Coping style, trait anxiety and cortisol reactivity during mental stress

ForDigitStress: presentation and evaluation of a new laboratory stressor using a digital job interview-scenario

Introduction

Since the COVID-19 pandemic, working environments and private lives have changed dramatically. Digital technologies and media have become more and more important and have found their way into nearly all private and work environments. Communication situations have been largely relocated to virtual spaces. One of these scenarios is digital job interviews. Job interviews are usually-also in the non-digital world-perceived as stressful and associated with biological stress responses. We here present and evaluate a newly developed laboratory stressor that is based on a digital job interview-scenario.

Methods

N = 45 healthy people participated in the study (64.4% female; mean age: 23.2 ± 3.6 years; mean body mass index = 22.8 ± 4.0 kg/m²). Salivary alpha-amylase (sAA) and cortisol were assessed as measures for biological stress responses. Furthermore, perceived stress was rated at the time points of the saliva samplings. The job interviews lasted between 20 and 25 min. All materials, including instructions for the experimenter (i.e., the job interviewer) and the data set used for statistical analysis, as well as a multimodal data set, which includes further measures, are publicly available.

Results

Typical subjective and biological stress-response patterns were found, with peak sAA and perceived stress levels observed immediately after the job interviews and peak cortisol concentrations 5 min afterwards. Female participants experienced the scenario as more stressful than male participants. Cortisol peaks were higher for participants who experienced the situation as a threat in comparison to participants who experienced it as a challenge. Associations between the strength of the stress response with further person characteristics and psychological variables such as BMI, age, coping styles, and personality were not found.

Discussion

Overall, our method is well-suited to induce biological and perceived stress, mostly independent of person characteristics and psychological variables. The setting is naturalistic and easily implementable in standardized laboratory settings.

Development of a Prototype Lateral Flow Immunoassay of Cortisol in Saliva for Daily Monitoring of Stress

Emotional stress negatively affects the quality of a person's daily life. From a physiological point of view, stress is expressed in the excitation of the hypothalamic-pituitary-adrenal cortex axis, which leads to the release of the hormone cortisol into the blood. We developed a lateral flow immunoassay to detect cortisol in human salivary fluid and tested it on 10 healthy volunteers daily for about one month (n = 293 saliva samples). Cortisol was detected in concentrations ranging from 1 to 70 ng/mL. Salivary cortisol levels were confirmed by ELISA. The straightness range of LFIA calibration was from 1 to 100 ng/mL. The diagnostic sensitivity of the method was 73%. It was found that in 3 out of 10 subjects, fluctuations in the level of cortisol in saliva partially corresponded to the subjectively assessed level of stress.

Glycyrrhizin treatment ameliorates post-traumatic stress disorder-like behaviours and restores circadian oscillation of intracranial serotonin

Post-traumatic stress disorder (PTSD) has become a major disease that threatens human health. Neurotransmitters and the amygdala are found to be critical in the development and maintenance of PTSD. We aim to investigate the role of glycyrrhizin in treating PTSD. Contextual fear extinction and elevated plus maze test were applied to evaluate the anxiety and fear memory. Microdialysis and high-performance liquid chromatography were used to analyze the expression of amygdala neurotransmitters in PTSD animal models and to verify the effects of glycyrrhizin on major neurotransmitters. The protein levels of tryptophan hydroxylase 2 (TPH2) were examined by western bolt. Glycyrrhizin treatment significantly reduced anxiety and fear memory after 1 and 7 days of PTSD modelling. In addition, glycyrrhizin treatment restored the circadian rhythm changes of serotonin and TPH2. The present study found a significant circadian rhythm change of serotonin in the amygdala in PTSD rats. Besides, glycyrrhizin treatment restored the altered serotonin diurnal fluctuations, which raises important implications for PTSD treatment.

Post-traumatic stress disorder and incident fractures in the Danish population

Psychological stress may be associated with increased risk of fractures. It is unknown whether post-traumatic stress disorder (PTSD), a marker of chronic severe psychological stress occurring in response to a traumatic event, influences fracture risk. In this nationwide cohort study, persons with PTSD had an increased risk of fractures compared to the general population.

INTRODUCTION

We conducted a population-based national cohort study in Denmark to examine the association between PTSD and incident fractures.

METHODS

We examined the incidence rate of overall and specific fractures among patients with clinician-diagnosed PTSD (n = 4114), compared with the incidence rate in the general population from 1995 to 2013, using Danish medical registry data. We further examined differences in associations by gender, age, psychiatric and somatic comorbidity, and follow-up time. We calculated absolute risks, standardized incidence ratios (SIRs), and 95% confidence intervals (95% CIs).

RESULTS

Risk of any fracture among persons with PTSD was 24% (95% CI 20%, 28%) over the study period. The SIR for any fracture was 1.7 (95% CI 1.6, 1.9). We found little evidence of effect measure modification of the association between PTSD and fractures in our stratified analyses.

CONCLUSIONS

Our findings suggest that PTSD is associated with increased fracture risk.

Distraction coping predicts better cortisol recovery after acute psychosocial stress

The aim of this study was to explore whether different manifestations of state coping predict cortisol response and recovery in an acute stress situation. Fifty-nine healthy adults (59.3% female) were exposed to the Trier Social Stress Test (TSST), and salivary cortisol was measured repeatedly before and after stress. Hierarchical linear modeling was used to test for relationships between factor-analytically derived measures of state coping and cortisol response and recovery. Independent of sex, age, BMI, chronic stress and depression, denial coping was related with higher peak levels of cortisol (β=0.0798, SE=0.0381, p=0.041) while distraction coping predicted steeper recovery after TSST (linear effect: β=-0.0430, SE=0.0184, p=0.023) and less pronounced curvature (quadratic effect: β=0.0043, SE=0.0017, p=0.016). Our results demonstrate the stress-buffering effect of distraction coping on hypothalamic-pituitary-adrenal (HPA) axis activity in situations without sufficient control.

