Gender and stress: differential psychophysiological reactivity to stress reexposure in the laboratory

Perceptions of publication pressure among Hungarian researchers: Differences across career stage, gender, and scientific field

Excessive publication pressure has been associated with detrimental aspects for individual researchers and scientific integrity but has not been well-studied in Eastern European countries. The aim of this study is to assess perceived publication pressure and its relationship with career stage, scientific field, and gender in Hungary. The survey included demographic questions, such as gender, age, scientific field, career stage, and the Revised Publication Pressure Questionnaire (PPQr). A total of 408 respondents completed the survey, 46% were female, and 54% were male. 45% are PhD students, 17% are postdocs or assistant professors, and 38% are associate or full professors. 31% are from the Biomedical Sciences, 39% from Natural Sciences, 18% from Social Sciences, and 12% from Humanities. Our results showed no significant disciplinary differences in perceived publication pressure. PhD students perceived a greater lack of resources than postdocs and professors. The same applied to postdocs and assistant professors when compared to associate professors. The findings also showed that female researchers perceive greater stress than male researchers. Our study highlights the need to improve mentoring during the development of early-career researchers. It also emphasizes the importance of organizational structures developing policies or strategies to address gender differences in academia.

Psychological Stress as a Determinant of Increased Maximum Voluntary Bite Force - A Clinical Observational Study

Background Psychological stress is a known risk factor and modulator for several oral diseases. It is among the critical etiological factors of bruxism and several other disorders. The quantum of bite force is one of the prime determinants of wear resistance and the clinical performance of restorations. Thus, the present study aims to investigate the relationship between the maximum voluntary bite force (MVBF) and the amount of perceived stress experienced by an individual.  Materials and methods Patients (n=111) fulfilling the exclusion and inclusion criteria were divided into high, medium, and low-stress groups based on their stress scores deduced from the Perceived Stress Scale questionnaire (PSS). Bite force measurement was recorded in Newtons (N) for each subject using a portable customized bite recording FlexiForce sensor (B 201). The data were analyzed using Kruskal-Wallis and independent samples t-test. Results  Among the females, the bite force in the medium and high-stress groups was greater compared to the low-stress level group. On the other hand, there was no difference in bite force between any of the stress level groups among male participants.  Conclusion The results show that higher MVBF is associated with higher perceived stress scores in adult females. Practical Implications Psychological counseling can be included in the dental treatment plan of individuals with a high-stress score to counteract their stress-related higher occlusal forces, parafunctional jaw movements, and risky oral health behaviors, thereby potentially reducing the incidence of adverse outcomes such as temporomandibular joint dysfunction and restoration failure by careful choice of restorative materials.

Gender Differences in the Motivational Process of the Job Demands-Resources Model

Background

Achieving gender equality is an important goal in Japan. Consequently, this study aimed to examine gender differences in a series of associations between job demands or resources and job performance mediated by work engagement (WE) in the motivational process of the job demands-resources model.

Methods

This study recruited 671 non-manual workers (260 men and 411 women) through an online survey. The measured variables were demographic information, job demands or resources, WE, and job performance. Multiple-group structural equation modeling was used to analyze the data.

Results

Regarding the level of job demands or resources and WE, no significant difference was observed between men and women. Whereas, job performance was significantly higher in women than in men. Additionally, multiple-group structural equation modeling indicated that the model that imposed on all path coefficients for equality constraints had a better fit, and consequently, no gender differences.

Conclusion

Although the motivational process indicated no gender differences, job performance was higher in women than in men due to the management of a gender-equal and friendly work environment. Further comprehensive examinations, that use other variables not included in the present study, are required to understand women's high job performance.

Machine learning in biosignals processing for mental health: A narrative review

Machine Learning (ML) offers unique and powerful tools for mental health practitioners to improve evidence-based psychological interventions and diagnoses. Indeed, by detecting and analyzing different biosignals, it is possible to differentiate between typical and atypical functioning and to achieve a high level of personalization across all phases of mental health care. This narrative review is aimed at presenting a comprehensive overview of how ML algorithms can be used to infer the psychological states from biosignals. After that, key examples of how they can be used in mental health clinical activity and research are illustrated. A description of the biosignals typically used to infer cognitive and emotional correlates (e.g., EEG and ECG), will be provided, alongside their application in Diagnostic Precision Medicine, Affective Computing, and brain-computer Interfaces. The contents will then focus on challenges and research questions related to ML applied to mental health and biosignals analysis, pointing out the advantages and possible drawbacks connected to the widespread application of AI in the medical/mental health fields. The integration of mental health research and ML data science will facilitate the transition to personalized and effective medicine, and, to do so, it is important that researchers from psychological/ medical disciplines/health care professionals and data scientists all share a common background and vision of the current research.

