorticoid concentration, self-perceived stress and their associations with cardiometabolic risk markers in Swedish adolescents

BACKGROUND

While hair cortisol is proposed as a biomarker for chronic stress and a possible mediator linking chronic stress and cardiovascular risk in adults, studies in adolescents are scarce. We explored the associations between self-perceived stress, hair cortisol (HairF) and cortisone (HairE), and cardiometabolic risk markers in adolescents. Further, we examined whether association between self-perceived stress and HairF may depend on the use of the coping strategies "shift-persist".

METHODS

Participants were 7th grade pupils recruited to the STudy of Adolescence Resilience and Stress (STARS) and data from the baseline examinations were used. Adolescents (n = 1553, 26 % boys, Mage=13.6, SD = 0.4) completed questionnaires assessing perceived stress and coping strategies "shift-persist", provided hair sample, and examined for cardiometabolic risk factors including waist circumference (WC), body mass index (BMI) z-score, blood pressure, and white blood cell counts (WBC). HairF and HairE were analysed using liquid chromatography with tandem mass spectrometry. We conducted descriptive analyses (Student's t-test, Wilcoxon Signed Ranks test, Chi-square test) and linear regression analyses.

RESULTS

Perceived stress was not associated with HairF, neither had the use of coping strategies "shift-persist" any influence on this association. Both HairF and HairE were positively associated with BMI z-score (beta coefficients (β): 0.178 (p < 0.001) and 0.119 (p < 0.001) for boys; 0.123 (p < 0.001) and 0.089 (p < 0.01) for girls) and WC (β: 0.089 (p > 0.05) and 0.098 (p < 0.05) for boys; 0.103 (p < 0.01) and 0.076 (p < 0.05) for girls). Perceived stress was also positively associated with BMI z-score and WC. Perceived stress, but not HairF, remained associated with WC in boys (β = 0.200, p < 0.001) in the models with HairF and perceived stress presented simultaneously. Modest association between HairE and WBC was found in boys (β = 0.149, p < 0.01).

CONCLUSIONS

The study supports the association between chronic stress and overweight/obesity in adolescents. Hair cortisol and self-perceived stress capture different aspects of how chronic stress is related to overweight/obesity in adolescents.

The relation between sensory processing sensitivity and telomere length in adolescents

BACKGROUND

In the present study, we investigated the association between sensory processing sensitivity (SPS) and telomere length (TL), which is considered a biomarker of cellular aging. SPS is an individual characteristic describing increased perception and procession of inner or outer stimuli, and is positively related to self-perceived stress.

METHODS

We recruited 82 healthy adolescents aged 13-16 from secondary schools in Germany. SPS was measured with the Highly Sensitive Person Scale, and TL was determined by a multiplex quantitative PCR method.

RESULTS

Our results show that students with higher values of SPS are likely to have shorter telomeres (β = 0.337, p = .001), when adjusting for sex, socioeconomic status, age, and body mass index. These findings are also independent of the negative impact of stress students might have perceived shortly before data collection.

CONCLUSIONS

Our analysis suggests that students who struggle with low sensory threshold are likely to have shorter telomeres.

Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial

Background

Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress.

Objective

The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination.

Methods

This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions.

Results

Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021.

Conclusions

Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally.

Trial Registration

ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888

International Registered Report Identifier (IRRID)

PRR1-10.2196/25545

Psychosocial factors and multiple health risk behaviors among early adolescents: a latent profile analysis

Early adolescence is a pivotal developmental period when multiple health risk behaviors, such as obesity and substance use, are often established. Several psychosocial factors, often considered traits, have been independently associated with these increases, including executive function (EF), mindfulness disposition (MD), perceived stress, distress tolerance (DT), and anhedonia. However, these factors have not been evaluated for their conjoint relationships to determine whether different patterns may signal greater or lesser risk for obesity and substance use, and whether the same patterns relate to obesity and substance use in the same ways (same magnitude of risk). To evaluate these patterns, a latent profile analysis was conducted, resulting in a three-profile model. Profile 1 (8% of sample) was characterized by the lowest levels of EF, MD, DT and highest levels of stress and anhedonia, profile 2 (44%) intermediate levels, and profile 3 (48%) the highest levels of EF, MD, DT and lowest levels of stress and anhedonia. Youth classified to profile 1 reported significantly greater levels of both obesogenic and substance use behaviors relative to other profiles. Findings suggest that adolescents engaging in obesogenic and substance use behaviors may share common profiles of psychosocial risk.

Measuring stress in Australia: validation of the perceived stress scale (PSS-14) in a national sample

Background

In Australia, the stress levels have increased over the years, impacting on the physical and mental health of the general population. The aim of the present study was to evaluate the validity and reliability of the PSS-14 in an Australian population.

Methods

The PSS-14 was applied to a large national sample comprising 3857 Australians in the population-based cross-sectional study Australia’s National Survey of Adult Oral Health 2004–2006. The psychometric properties analyzed with the Rasch model and Graphical Log-linear Rasch models were: model fit, item fit, local dependence, differential item functioning, unidimensionality, reliability, targeting and criterion validity.

Results

The PSS-14 did not fit the pure RM (χ2 (55) = 3828.3, p = < 0.001) and the unidimensionality of the whole scale was rejected (p = < 0.001). The Perceived Stress (χ2 (27) = 1409.7, p = < 0.001) and Perceived Control (χ2 (27) = 713.4, p = < 0.001) subscales did not fit the pure RM. After the deletion of two items, the Perceived Stress subscale (χ2 (96) = 94.4, p = 0.440) fitted a GLLRM, while the Perceived Control scale (χ2 (55) = 62.50, p = 0.224) fitted a GLLRM after the exclusion of four misfitting items.

Conclusions

The Perceived Stress subscale displayed adequate psychometric properties after the deletion of two items; however, the majority of problems centered around the Perceived Control subscale. The presence of differential item functioning among four items indicates that adjustment of total scores is required to avoid measurement bias. Recommendations for future applications in Australia are provided.