Stress, Cortisol, and Periodontitis in a Population Aged 50 Years and Over

Periodontitis and its relationship with psycho-neuro-immunological variables, such as psychological stress and cortisol, have been little explored. The objective of this study was to evaluate the extent and severity of chronic periodontitis and its association with the levels of salivary cortisol and the scores obtained with a stress questionnaire in a population aged 50 years and over. We studied 235 individuals in a cross-sectional study. They answered the Lipp’s Inventory of Stress Symptoms for Adults, were instructed to collect three saliva samples for cortisol analysis, and were examined for evaluation for periodontitis. Based on logistic regression, cortisol levels were positively associated with the following outcomes: means of clinical attachment level (CAL) > = 4 mm [OR = 5.1, 95%CI (1.2, 20.7)]; 30% of sites with CAL > = 5 mm [OR = 6.9, 95%CI (1.7, 27.1)]; and 26% of sites with probing depth > = 4 mm [OR = 10.7, 95%CI (1.9, 54.1)] after adjustment for confounding variables. The results suggest that cortisol levels were positively associated with the extent and severity of periodontitis.

Does Psychological Stress Mediate Social Deprivation in Tooth Loss?

It is unclear which theoretical dimension of psychological stress affects health status. We hypothesized that both distress and coping mediate the relationship between socio-economic position and tooth loss. Cross-sectional data from 2915 middle-aged adults evaluated retention of < 20 teeth, behaviors, psychological stress, and sociodemographic characteristics. Principal components analysis of the Perceived Stress Scale (PSS) extracted ’distress’ (a = 0.85) and ’coping’ (a =0.83) factors, consistent with theory. Hierarchical entry of explanatory variables into age- and sex-adjusted logistic regression models estimated odds ratios (OR) and 95% confidence intervals [95% CI] for retention of < 20 teeth. Analysis of the separate contributions of distress and coping revealed a significant main effect of coping (OR = 0.7 [95% CI = 0.7–0.8]), but no effect for distress (OR = 1.0 [95% CI = 0.9–1.1]) or for the interaction of coping and distress. Behavior and psychological stress only modestly attenuated socio-economic inequality in retention of < 20 teeth, providing evidence to support a mediating role of coping.

Prefrontal Cortex Activity Is Associated with Biobehavioral Components of the Stress Response

Contemporary theory suggests that prefrontal cortex (PFC) function is associated with individual variability in the psychobiology of the stress response. Advancing our understanding of this complex biobehavioral pathway has potential to provide insight into processes that determine individual differences in stress susceptibility. The present study used functional magnetic resonance imaging to examine brain activity during a variation of the Montreal Imaging Stress Task (MIST) in 53 young adults. Salivary cortisol was assessed as an index of the stress response, trait anxiety was assessed as an index of an individual’s disposition toward negative affectivity, and self-reported stress was assessed as an index of an individual’s subjective psychological experience. Heart rate and skin conductance responses were also assessed as additional measures of physiological reactivity. Dorsomedial PFC, dorsolateral PFC, and inferior parietal lobule demonstrated differential activity during the MIST. Further, differences in salivary cortisol reactivity to the MIST were associated with ventromedial PFC and posterior cingulate activity, while trait anxiety and self-reported stress were associated with dorsomedial and ventromedial PFC activity, respectively. These findings underscore that PFC activity regulates behavioral and psychobiological components of the stress response.

Chronic Smoking, Trait Anxiety, and the Physiological Response to Stress

BACKGROUND AND OBJECTIVES

Both chronic smoking and trait anxiety have been associated with dysregulations in psychobiological stress response systems. However, these factors have not been studied in conjunction. We expected trait anxiety and smoking status to attenuate stress reactivity. Furthermore, we expected an allostatic load effect resulting in particularly attenuated stress reactivity in high-anxious smokers. In addition, high-anxious smokers were expected to exhibit increased urges to smoke in response to stress.

METHODS

115 smokers and 37 nonsmokers, aged 18-64 years, completed a laboratory session including mental stressors such as evaluated public speaking and mental arithmetic. Trait anxiety was assessed using Spielberger's State-Trait Anxiety Inventory. Cardiovascular autonomic indices, salivary cortisol, and the desire to smoke were measured at baseline, during stressors, and at recovery.

RESULTS

Regression analyses showed that smokers exhibited attenuated cardiovascular stress responses in comparison to nonsmokers. Higher trait anxiety predicted attenuated systolic blood pressure responses to stress. No interaction effect of smoking status and trait anxiety was found in stress response measures. Higher trait anxiety predicted an increased desire to smoke in response to stress among smokers.

CONCLUSION

Results indicate that both smoking status and trait anxiety are associated with blunted sympatho-adrenal cardiovascular stress reactivity. Elevated urges to smoke in response to stress found among smokers with high trait anxiety suggest an important role of anxiety in smoking propensity and relapse.