Perceived Stress in Relation to Demographics and Clinical Forms among Patients with Infective Endocarditis: A Cross-Sectional Study

(1) Background: Infective endocarditis (IE) is a disease of the endocardial surface of the heart, caused by infection of the native or prosthetic valve or an indwelling cardiac device. Apart from IE predisposing risk factors that include heart conditions and medical procedures, the novel trajectories from demographic factors to perceived stress conditions have been under investigation in recent years. The aim of the present study was to evaluate the associations between perceived stress and demographic characteristics as well as clinical forms of IE among survivors of IE in Kaunas, Lithuania. (2) Methods: A cross-sectional study among IE cases (n = 135) at the Lithuanian University of Health Sciences Kaunas Clinics Cardiology department during the period 2014-2017 was performed. Data about IE clinical features, sociodemographic characteristics and perceived stress level (Perceived Stress Scale (PSS-10)) upon diagnosis were collected. Package "SPSS 25.0" was used in the statistical analysis. Logistic regression analysis was performed including gender, previous occupation, place of residence and clinical forms of IE in the analysis of perceived stress among survivors of IE. The STROBE checklist for cross-sectional studies was used in this study. (3) Results: Perceived stress was experienced by 54.8 percent of the respondents. In the final model, the OR (odds ratio) of perceived stress for females was 2.07 as compared to men; for rural residents, the OR was 2.25 as compared to urban residents. These results were statistically significant. A tendency for increased OR of perceived stress for low-skilled workers as compared to high-skilled ones and classical IE clinical form as compared to non-classical form was observed, but these results were not statistically significant. (4) Conclusions: The present study is an attempt to focus the attention of IE researchers on the effects of psychological state in the disease development. Differences in perceived stress and some demographic characteristics, as well as tendencies of IE clinical forms, were observed among survivors of IE in Kaunas, Lithuania.

Temporal Trends in the Incidence and Disability Adjusted Life Years of Schizophrenia in China Over 30 Years

BACKGROUND

Schizophrenia is an important public health problem in China. This study aims to assess the long-term trends in the incidence and disability-adjusted life years (DALYs) rate of schizophrenia in China between 1990 and 2019.

METHODS

The incidence and DALYs data were drawn from the Global Burden of Disease Study 2019, and an age-period-cohort model was used in the analysis.

RESULTS

The age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) of schizophrenia increased by 0.3 and 3.7% for both sexes between 1990 and 2019. For males, the local drift for incidence was higher than 0 (P < 0.05) in those aged 10 to 29 years (local drifts, 0.01 to 0.26%) and lower than 0 (P < 0.05) in those aged 35 to 74 years (local drifts, -1.01 to -0.06%). For females, the local drift was higher than 0 (P < 0.05) in those aged 10 to 34 years (local drifts, 0.05 to 0.26%) and lower than 0 (P < 0.05) in those aged 40 to 74 years (local drifts, -0.86 to -0.11%). The local drift for DALYs rate was higher than 0 (P < 0.05) in the age group from 10 to 69 years (local drifts, 0.06 to 0.26% for males and 0.06 to 0.28% for females). The estimated period and cohort relative risks (RR) for DALYs rate of schizophrenia were found in monotonic upward patterns, and the cohort RR for the incidence increased as the birth cohort moved forward starting with those born in 1972.

CONCLUSION

Although the crude incidence of schizophrenia has decreased in China, the ASIR, ASDR, and crude DALYs rate all showed a general increasing trend over the last three decades. The DALYs rate continue to increase as the birth cohort moved forward, and the increasing trend of incidence was also found in individuals born after 1972. More efforts are needed to promote mental health in China.

Gender differences in perceived stress and coping among college students

Background

Many college students register each semester for courses, leading to productive careers and fulfilled lives. During this time, the students have to manage many stressors stemming from academic, personal, and, sometimes, work lives. Students, who lack appropriate stress management skills, may find it difficult to balance these responsibilities.

Objectives

This study examined stress, coping mechanisms, and gender differences in undergraduate students towards the end of the semester.

Design and method

University students (n = 448) enrolled in three different undergraduate exercise science courses were assessed. Two instruments, the Perceived Stress Scale and Brief Cope, were administered during the twelfth week of the semester, four weeks prior to final exams. T-tests were used to detect gender differences for the stress levels and coping strategies.

Results

Overall, females indicated higher levels of stress than their male counterparts. Gender differences were evident in both coping dimensions and individual coping strategies used. Females were found to utilize the emotion-focused coping dimension and endorsed the use of four coping strategies more often than males. These included self-distraction, emotional support, instrumental support, and venting.

Conclusions

This research adds to the existing literature by illuminating the level of perceived stress and different coping strategies used by undergraduate female and male students. In turn, students may need educational interventions to develop effective and healthy coping strategies to last a lifetime. Faculty and other university officials may want to highlight and understand these various factors to protect the students’ wellbeing in their classes.