Daily family stress and HPA axis functioning during adolescence: The moderating role of sleep

The present study examined the moderating role of sleep in the association between family demands and conflict and hypothalamic-pituitary-adrenal (HPA) axis functioning in a sample of ethnically diverse adolescents (n=316). Adolescents completed daily diary reports of family demands and conflict for 15 days, and wore actigraph watches during the first 8 nights to assess sleep. Participants also provided five saliva samples for 3 consecutive days to assess diurnal cortisol rhythms. Regression analyses indicated that sleep latency and efficiency moderated the link between family demands and the cortisol awakening response. Specifically, family demands were related to a smaller cortisol awakening response only among adolescents with longer sleep latency and lower sleep efficiency. These results suggest that certain aspects of HPA axis functioning may be sensitive to family demands primarily in the context of longer sleep latency and lower sleep efficiency.

Subjective Stress and Coping Resources Interact to Predict Blood Pressure Reactivity in Black College Students

This study examined the effects of subjective stress and coping resources on blood pressure reactivity. Sixty-nine Black college students (mean age = 23.58 years) completed the Life Experiences and Stress Scale to explore the subjective stressfulness associated with life events, the Coping Orientations to Problems Experienced Scale to measure usual ways of coping, and a standardized serial addition laboratory challenge during which blood pressure was assessed. Multiple regression analyses revealed that the interactive effects of subjective stress and coping resources predicted diastolic blood pressure reactivity (both p < .025) but not systolic blood pressure reactivity (both p > .10). These significant interaction effects indicated that higher levels of problem-focused coping were related to more marked diastolic blood pressure changes under conditions of high subjective stress and that emotion-focused coping was associated with less exaggerated diastolic blood pressure changes under conditions of low subjective stress. These findings highlight the potential contribution of psychosocial factors to blood pressure reactivity in Blacks.

The Effects of Mind Subtraction Meditation on Depression, Social Anxiety, Aggression, and Salivary Cortisol Levels of Elementary School Children in South Korea

This study analyzed the effects of a school-based mind subtraction meditation program on depression, social anxiety, aggression, and salivary cortisol levels of 42 elementary school children in South Korea. The research design was a nonequivalent group comparison with pretest and post-test. The experimental group was given 8weeks of the meditation program. The results showed social anxiety, aggression, and salivary cortisol levels were significantly lowered in the experimental group. This demonstrated that the school-based mind subtraction meditation program could be effective in improving psychosocial and behavioral aspects of mental health in elementary school children.

Blunted cardiac reactivity to psychological stress associated with higher trait anxiety: a study in peacekeepers

Background

Both exaggerated and diminished reactivity to stress can be maladaptive. Previous studies have shown that performing increasingly difficult tasks leads first to increased reactivity and then to a blunted response when success is impossible. Our aim was to investigate the influence of trait anxiety on cardiac and cortisol response to and recovery from a standardized psychosocial stress task (Trier Social Stress Task) in a homogeneous sample of healthy peacekeepers. We hypothesized that participants with higher trait anxiety would show blunted reactivity during the performance of an overwhelmingly difficult and stressful task. Participants (N = 50) delivered a speech and performed an arithmetic task in the presence of critical evaluators. Cortisol samples and electrocardiogram data were collected. Participants completed the State-Trait Anxiety Inventory—Trait version, the Posttraumatic Stress Disorder Checklist—Civilian Version (PCL-C) and the Military Peace Force Stressor Inventory.

Results

For heart rate, the findings showed that peacekeepers with higher trait anxiety reacted less to the speech task (p = 0.03) and to the arithmetic task (p = 0.008) than those with lower trait anxiety. Trait anxiety did not modulate cortisol responses to the task. Despite the high trait anxiety group having higher PCL-C scores than the low trait anxiety group (p < 0.0001), this did not influence the cardiac results.

Conclusions

We concluded that individuals with higher trait anxiety had less tachycardia in response to acute psychological stress than those with lower trait anxiety. The present results point to a higher risk for more anxious individuals of a maladaptive reaction to stressful events.

Integrated Genome-wide association and hypothalamus eQTL studies indicate a link between the circadian rhythm-related gene PER1 and coping behavior

Animal personality and coping styles are basic concepts for evaluating animal welfare. Struggling response of piglets in so-called backtests early in life reflects their coping strategy. Behavioral reactions of piglets in backtests have a moderate heritability, but their genetic basis largely remains unknown. Here, latency, duration and frequency of struggling attempts during one-minute backtests were repeatedly recorded of piglets at days 5, 12, 19, and 26. A genome-wide association study for backtest traits revealed 465 significant SNPs (FDR ≤ 0.05) mostly located in QTL (quantitative trait locus) regions on chromosome 3, 5, 12 and 16. In order to capture genes in these regions, 37 transcripts with significant SNPs were selected for expressionQTL analysis in the hypothalamus. Eight genes (ASGR1, CPAMD8, CTC1, FBXO39, IL19, LOC100511790, RAD51B, UBOX5) had cis- and five (RANGRF, PER1, PDZRN3, SH2D4B, LONP2) had trans-expressionQTL. In particular, for PER1, with known physiological implications for maintenance of circadian rhythms, a role in coping behavior was evidenced by confirmed association in an independent population. For CTC1 a cis-expression QTL and the consistent relationship of gene polymorphism, mRNA expression level and backtest traits promoted its link to coping style. GWAS and eQTL analyses uncovered positional and functional gene candidates for coping behavior.

A time to be stressed? Time perspectives and cortisol dynamics among healthy adults

Perceptions of past, present, and future events may be related to stress pathophysiology. We assessed whether Time Perspective (TP) is associated with cortisol dynamics among healthy adults (N=61, Ages=18-35, M=22.9, SD=4.1) exposed to the Trier Social Stress Test (TSST). TP was measured according to two profiles: maladaptive Deviation from Balanced TP (DBTP) and adaptive Deviation from Negative TP (DNTP). Eight salivary cortisol samples were analyzed using area under the curve with respect to ground (AUCg) and to increase (AUCi). Statistic analyses involved partial correlations controlling for depressive symptoms. Results for both sexes showed that higher DBTP scores were associated with lower cortisol AUCg scores, while higher DNTP scores were associated with higher cortisol AUCg scores. These novel findings suggest that maladaptive TP profiles influence hypocortisolism, whereas adaptive TP profiles influence hypercortisolism. Thus, TP profiles may impact conditions characterized by altered cortisol concentrations.

Personality traits modulate emotional and physiological responses to stress

An individual's susceptibility to psychological and physical disorders associated with chronic stress exposure, for example, cardiovascular and infectious disease, may also be predicted by their reactivity to acute stress. One factor associated with both stress resilience and health outcomes is personality. An understanding of how personality influences responses to acute stress may shed light upon individual differences in susceptibility to chronic stress-linked disease. This study examined the relationships between personality and acute responses to stress in 125 healthy adults, using hierarchical linear regression. We assessed personality traits using the Multidimensional Personality Questionnaire (MPQ-BF), and responses to acute stress (cortisol, heart rate, blood pressure, mood) using a standardized laboratory psychosocial stress task, the Trier Social Stress Test. Individuals with high Negative Emotionality exhibited greater emotional distress and lower blood pressure responses to the Trier Social Stress Test. Individuals with high agentic Positive Emotionality exhibited prolonged heart rate responses to stress, whereas those with high communal Positive Emotionality exhibited smaller cortisol and blood pressure responses. Separate personality traits differentially predicted emotional, cardiovascular, and cortisol responses to a psychosocial stressor in healthy volunteers. Future research investigating the association of personality with chronic stress-related disease may provide further clues to the relationship between acute stress reactivity and susceptibility to disease.

Examination of cortisol and state anxiety at an academic setting with and without oral presentation

Holding oral presentations in a university course is perceived as stressful and can increase stress hormone concentrations and state anxiety. In such a naturalistic setting, further attention should be paid to the relationship between psychological and hormonal measures of acute stress, as well as women's intake of hormonal contraceptives as a potential moderating variable. In the present study, 76 healthy students gave saliva samples before and after their oral presentations in a university course as well as on a second, control day in the same course without giving an oral presentation. Anticipatory state anxiety was rated on both days. Cortisol concentrations as well as state anxiety were substantially higher on the presentation relative to the control day. During the oral presentation, an increase in cortisol concentrations was observed, whereas a decrease occurred on the control day. Nearly the same picture emerged for both variables when looking at men, women taking hormonal contraceptives and free-cycling women separately. A positive correlation was found between the change in anticipatory state anxiety in the presentation compared to the control day and cortisol concentrations before and after the oral presentation. Concluding, oral presentations constitute a potent stressor and do not seem to be substantially different between men, free-cycling women and women taking hormonal contraceptives. Future studies may want to explore changes associated with specific menstrual cycle phases and with specific hormonal contraceptives.

Academic self-concept of ability and cortisol reactivity

The present study aimed to clarify the relationship between a school-specific trait (academic self-concept of ability [ASCA]) and hormonal stress response by using a trait-compatible stressor (test). First, we determined 52 students' ASCA scores for biology and measured their salivary cortisol concentration before and after a biology test (experimental group, n=28) or a free writing task (control group, n=24). For participants who took the test, statistical analysis indicated a significant negative correlation between ASCA score and cortisol response. In contrast, the control group showed a decrease in cortisol concentrations between test times and no correlation between cortisol concentration and ASCA scores were found. These findings indicated an interaction between ASCA scores and hormonal stress response when an academic-related stressor is present. Furthermore, these variables might influence each other adversely: high cortisol concentrations during a test situation may lead to greater feelings of insecurity, resulting in low ASCA scores and awareness of these low scores may lead to a further increase in cortisol, creating a vicious cycle.

The effect of communication skills training on residents' physiological arousal in a breaking bad news simulated task

OBJECTIVE

Breaking bad news (BBN) is a complex task which involves dealing cognitively with different relevant dimensions and a challenging task which involves dealing with intense emotional contents. No study however has yet assessed in a randomized controlled trial design the effect of a communication skills training on residents' physiological arousal during a BBN task.

METHODS

Residents' physiological arousal was measured, in a randomized controlled trial design, by heart rate and salivary cortisol before, during and after a BBN simulated task.

RESULTS

Ninety-eight residents were included. MANOVA showed significant group-by-time effects. Trained residents' mean heart rate levels remained elevated after training and cortisol areas under the curve increased after training compared to untrained residents.

CONCLUSION

Communication skills training has an effect on residents' physiological arousal. Residents' self-efficacy and communication skills improvements in a BBN simulated task are associated with an elevated physiological arousal, which becomes proportional to the complexity of the task and reflects a better engagement and performance.

PRACTICE IMPLICATIONS

Residents should be informed that, to perform a task, they need to engage in the task with a physiological arousal proportional to the complexity of this task. Communication skills training should be adapted.