Resilience and Psychobiological Response to Stress in Older People: The Mediating Role of Coping Strategies

Resilience, the ability to overcome adversity and face stressful demands and experiences, has been strongly associated with successful aging, a low risk of diseases and high mental and physical functioning. This relationship could be based on adaptive coping behaviors, but more research is needed to gain knowledge about the strategies employed to confront social stress. Thus, we aimed to investigate the role of the use of active or passive coping strategies by resilient people in dealing with stressful situations. For this purpose, we measured resilience, coping strategies, and perceived stress in 66 healthy older adults (31 men and 35 women) between 56 and 75 years old who were exposed to stress (Trier Social Stress Test, TSST) or a control situation. The stress response was analyzed at endocrine (cortisol) and psychological (anxiety) levels. In the stress condition, moderated mediation analysis showed a conditional indirect effect of resilience on cortisol reactivity through active coping. However, passive coping strategies did not mediate the resilience-cortisol relationship. In addition, neither active nor passive coping mediated the relationship between resilience and the anxiety response. These results suggest that resilience is associated with active coping strategies, which in turn could explain, at least in part, individual differences in the cortisol response to a psychosocial laboratory stressor. These factors may prevent the development of stress-related pathologies associated with aging and facilitate healthy and satisfactory aging.

What Makes Tinnitus Loud?

INTRODUCTION

Tinnitus loudness is a subjective measure, and it does not directly reflect either tinnitus severity or the impact on daily life. Nevertheless, loud tinnitus may be the most frequent clinical complaint of tinnitus patients. Factors contributing to the loudness of the phantom sound have rarely been studied. We evaluated both matched and self-rated loudness in a large sample of patients with tinnitus and analyzed the influencing factors among demographic, hearing, and tinnitus characteristics.

METHODS

Two hundred ninety-nine patients with chronic tinnitus were enrolled. We evaluated the matched loudness, minimal masking level (MML), and visual analog scale (VAS) loudness. Stepwise multiple regression analyses were performed for each loudness measure using independent variables of age, sex, time since tinnitus onset, tinnitus laterality, pure-tone average, tinnitus pitch, tinnitus handicap inventory (THI) score, VAS annoyance, disturbance and daily tinnitus duration, and depression score. We calculated bivariate correlations between each loudness measure and all independent variables.

RESULTS

The psychoacoustic loudness measures (matched loudness and MML) were highly correlated and were affected by the hearing deficit and tinnitus pitch (Pearson r > 0.5 for pure tone averages, and r > 0.3 for tinnitus pitch for both variables, p < 0.05), whereas the subjective measurement (VAS loudness) exhibited little to no correlation with the other two measures and was related to psycho-emotional factors such as the THI score, VAS variables, and depression (Pearson r > 0.6 for VAS annoyance, r > 0.4 for VAS daily duration and disturbance and THI score, r > 0.3 for the depression score, p < 0.05).

CONCLUSION

The matched tinnitus loudness and MML values were influenced principally by the extent of hearing loss and related factors, suggesting that rehabilitation using hearing aids could help reduce perception of tinnitus loudness. A psycho-emotional approach might more effectively lessen self-perceived loudness.

Gender differences in the experienced emotional intensity of experimentally induced memories of negative scenes

It is well documented that women have an increased risk of emotional disorders, such as anxiety and depression. Such disorders are typically characterized by intrusive memories and rumination of past events, but findings are mixed as to whether women have enhanced access to memories of emotional events. Some studies have found that women, compared with men, report more frequent and more intense memories of emotionally stressful events, whereas other studies have failed to replicate this effect. These conflicting findings may reflect the use of different memory sampling techniques (e.g., retrospective vs. experimental data) and limited control for factors associated with both gender and emotional memory. The purpose of the present study was to investigate gender differences in memory for emotionally negative events, using three different sampling methods, while at the same time controlling for parameters that might co-vary with gender. Consistent with some previous studies, we found that women and men did not differ in their frequencies of emotionally negative involuntary memories. However, women rated their memories as more intense and arousing than men did, and women also reported higher increases in state anxiety after retrieval. Female gender accounted for unique variance in the emotional intensity and subjective arousal associated with negative memories, when controlling for other theoretically derived variables. The findings provide evidence that female gender is associated with a stronger emotional response to memories of negative events, but not that women remember such events more frequently than men do.

Depressive Symptoms among Industrial Workers in Vietnam and Correlated Factors: A Multi-Site Survey

Depressive disorders have been found to be a significant health issue among industrial workers, resulting from work-related factors and causing serious burdens for the workers as well as their employers. Literature on mental health problems of Vietnamese industrial workers has been limited, despite the rapid foreign investment-fueled industrialization process of the country. This study aimed to fill the gap in literature by examining the prevalence of depressive disorders and their potential associated factors among a cohort of Vietnamese industrial workers. A cross-sectional study was conducted in 3 industrial areas in Hanoi and Bac Ninh. A total of 289 workers agreed to participate in the study. Generalized linear mixed models were applied to identify associated factors with depression status of respondents. 38.6% of participants reported suffering depression. Factors found to be positively associated with the possibility of having depression and higher PHQ9 score were long working hours, suffering more health problems, and health hazards exposure at work. Meanwhile, being females, having more children, living with parents, engaging in smoking, and being local workers were found to correlate with lower likelihood of being depressed. The findings suggested the importance of regular health screening, work safety assurance, and social support outside of workplace on the mental health of the workers.

Gender Differences Affecting Psychiatric Distress and Tinnitus Severity

Objective

This study evaluated gender differences in the relationship between psychiatric distress and subjective tinnitus severity.