The negative impact of single prolonged stress (SPS) on bone development in mice

Posttraumatic stress disorder (PTSD) disrupts hypothalamic-pituitary-adrenal (HPA) axis function. Given the established role of HPA axis hormones in regulating bone metabolism, we tested the hypothesis that traumatic stress has a negative impact on bone development. We employed a variant single prolonged stress (SPS) model in which several stressors were applied to three week old C57BL/6J mice. Compared to the controls, the stressed mice showed increased freezing behavior reminiscent of PTSD symptoms. At two weeks, bone mineral content (BMC), bone area (B area) and bone mineral density (BMD) in total body based on dual-energy X-ray absorptiometry (DXA) analysis were reduced by 10.2%, 7.0% and 3.6%, respectively. Micro-CT analysis of the metaphyseal region of the excised tibia revealed that SPS caused a deterioration of trabecular architecture with trabecular number (Tb.N), BV/TV, connectivity density (Conn-Den) decreasing 12.0%, 18.9%, 23.3% and trabecular spacing (Tb.Sp), structure model index (SMI) increasing 13.9%, 21.8%, respectively. Mechanical loading increased the cross-sectional area in the mid-shaft region of the loaded right versus unloaded left tibia by 7.6% in the controls, and 10.0% in the stressed mice. Therefore, SPS applied to pre-pubertal young mice produced strong negative impact on both bone mass acquisition and trabecular architecture. Mechanical loading can be employed to increase bone size, a parameter related to bone strength, in normal as well as stressed conditions.

Status of oral ulcerative mucositis and biomarkers to monitor posttraumatic stress disorder effects in breast cancer patients

BACKGROUND

This study was designed to assess oral ulcerative mucositis, C-reactive protein, blood pressure, heart rate and thyroid function in breast cancer patients in relation to the occurrence of posttraumatic stress disorder 
(PTSD).

METHODS

A total of 120 female breast cancer patients and women 100 healthy subjects were enrolled in this study. PTSD status was assessed by questionnaire. Before and after treatment (modified radical mastectomy and chemotherapy), serum samples were collected and measured for levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) and high-sensitivity C-reactive protein (hs-CRP) by ELISA. Oral ulcerative mucositis was evaluated by the number and duration of oral ulcers and the degree of pain.

RESULTS

Breast cancer patients experienced long-term PTSD and had elevated serum T3 and T4 levels. Patients experienced more severe pain and longer duration of oral ulcers compared with the healthy group. Oral ulcers were significantly associated with PTSD score in terms of the number of ulcers (p=0.0025), the degree of pain (p<0.0001) and the duration of ulcers (p<0.0001).

CONCLUSION

These findings support that thyroid function is altered in breast cancer patients with PTSD. Elevation of T3 and T4 and oral ulcerative mucositis might be indicative of the emotional status of breast cancer patients.

Lifestyle, stress and cortisol response: Review I : Mental stress

The incidences of diseases related to mental stress are increasing in Japan. Mental stress, unacknowledged for long periods, has been shown to lead to the development of a number of diseases. Thus, an index for mental stress is important to induce awareness of its presence. We focused on the relationship between cortisol and mental stress in this review. We will discuss both the usefulness and problems of cortisol as a mental stress index by summarizing the relationship between cortisol and mental stress. The present findings suggested that cortisol appears to be an adequate index for mental stress. However, there are several problems; the present group clarifies these problems and builds the comprehensive mental stress assessment systems by using saliva samples.

Salivary cortisol in ambulatory assessment--some dos, some don'ts, and some open questions

The impact of stress on health and disease is an important research topic in psychosomatic medicine. Because research on hypothalamic-pituitary-adrenal (HPA) axis regulation under controlled laboratory studies lacks ecological validity, it needs to be complemented by a research program that includes momentary ambulatory assessment. The measurement of salivary cortisol offers the possibility to trace the free steroid hormone concentrations in ambulant settings. Therefore, in this article, we first discuss the role of salivary cortisol in ambulatory monitoring. We start with a brief description of HPA axis regulation, and we then consider cortisol assessments in other organic materials, followed by a presentation of common salivary markers of HPA axis regulation suitable for ambulatory assessment. We further provide an overview on assessment designs and sources of variability within and between subjects (intervening variables), acknowledge the issue of (non)compliance, and address statistical aspects. We further give an overview of associations with psychosocial and health-related variables relevant for ambulatory assessment. Finally, we deal with preanalytical aspects of laboratory salivary cortisol analysis. The relative simplicity of salivary cortisol assessment protocols may lead to an overoptimistic view of the robustness of this method. We thus discuss several important issues related to the collection and storage of saliva samples and present empirical data on the stability of salivary cortisol measurements over time.

Programming of offspring sex ratios by maternal stress in humans: assessment of physiological mechanisms using a comparative approach

Sex ratio adjustment has become a hot topic in ecology and evolutionary biology, as documentations of sex ratio skews are numerous, and include examples in diverse animal species. Over the past several decades, scientists have repeatedly debated whether human sex ratios also significantly deviate toward one sex or the other based on environmental or social conditions. An increasing number of studies supports the idea that exposure to stressful conditions can influence the sexes of offspring produced by humans, a majority of which document significantly fewer males after exposure to adverse conditions such as severe life events, economic disruption, or natural disasters. From a comparative standpoint, these findings are similar to studies in non-human mammals and other vertebrate species showing a bias toward females during times of stress. However, the mechanisms by which stress-related biases in the offspring sex ratio may occur remain elusive, and the involvement of glucocorticoids indicating a true influence of stress itself remains unstudied. Here, I review the evidence that stressful events induce sex ratio adjustment in humans. Additionally, I discuss the possibility for glucocorticoid mediation of sex ratio adjustment and the potential reproductive stages during which stress-induced sex ratio adjustment may occur in humans and other mammals.

Experimental stress in inflammatory rheumatic diseases: a review of psychophysiological stress responses

Introduction

Stressful events are thought to contribute to the aetiology, maintenance and exacerbation of rheumatic diseases. Given the growing interest in acute stress responses and disease, this review investigates the impact of real-life experimental psychosocial, cognitive, exercise and sensory stressors on autonomic, neuroendocrine and immune function in patients with inflammatory rheumatic diseases.

Methods

Databases Medline, PsychINFO, Embase, Cinahl and Pubmed were screened for studies (1985 to 2009) investigating physiological stress responses in inflammatory rheumatic diseases. Eighteen articles met the inclusion criteria.

Results

Results suggest that immune function may be altered in response to a stressor; such alterations could contribute to the maintenance or exacerbation of inflammatory rheumatic diseases during stressful events in daily life.

Conclusions

This review emphasizes the need for more experimental research in rheumatic populations with controlled stress paradigms that include a follow-up with multiple evaluation points, simultaneous assessment of different physiological stress systems, and studying factors contributing to specific physiological responses, such as stress appraisal.

Hormonal changes and couple bonding in consensual sadomasochistic activity

In two studies, 58 sadomasochistic (SM) practitioners provided physiological measures of salivary cortisol and testosterone (hormones associated with stress and dominance, respectively) and psychological measures of relationship closeness before and after participating in SM activities. Observed activities included bondage, sensory deprivation, a variety of painful and pleasurable stimulation, verbal and non-verbal communication, and expressions of caring and affection. During the scenes, cortisol rose significantly for participants who were bound, receiving stimulation, and following orders, but not for participants who were providing stimulation, orders, or structure. Female participants who were bound, receiving stimulation, and following orders also showed increases in testosterone during the scenes. Thereafter, participants who reported that their SM activities went well showed reductions in physiological stress (cortisol) and increases in relationship closeness. Among participants who reported that their SM activities went poorly, some showed decreases in relationship closeness whereas others showed increases. The increases in relationship closeness combined with the displays of caring and affection observed as part of the SM activities offer support for the modern view that SM, when performed consensually, has the potential to increase intimacy between participants.

Psychological coping styles and cortisol over the day in healthy older adults

Patterns of psychological coping are associated with a variety of health outcomes but the underlying pathways are not yet established. The purpose of this study was to assess the relationship between salivary cortisol output over the course of a day and coping style. Data were available from 350 men and 192 women with an average age of 60.9 years. Participants were drawn from the Whitehall II cohort, and had no history of cardiovascular disease. Individuals who were taking medication that might affect cortisol levels were also excluded. Saliva samples were provided on waking, then 0.5, 2.5, 8 and 12h after waking, and just before the participant went to sleep. Coping style was measured with a standard instrument, the COPE, and data were factor analysed to generate three factors: seeking social support, problem engagement and problem avoidance. The relationships between these factors and the cortisol awakening response (CAR), the slope of cortisol change over the day and total cortisol output over the day (excluding the waking period) were assessed using multiple linear regression. Cortisol output over the day was inversely associated with coping with stress by seeking social support (p=0.034) and by problem engagement (p=0.003), independently of age, gender, body mass index, smoking, depression, self-rated health, time of waking and income. Individuals who coped by problem engagement and seeking support had lower cortisol levels. Additionally, gender, BMI, smoking, self-rated health and time of waking were independently related to cortisol output over the day. There were no significant associations between coping and the CAR or cortisol slope over the day. The results indicate that adaptive coping styles are related to low levels of cortisol over the day, suggesting that neuroendocrine pathways may partly mediate relationships between psychological coping and health.

Evaluation of the NITV CVSA

The purpose of this study was to evaluate a commonly used voice stress analyzer, the National Institute of Truth Verification's (NITV) Computer Voice Stress Analyzer (CVSA), using a speech database containing materials recorded (i) in the laboratory, while highly controlled deceptive and shock-induced stress levels were systematically varied, and (ii) during a field procedure. Subjects were 24 each males/females (age range 18-63 years) drawn from a representative population. All held strong views on an issue and were required to make sharply derogatory statements about it. The CVSA system was then evaluated in a double-blind study using three sets of examiners: (i) two UF scientists trained/certified by NITV in CVSA operation, (ii) three experienced NITV operators provided by the manufacturer and (iii) five experimental phoneticians. The results showed that the "true positive" (or hit) rates for all examiners ranged from chance to somewhat higher levels (c. 50-65%) for all conditions and types of materials (e.g., stress vs. unstressed, truth vs. deception). However, the false-positive rate was just as high - often higher. Sensitivity statistics demonstrated that the CVSA system operated at about chance level.

Neuroendocrine stress responses to an oral academic examination: No strong influence of sex, repeated participation and personality traits

Public speaking tasks have been widely used as laboratory stressors in human research. Fewer studies have investigated similar real life situations like oral examinations and results have been inconsistent. The present study investigated salivary cortisol (as a marker of hypothalamus-pituitary-adrenal (HPA) activity) and salivary alpha-amylase (sAA as a marker of sympathetic nervous system (SNS) activity) within the context of a university examination. Subjects were 40 undergraduate students who participated in an oral examination. Of these, 20 also participated in a second examination within a few weeks. Cortisol and sAA were measured immediately before and after the examination and on a control day. Additionally, subjects filled out personality questionnaires. A strong anticipatory increase in salivary cortisol and sAA as well as more modest further increases between the pre- and post-measurements were detected during the examination. Sex or oral contraceptive use had no influence on either measure. In addition, no significant differences between the first and second examination were observed. The findings indicate the neuroendocrine stress responses to laboratory stressors and to heralded real life stressors as well as the modulatory variables involved differ from each other.