Methods

This cross-sectional study included 134 female and 114 male patients who visited the otology outpatient clinic at Seoul St. Mary's Hospital for tinnitus from February to July 2015. Patients completed a series of instruments, including the Tinnitus Handicap Inventory, Beck Depression Inventory, Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), and visual analogue scales assessing various tinnitus characteristics (loudness, awareness, annoyance, and effect on life).

Results

Tinnitus severity did not significantly differ between the gender groups (p=0.632), and it correlated significantly with tinnitus characteristics and psychiatric distress. Partial correlations between tinnitus severity and depressive symptoms were stronger in males (r=0.411, p＜0.01) than in females (r=0.304, p＜0.01) while controlling for duration of tinnitus and tinnitus characteristics. However, stress (BEPSI-K) was positively correlated with tinnitus severity in only males (r=0.463, p＜0.01). A multiple regression analysis revealed that effect of tinnitus on life, depressive symptoms, and stress were significantly associated with tinnitus severity in males, whereas only tinnitus annoyance and depressive symptoms were associated with tinnitus severity in females.

Conclusion

Tinnitus severity was significantly correlated with depressive symptoms and stress, and there were gender differences in the relationship between tinnitus severity and psychiatric components. It is necessary to be vigilant of psychiatric symptoms among patients with tinnitus who visit the otology outpatient clinic, especially for male patients.

Discrimination, Mental Health, and Substance Use Disorders Among Sexual Minority Populations

PURPOSE

Sexual minority (lesbian, gay, bisexual) populations have a higher prevalence of mental health and substance use disorders compared to their heterosexual counterparts. Such disparities have been attributed, in part, to minority stressors, including distal stressors such as discrimination. However, few studies have examined associations between discrimination, mental health, and substance use disorders by gender among sexual minority populations.

METHODS

We analyzed data from 577 adult men and women who self-identified as lesbian, gay, or bisexual and participated in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Six questions assessed discrimination due to sexual orientation. Weighted multivariable logistic regression examined associations between experiences of sexual orientation discrimination and both mental health and substance use disorders. Analyses were conducted separately for sexual minority men and women, adjusting for sociodemographic covariates.

RESULTS

Sexual minority men who ever experienced discrimination (57.4%) reported higher odds of any lifetime drug use disorder and cannabis use disorder compared to sexual minority men who never experienced discrimination. Sexual minority women who ever experienced discrimination (42.9%) reported higher odds of any lifetime mood disorder and any lifetime anxiety disorder compared to sexual minority women who never experienced discrimination.

CONCLUSION

The findings suggest that discrimination is differentially associated with internalizing (mental health) and externalizing (substance use) disorders for sexual minority men and women. These findings indicate a need to consider how homophobia and heteronormative discrimination may contribute to distinct health outcomes for lesbian and bisexual women compared with gay and bisexual men.

Prevalence of Depressive Symptoms and Related Factors in Korean Employees: The Third Korean Working Conditions Survey (2011)

The aim of this study was to analyze the association between general working conditions and depressive symptoms among Korean employees. The target population of the study was native employees nationwide who were at least 15 years old, and 50,032 such individuals were enrolled in the study. Depressive symptoms was assessed using the WHO-5 wellbeing index. Associations between general characteristics, job-related characteristics, work environment, and depressive symptoms were tested using chi-square tests, t-tests, and multiple logistic regression analysis. The prevalence of depressive symptoms was 39% (40.7% in males and 36.5% in females). Multiple regression analysis revealed that male subjects, older subjects, subjects with higher education status, subjects with lower monthly income, current smokers, and frequent drinkers were more likely to have depressive symptoms. In addition, longer weekly work hours, occupation type (skilled, unskilled, operative, or economic sector), shift work, working to tight deadlines, exposure to stress at work, and hazard exposure were associated with depressive symptoms. This representative study will be a guide to help manage depression among Korean employees. We expect that further research will identify additional causal relationships between general or specific working conditions and depression.

Ovarian hormones, menstrual cycle phase, and smoking: a review with recommendations for future studies

Cigarette smoking continues to be the leading cause of preventable morbidity and mortality. Similar to other addictive substances, the prevalence of cigarette smoking is greater among men than women, yet women are less successful at quitting smoking. Preclinical and clinical research suggests that ovarian hormones (i.e., estradiol and progesterone), which fluctuate over the course of the menstrual cycle, may contribute to these sex differences. Specifically, research suggests that progesterone may protect against cigarette smoking and nicotine addiction; whereas estradiol may underlie enhanced vulnerability. In this review, we discuss new research on ovarian hormone and menstrual cycle phase effects on smoking-related responses and behavior in women, including studies examining neural responses to smoking cues, hormonal influences on medication-assisted smoking cessation, and acute smoking abstinence. We highlight innovative studies with strong research methodology and provide suggestions for future research that may allow evidence-based knowledge for immediate translation to the clinic to guide novel, hormonally-informed treatment strategies. Thus, rigorous scientific study holds the potential to reduce relapse rates, thus improving the health and saving the lives of the many thousands of women who unfortunately do not respond to current treatments.

Parental disability, parent care, and offspring mental health outcomes

Decades of research supports a widely held view that providing parent care is stressful, and that these stresses are associated with adverse mental health outcomes. However, some recent studies suggest an additional possibility, namely that "noncaregiver stress"-a consequence of having a parent with major care needs, but not being an active caregiver-may be a serious problem as well. This finding emerges in data which permit separate controls for parental needs for care and offspring provision of parent care. We extend these results using Generations and Gender Programme data from five countries-Bulgaria, France, Georgia, Romania, and Russia-for which the necessary variables can be comparably measured. Our outcome variable is a depression score based on a 7-item scale. In country-specific regressions, we find two instances of statistically significant associations of depression with the regular provision of personal care to a parent with care needs, i.e., the usual "caregiver stress" result. However, we also find two instances of statistically significant differences in respondents' depressive symptoms that are associated with having a parent with care needs, i.e., instances of "noncaregiver stress." We find limited evidence of gender-specific responses to both forms of stress. Our evidence supports both the typical caregiver stress response and the less-studied noncaregiver stress response, which suggests the need for additional research.

Menstrual cycle phase effects in the gender dimorphic stress cue reactivity of smokers

INTRODUCTION

We previously reported that female smokers evidence greater subjective craving and stress/emotional reactivity to personalized stress cues than males. The present study employed the same dataset to assess whether females in the follicular versus luteal phase of the menstrual cycle accounted for the gender differences.

METHODS

Two objective criteria, onset of menses and luteinizing hormone surge (evaluated via home testing kits), were used to determine whether female smokers were in either the follicular (n = 22) or the luteal (n = 15) phase of their menstrual cycle, respectively. The females and a sample of male smokers (n = 53) were then administered a laboratory-based cue reactivity paradigm that involved assessment of craving, stress, and emotional reactivity in response to counterbalanced presentations of both a personalized stress script and neutral/relaxed script.

RESULTS

While there were no significant differences between females in the follicular versus luteal phase on any outcome measure, females in the luteal menstrual phase reported greater craving than males whereas females in the follicular phase reported greater stress and arousal than males and perceived the stress cues as more emotionally aversive than males.

CONCLUSIONS

This preliminary investigation suggests that gender differences in craving versus affective responding to stress cues may, in part, be explained variation by menstrual cycle phase. Study limitations and implications of the findings for future research and treatment are briefly discussed.

Dissociable effects of Sry and sex chromosome complement on activity, feeding and anxiety-related behaviours in mice

Whilst gonadal hormones can substantially influence sexual differentiation of the brain, recent findings have suggested that sex-linked genes may also directly influence neurodevelopment. Here we used the well-established murine ‘four core genotype’ (FCG) model on a gonadally-intact, outbred genetic background to characterise the contribution of Sry-dependent effects (i.e. those arising from the expression of the Y-linked Sry gene in the brain, or from hormonal sequelae of gonadal Sry expression) and direct effects of sex-linked genes other than Sry (‘sex chromosome complement’ effects) to sexually dimorphic mouse behavioural phenotypes. Over a 24 hour period, XX and XY gonadally female mice (lacking Sry) exhibited greater horizontal locomotor activity and reduced food consumption per unit bodyweight than XX and XY gonadally male mice (possessing Sry); in two behavioural tests (the elevated plus and zero mazes) XX and XY gonadally female mice showed evidence for increased anxiety-related behaviours relative to XX and XY gonadally male mice. Exploratory correlational analyses indicated that these Sry-dependent effects could not be simply explained by brain expression of the gene, nor by circulating testosterone levels. We also noted a sex chromosome complement effect on food (but not water) consumption whereby XY mice consumed more over a 24hr period than XX mice, and a sex chromosome complement effect in a third test of anxiety-related behaviour, the light-dark box. The present data suggest that: i) the male-specific factor Sry may influence activity and feeding behaviours in mice, and ii) dissociable feeding and anxiety-related murine phenotypes may be differentially modulated by Sry and by other sex-linked genes. Our results may have relevance for understanding the molecular underpinnings of sexually dimorphic behavioural phenotypes in healthy men and women, and in individuals with abnormal sex chromosome constitutions.

Gender differences in craving and cue reactivity to smoking and negative affect/stress cues

There is evidence that women may be less successful when attempting to quit smoking than men. One potential contributory cause of this gender difference is differential craving and stress reactivity to smoking- and negative affect/stress-related cues. The present human laboratory study investigated the effects of gender on reactivity to smoking and negative affect/stress cues by exposing nicotine dependent women (n = 37) and men (n = 53) smokers to two active cue types, each with an associated control cue: (1) in vivo smoking cues and in vivo neutral control cues, and (2) imagery-based negative affect/stress script and a neutral/relaxing control script. Both before and after each cue/script, participants provided subjective reports of smoking-related craving and affective reactions. Heart rate (HR) and skin conductance (SC) responses were also measured. Results indicated that participants reported greater craving and SC in response to smoking versus neutral cues and greater subjective stress in response to the negative affect/stress versus neutral/relaxing script. With respect to gender differences, women evidenced greater craving, stress and arousal ratings and lower valence ratings (greater negative emotion) in response to the negative affect/stressful script. While there were no gender differences in responses to smoking cues, women trended towards higher arousal ratings. Implications of the findings for treatment and tobacco-related morbidity and mortality are discussed.