Association of Salivary Levels of Cortisol and Dehydroepiandrosterone With Periodontitis in Older Japanese Adults

BACKGROUND

The relationship between periodontitis and psychoneuroimmunologic variables, such as stress-related hormones, is poorly understood. The purpose of this cross-sectional study was to investigate the associations between two kinds of stress-related hormones, cortisol and dehydroepiandrosterone (DHEA), and periodontitis in healthy community-dwelling elderly subjects aged > or =60 years.

METHODS

A total of 171 subjects (85 males and 86 females) participated in this study. The subjects were independently living elderly people with a mean age of 68.4 (+/- 4.46) years. Stimulated whole saliva samples were collected, and hormone levels were determined. A medical questionnaire regarding medical conditions, lifestyle, and psychosocial stress also was administered. The clinical examinations included probing depth (PD), bleeding on probing, and clinical attachment level (CAL).

RESULTS

There was a positive correlation between hormone levels and PD and CAL values. When the subjects were divided into two groups based on periodontitis severity, hormone levels were significantly higher in subjects with severe PD or CAL. Multiple regression analysis showed that higher cortisol and DHEA levels were associated significantly with greater numbers of teeth with severe PD or CAL, after adjusting for confounding variables.

CONCLUSIONS

These results suggested close relationships between the extent and severity of periodontitis and salivary levels of cortisol and DHEA in healthy elderly subjects. To the best of our knowledge, this is the first report on the association between the levels of DHEA and extensive periodontitis.

Evolutionary background for stress-coping styles: relationships between physiological, behavioral, and cognitive traits in non-mammalian vertebrates

Reactions to stress vary between individuals, and physiological and behavioral responses tend to be associated in distinct suites of correlated traits, often termed stress-coping styles. In mammals, individuals exhibiting divergent stress-coping styles also appear to exhibit intrinsic differences in cognitive processing. A connection between physiology, behavior, and cognition was also recently demonstrated in strains of rainbow trout (Oncorhynchus mykiss) selected for consistently high or low cortisol responses to stress. The low-responsive (LR) strain display longer retention of a conditioned response, and tend to show proactive behaviors such as enhanced aggression, social dominance, and rapid resumption of feed intake after stress. Differences in brain monoamine neurochemistry have also been reported in these lines. In comparative studies, experiments with the lizard Anolis carolinensis reveal connections between monoaminergic activity in limbic structures, proactive behavior in novel environments, and the establishment of social status via agonistic behavior. Together these observations suggest that within-species diversity of physiological, behavioral and cognitive correlates of stress responsiveness is maintained by natural selection throughout the vertebrate sub-phylum.

Diurnal cycle of salivary cortisol in older adult men and women with subjective complaints of memory deficits and/or depressive symptoms: relation to cognitive functioning

In populations of young and older adults, it has been shown that individuals may be categorized into one of three diurnal subgroups when salivary cortisol levels are assessed over a 2-day period and compared for their consistency across days: a typical subgroup, a flat subgroup, and an inconsistent subgroup. Interestingly, recent studies have reported that the typical subgroup represents the majority of the young and older adult population, a finding that is difficult to reconcile with previous studies showing increased cortisol levels in older adults with depression or cognitive impairments. In order to assess whether a typical diurnal cortisol profile is representative across different subgroups of older adults, we assessed diurnal cortisol cycle representation in a sample of older adults with subjective complaints of depression and/or memory problems. Furthermore, given the robust relationship between cortisol and cognitive function, the present study examined the association between the three diurnal subgroups and cognitive performance. Forty-two older individuals were recruited on the basis of reporting subjective complaints of either memory problems and/or depressive mood. Participants were asked to sample their saliva over a 2-day period and were then asked to undergo a neuropsychological evaluation that taps into short-term memory, declarative memory and language. The results showed that 69% of the sample presented a Flat cycle of salivary cortisol over a 2-day period while 19% presented an inconsistent pattern and 12% presented a typical pattern. Participants in the flat subgroup were significantly impaired on letter verbal fluency. Furthermore, a relationship was found between diurnal cortisol subgroup representation and subjective complaint profile. These findings show that older adults with complaints of memory problems and/or depressive symptoms do not present the typical profile of the diurnal cortisol cycle, and they provide a preliminary view of how diurnal cortisol profile relates to cognitive function during human aging.

Effect of coping on endocrinoimmune functions in different stress situations

The objective of this study was to examine the effects of coping strategies on the endocrine and immune functions in different stress situations. Thirty-eight medical students were enrolled in this study. Cell-mediated immune function was measured using the lymphocyte proliferative response to phytohemagglutinin (PHA) and interleukin-2 (IL-2) production during the nonexamination period and during the preexamination period. Endocrine functions were assessed by measuring the plasma levels of norepinephrine, adrenocorticotropic hormone (ACTH) and cortisol. The Global Assessment of Recent Stress (GARS) scale, the Stress Response Inventory, the anxiety, depression, and somatization subscales of the Symptom Checklist-90-revised, the Way of Coping-revised, the Toronto Alexithymia Scale and the Anger Expression Scale were used as psychometric measures. The subjects with higher levels of total GARS scores showed significantly higher IL-2 production during the nonexam period than those with lower levels of total GARS scores. During the same period, IL-2 production in the less positive reappraisal group was significantly higher than in the more positive reappraisal group. Lymphocyte proliferation in the group seeking less social support was also significantly higher than in the group seeking more social support. However, no significant association was found between the coping strategies and each of the hormone levels. These results suggest that positive reappraisal and seeking social support can be associated with the alteration of immune function during a chronic stress period. In particular, positive reappraisal is likely to reverse the stress-induced immune responses. This study did not find that neuroendocrine function such as the sympathetic-adrenal medullary axis or the hypothalamic-pituitary-adrenal axis is playing a mediating role in the relationship between coping and immunity.