Acute psychosocial stress: does the emotional stress response correspond with physiological responses?

Most stress experiences are accompanied by physiological and psychological responses. Laboratory stressors such as the Trier Social Stress Test (TSST) induce reliable stress responses, which are mainly assessed for biological parameters such as cortisol. The associations between physiological and psychological responses to the TSST have been rarely investigated and are addressed in this review. Up to August 2011, 358 studies were published in PubMed examining the impact of the TSST (71%) or variations of the protocol. A total of 49 studies were considered based on the following three inclusion criteria: (1) exposure to the standard TSST or slightly modified TSST versions, (2) at least one assessment of subjective emotional stress experience before, during or after the TSST, (3) reported associations between acute physiological and emotional stress measures. Significant correlations between cortisol responses and perceived emotional stress variables were found in approximately 25% of the studies. Our descriptive analysis revealed various essential elements that potentially contribute to this apparent dissociation, reaching from differing assessment approaches and methodological features of the stress protocols to possible mediating factors and interindividual differences in the degree of psychophysiological correspondence.

Maternal mood and neuroendocrine programming: effects of time of exposure and sex

Adverse exposures that influence growth in prenatal and early postnatal periods are considered to influence vulnerability to chronic diseases via their effects on the neuroendocrine system. In humans, the assessment of the underlying mechanisms has been restricted. The present study aimed to investigate the effects of adverse early-life exposures, specifically maternal mood, on hypothlamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) responses to an acute physiological stressor. In addition, we conducted a preliminary examination into whether these effects varied by time of exposure and sex. One hundred and thity-nine individuals (mean age 15.12 years) were recruited from the ALSPAC (Avon Longitudinal Study of Parents and Children) birth cohort. Participants underwent the CO(2) stress test and indices of the PNS, SNS and HPA axis were measured. Pre-existing data on demographic and psychosocial factors of the mothers during pregnancy (18 and 32 weeks) and postnatally (8 weeks and 8 months) were extracted, as were participants' clinical and demographic data at birth. Increases in both pre- and postnatal anxiety and depression were associated with greater SNS reactivity to the stressor and slower recovery, as well as blunted HPA axis responses. Programming effects on the SNS appeared to be restricted to male offspring only. No consistent relationships were evident for any of the measures of pre-stress function. We have found preliminary evidence that both pre- and postnatal maternal anxiety and depression have sustained programming effects on the SNS and HPA axis. Effects on the SNS were restricted to male offspring.

The effect of trait rumination on adaptation to repeated stress

OBJECTIVE

Exaggerated and prolonged cardiovascular responses to mental stress have been implicated in the etiology of hypertension. Rumination may play a role in the maintenance or reactivation of cardiovascular responses to mental stress and prevent cardiovascular adaptation or create sensitization on reexposure. The purpose of this study was to evaluate the influence of trait rumination on patterns of cardiovascular response adaptation after repeated exposure to a mental stressor.

METHODS

Cardiovascular data were collected from 82 undergraduate women during a baseline period and during a 5-minute emotional recall task on two separate occasions. Trait rumination was assessed using the Stress-Reactive Rumination Scale.

RESULTS

A series of session (Sessions 1 and 2)-by-trait rumination general linear model repeated-measures analyses of covariance revealed several session-by-trait rumination interactions, such that participants who displayed higher levels of trait rumination showed less SBP (partial η(2) = 0.83, p = .01), diastolic blood pressure (partial η(2) = 0.84, p = .01), and heart rate (partial η(2) = 0.82, p = .02) adaptation to the laboratory mental stress task at the second exposure relative to those with lower levels of trait rumination.

CONCLUSIONS

These findings suggest that trait rumination may contribute to sustained increases in blood pressure by influencing adaptation to mental stress.

Limited impact on self-concept in individuals with Lynch syndrome; results from a national cohort study

An increasing number of individuals seek genetic counseling and hereby learn about hereditary cancer in the family. Lynch syndrome is associated with an inherited high risk for colorectal and gynecological cancer, but knowledge about how family members at risk perceive their situation is limited. We used the national Danish HNPCC register to collect data on self-concept from 413 individuals with Lynch syndrome. The recently developed Lynch syndrome self-concept scale contains 20 items within two subscales related to stigma-vulnerability and bowel symptom-related anxiety. Significantly higher total scores, indicating a greater impact on self-concept, were reported by females and by individuals with experience from cancer in close relatives, whereas individuals with less formal education scored significantly higher on the stigma and vulnerability subscale. Scores in the upper quartile were more often reported by women (odds ratio 1.8) and by individuals with less education (OR 1.8). This study provides the first extended use of the Lynch syndrome self-concept scale and suggests that the majority of the Danish mutation carriers adapt well to the situation, though knowledge about the increased risk of cancer seem to have a greater impact in females, individuals with less education and those with experience of cancer in close relatives.

Major depressive disorders in chronic hemodialysis patients in Nazareth: identification and assessment

OBJECTIVE

Depression illnesses are commonly observed in hemodialysis (HD) patients, which can influence the quality of life of end-stage renal disease patients. We evaluate the prevalence and predictive risk factors of depression in the Arab population undergoing HD in Nazareth, Israel.

METHODS

We conducted a prospective study that included 71 patients in the HD unit with a mean age of 61.9 ± 14.13 years who had undergone HD and 26 healthy control subjects with a mean age of 59.3 ± 7.3. Beck's Depression Inventory and Hamilton Depression Scale assessments were administered. Blood analysis for hematological and biochemical parameters was obtained. Diagnosis was made using the Diagnostic and Statistical Manual of Mental Disorders scale to correlate psychological variables with clinical, hematological, and biochemical parameters. Statistical analysis was carried out using analysis of variance followed by Tukey post-hoc multiple comparison tests.

RESULTS

The prevalence of depression was 43.7% in HD patients. Between HD patients and controls, cortisol values were 16.96 ± 0.5476 and 11.96 ± 1.116, respectively (P < 0.0001; 95% confidence intervals [CI]: 2.416-6.825). Between depressed HD patients versus control subjects, cortisol values were 16.48 ± 0.72 and 11.96 ± 1.116, respectively (P = 0.0013; 95% CI: 1.878-7.184). Hematological and biochemical parameters were compared between depressed HD and nondepressed patients, but differences between the two groups were found to be insignificant (P > 0.05).

CONCLUSION

Our HD patients were severely depressed. Studies of glucocorticoid turnover activity such as cortisol, a potent chemical stress hormone, may be used as a model and marker for early diagnosis of depression among HD patients. The strong familial support system in Arabic traditions has failed to decrease depression among these patients.

Gender, gender roles, and anxiety: perceived confirmability of self report, behavioral avoidance, and physiological reactivity

Despite the well-documented gender effect in anxiety, less is known about contributing factors to women's greater risk for anxiety and fears. The present study examined the relationship between gender, gender role orientation (i.e., expressivity/instrumentality) and fear of harmless insects (tarantula), using a multimodal approach of self-report measures, a Behavioral Approach Test (BAT), and physiological reactivity. Participants (144 college students; 67 women, 77 men) completed a questionnaire packet and then were instructed to approach a tarantula. We were unable to replicate Pierce and Kirkpatrick's (1992) findings that men underreport anxiety. Consistent with the literature, women in the study experienced greater anxiety and avoidance compared to men. However, men and women did not differ on physiological reactivity during the first 2 min of the BAT. The concordance across avoidance, anxiety and heart rate reactivity differed by gender, suggesting that men and women have different experiences when faced with a fearful object. Furthermore, instrumentality (masculinity) was negatively related to anticipatory anxiety for women but not for men.

Effects of 5HTTLPR on cardiovascular response to an emotional stressor

OBJECTIVES

To replicate a prior main effect of the serotonin transporter gene promoter (5HTTLPR) genotype on cardiovascular reactivity (CVR) and explore caregiver stress as a potential moderator of 5HTTLPR effects on CVR. On the basis of prior findings, we hypothesized that the more transcriptionally active allele variants would be associated with increased CVR.

METHODS

Expression of the serotonin transporter is affected by the genotype of the 5HTTLPR (S-short and L-long forms) as well as the genotype of the SNP rs25531 within this region. Based on the combined genotypes for these polymorphisms, we designated each allele as a Hi or Lo expressing allele according to expression levels-resulting in HiHi, HiLo, and LoLo groups. We examined the relationship between 5HTTLPR genotype and CVR in 164 caregivers and 158 noncaregivers. Main effects of 5HTTLPR on baseline adjusted blood pressure (systolic and diastolic blood pressures) and heart rate (HR) reactivity were examined, along with moderation by caregiving.

RESULTS

The 5HTTLPR × Caregiver Stress interaction moderated both systolic blood pressure (p < .02) and HR (p < .02) reactivity. In controls, the Hi activity allelic variants were associated with greater systolic blood pressure and HR reactivity as compared with the Lo activity variants. In caregivers, 5HTTLPR genotype was not associated with CVR.

CONCLUSIONS

Replication in this study's control group of our prior finding that 5HTTLPR alleles associated with Hi activity are associated with increased CVR to an emotion recall stressor strengthens the case that this association is real and could be partially responsible for the increased cardiovascular disease observed in persons carrying the 5HTTLPR L allele.

Higher comorbidity of depression and cardiovascular disease in women: a biopsychosocial perspective

OBJECTIVES

The present paper aims at offering a synthesis of possible reasons of the higher comorbidity of cardiovascular disease (CVD) and depression in women from a biopsychosocial perspective.

METHOD

The available literature is reviewed under sex/gender aspects related to the link between depression and CVD and common pathways to depression and CVD associated with chronic stress experiences including pathophysiological mechanisms and behavioural, cognitive, psychosocial and sociological risk factors/predictors.

RESULTS

There is considerable evidence that greater exposure to chronic stressors in women, interpersonal stress responsiveness, and internalizing coping styles are associated with an elevated risk of CVD and/or depression through behavioural and pathophysiological mechanisms including alterations in HPA axis functioning and autonomic nervous system which appear to be specific for women.