Prenatal stress, the hypothalamic-pituitary-adrenal axis, and fetal and infant neurobehaviour

BACKGROUND

Although it has long been acknowledged that chronic HPA axis dysregulation impacts on adult neural function, little attention has been paid to the impact that disturbances of the maternal HPA axis may have on the developing fetal brain.

AIM

This editorial examines the associations between prenatal stress, neuroendocrine functioning, and behavioural outcome in both animal and human offspring, with a particular focus on the relationship between prenatal stress and human fetal and infant neurobehaviour.

STUDY DESIGN

Using electronic databases, a computerized search of published and unpublished data was undertaken.

RESULTS

There is growing evidence that prenatal stress impacts on offspring neural function and behaviour in animal populations. That these findings may be applicable to human fetal neurobehaviour and infant development and outcome is gaining research attention, and the potential importance of the timing of pregnancy stress is being increasingly highlighted.

CONCLUSIONS

There is a pressing need for more research into the role of maternal stress and anxiety during pregnancy on human fetal and infant outcomes. Future studies should prospectively pair physiological and psychological measures both pre- and postnatally if the HPA axis function of the mother and her infant is to be more fully understood.

Brief exposure to predator odor and resultant anxiety enhances mesocorticolimbic activity and enkephalin expression in CD-1 mice

The present study assessed alterations in mesolimbic enkephalin (ENK) mRNA levels after predator [2,5-dihydro-2,4,5-trimethylethiazoline (TMT)] and non-predator (butyric acid) odor encounter and/or light-dark (LD) testing in CD-1 mice immediately, 24, 48 and 168 h after the initial odor encounter and/or LD testing. The nucleus accumbens, ventral tegmental area, basolateral (BLA), central (CEA) and medial amygdaloid nuclei, prelimbic and infralimbic cortex were assessed for fos-related antigen (FRA) and/or ENK mRNA as well as neuronal activation of ENK neurons (FRA/ENK). Mice exposed to TMT displayed enhanced freezing and spent less time in the light of the immediate LD test relative to saline- or butyric acid-treated mice. Among mice exposed to TMT, LD anxiety-like behavior was associated with increased FRA in the prelimbic cortex and accumbal shell and decreased ENK-positive neurons in the accumbal core. Mice displaying high TMT-induced LD anxiety exhibited increased ENK-positive neurons in the BLA, CEA and medial amygdaloid nuclei relative to mice that displayed low anxiety-like behavior in the LD test after TMT exposure. In the BLA and CEA, 'high-anxiety' mice also displayed increased FRA/ENK after TMT exposure and LD testing. In contrast to neural cell counts, the level of ENK transcript was decreased in the BLA and CEA of 'high-anxiety' mice after TMT exposure and LD testing. These data suggest that increased FRA may regulate stressor-responsive genes and mediate long-term behavioral changes. Indeed, increased ENK availability in mesolimbic sites may promote behavioral responses that detract from the aversiveness of the stressor experience.

Neuroticism, cortisol reactivity, and antibody response to vaccination

This study examined whether neuroticism was related to the antibody response to influenza vaccination and whether the relationship was mediated by cortisol reactions to acute laboratory mental stress. Antibody status was assessed at baseline and to a trivalent influenza vaccination in 57 students at 5-week and 5-month follow-up. Neuroticism was also measured at baseline. Cortisol was measured at rest and in response to a pressurized mental arithmetic task. At both follow-ups, higher neuroticism scores were associated with poorer A/Panama antibody response, following adjustment for baseline antibody titer. Higher neuroticism scores were also associated with blunted cortisol reactivity, and blunted cortisol reactivity was associated with poorer A/Panama antibody response, but only at 5 months. However, there was no conclusive evidence that cortisol reactivity mediated the association between neuroticism and antibody response.

High trait anxiety in healthy subjects is associated with low neuroendocrine activity during psychosocial stress

Altered stress responsiveness has been repeatedly related to mood and anxiety disorders. In a traditional view, a reduction of the stress response has been thought favorable. The goal of the present study was to verify the hypothesis that high anxiety is accompanied by enhanced hormone release during stress. Healthy subjects at the upper (anxious, n = 15) and lower (non-anxious, n = 12) limits of the normal range of a trait anxiety scale (State trait anxiety inventory) were exposed to psychosocial stress procedure based on public speech. Hormone levels, cardiovascular activation and skin conductance were measured. Exposure to psychosocial stress was associated with significant increases of all parameters measured. During the stress procedure, subjects with high trait anxiety exhibited lower levels of hormones of the hypothalamo-pituitary-adrenocortical axis, namely ACTH and cortisol in plasma, as well as cortisol in saliva. Similarly, the stress-induced activation of epinephrine, norepinephrine and prolactin secretion was significantly lower in anxious subjects in comparison with that in non-anxious subjects. Thus, in contrast to the traditional view, high anxiousness was not associated with exaggerated stress response. Our findings suggest that high trait anxiety may be associated with an inability to respond with adequate hormone release to acute stress stimuli.