CONCLUSION

Women seem to be more strongly affected by psychosocial stressors related to CVD and depression as well as by direct and indirect effects of chronic stress compared to men. More evidence in understanding these differences within the biological, psychosocial and sociostructural determinants and pathways is essential for promoting women's health.

Stress enhancement of fear learning in mice is dependent upon stressor type: Effects of sex and ovarian hormones

In three experiments, chronic stress enhancement of subsequent fear learning was investigated in C57Bl/6 mice. The first experiment focused on the influence of stressor type on subsequent Pavlovian fear learning. Male mice were subjected to 7d of either repeated restraint stress or chronic variable stress before undergoing a fear conditioning procedure with three tone-shock trials. Subsequent tests were conducted of contextual and tone fear, through measures of the freezing response. Repeated restraint altered pre-training activity and the unconditional response to shock, but was ineffective in influencing conditional fear. Chronic variable stress significantly inflated contextual fear without altering tone fear. In a second experiment, investigating potential sex differences in the fear-enhancing effects of stress, female mice were subjected to the very same procedures. Among females, chronic variable stress selectively altered tone fear, rather than contextual fear. A final experiment investigated the potential role of ovarian hormones by subjecting female mice to either ovariectomy or sham surgery before the stress procedures. Ovariectomy had no significant effect on the ability of stress to enhance fear in females. In sum, the experiments indicate that stressor type significantly influences subsequent fear learning, that males and females are differentially sensitive to fear enhancement by stress, and that the mechanisms mediating these sex differences lie outside of the immediate influence of ovarian hormones. The findings should allow for refinement of animal models of human psychiatric disorders and for further investigations into the genetic and molecular substrates of significant gender differences in fear and anxiety.

Adiposity, leptin and stress reactivity in humans

Evidence suggests that individuals who are more obese may be more responsive to stress. Stress activates the sympathetic nervous system (SNS) and the adipose-tissue cytokine leptin stimulates SNS activity in animals. We examined the relationship between adiposity, leptin and physiological responses to acute laboratory stress in 67 women. We predicted that individuals with greater adiposity and/or higher plasma leptin would be more stress-responsive. Adiposity was unrelated to cardiovascular or neuroendocrine stress reactivity. However, women with larger waists had greater stress-induced increases in plasma leptin and interleukin-1 receptor antagonist (IL-1Ra). Similarly, women with higher basal leptin displayed greater stress-induced increases in heart rate and plasma interleukin-6, and larger decreases in heart rate variability and cardiac pre-ejection period. Heightened cardiovascular and inflammatory stress responses are predictive of future cardiovascular risk. Our findings suggest that the cytokines leptin and IL-1Ra may play a role in the association between obesity, stress and cardiovascular health.

Perioperative pain, psychological distress, and immune function in men undergoing prostatectomy for cancer of the prostate

Prostate cancer is a leading malignancy in men, and prostatectomy is widely used for its treatment. Psychological distress and pain are commonly experienced in the perioperative period, and both can contribute to suppression of the immune response to cancer. This study evaluated perioperative pain, psychological distress, and immune function in men undergoing prostatectomy. Men were evaluated prior to surgery, 1 and 2 days postoperatively and 4-6 weeks postoperatively. Compared to cancer-free men, the prostatectomy group reported increased perceived stress, depression, confusion, and anxiety prior to surgery. During the 2 postoperative days, mood disturbance and anxiety persisted and were accompanied by mild elevations in pain and reduced vigor. At 4-6 weeks postoperative, mood, pain, and immune function were similar to those of the cancer-free group; however, the prostatectomy group continued to report significant elevations in anxiety. Natural killer cell activity (NKCA) was significantly reduced on Day 1 after prostatectomy, but by postoperative Day 2, NKCA returned to a level similar to that of the cancer-free group. The reduction in NKCA was not accompanied by changes in circulating immune cells, demonstrating that this reduction represented a functional change in NKCA. No correlations between immune variables and pain or psychological variables were found, suggesting that the postoperative reduction in NKCA was likely the result of the physical stress of the surgical experience. Suppression of immune defenses during the critical postoperative period can place cancer patients at risk for nascent tumor seeding. Additional interventions are needed to reduce this risk.

Recent research in stress, coping and women's health

PURPOSE OF REVIEW

To highlight recent publications in the area of stress and coping, with specific reference to women's physical health status.

RECENT FINDINGS

The transactional model of stress and coping continues to be the mainstay of research in this area. Several longitudinal studies have demonstrated that stress appraisal and resultant coping responses affect health outcome and health-related quality of life in women. In addition to problem-focused coping, women often use distraction methods, seeking social support and faith or religious coping. Psychological interventions in chronic medical conditions need to move beyond education and incorporate more cognitive behavioral components, at the same time addressing women's specific needs.

SUMMARY

Coping behaviors in response to the negative threat appraisal of a chronic or severe medical illness serve to reduce psychological distress. However, it is still not clear how they impact at the physiological level. In addition, coping responses, which enhance positive effects and promote health-related quality of life, merit greater attention from researchers. There is a need for more gender comparative research to improve health outcomes in men and women.