On the Stress of Being a Woman: The synergistic contribution of sex as a biological variable and gender as a psychosocial one to risk of stress-related disorders

Lifetime stressor exposure is related to suicidality in autistic adults: A multinational study

Despite very high rates of suicidal thoughts and behaviors (STB) in autistic adults, the key psychosocial drivers of this phenomenon remain unknown. To investigate, we examined how lifetime stressor exposure and severity, which have been found to predict STB in non-autistic populations, related to STB in a multinational dataset of 226 autistic adults from the United Kingdom and Australia (67% female; Mage = 41.8, SD = 13.6, range = 19-73 years old). Results revealed that autistic men and women differ with respect to the count, severity, and type of stressors they experienced over the life course. Whereas autistic men were exposed to more numerous legal/crime-related stressors, autistic women experienced more stressors related to social relationships and chronic humiliation and typically experienced stressors as more severe. In addition, whereas chronic interpersonal loss was related to STB for men, acute stressors involving physical danger and lower exposure to chronic entrapment were related to STB in autistic women. These findings indicate that certain lifetime stressors may be differentially experienced, and relevant to STB, in autistic men versus women. They also suggest that screening for lifetime stressor exposure may help identify autistic individuals at greatest risk of suicide.Lay abstractWhen we encounter life events that we experience as stressful ("stressors"), it sets off a biological stress response that can impact mental health and contribute to suicidal thoughts and behaviors (STB). Although we know about specific stressors that are associated with STB in the general population, little is known about the kinds of stressors that increase the risk of STB in autistic people and whether these associations differ by gender. To examine this issue, we cataloged the life stressors that autistic men and women experienced over the entire life course and investigated how these stressors were related to STB. Data were derived from a multinational sample of 226 autistic adults from the United Kingdom and Australia who completed the Stress and Adversity Inventory for Adults. We found that autistic men and women differed in terms of both the lifetime stressors they experienced as well as their perceived severity. Whereas men experienced more legal/crime-related stressors, women experienced more stressors related to relationships with other people and more long-lasting stressors associated with humiliation. Autistic women often perceived life stressors as more severe than men, which is important given that it is the perceived severity of stressors that most strongly affects our health. We also found that different stressors may predict STB in autistic men versus women. Whereas loss of loved ones was most strongly associated with STB for men, for women, physically dangerous stressors were most relevant. In addition, women with fewer lifetime stressors involving entrapment had higher lifetime STB. These results suggest that lifetime stressor exposure may be important to assess to understand suicide risk in autistic people. Additional research is needed to confirm these associations and to examine possible mechanisms linking stress and STB.

Global, regional and national burdens of major depression disorders and its attributable risk factors in adolescents and young adults aged 10-24 years from 1990 to 2021

BACKGROUND

Major depressive disorder (MDD) is an important public health problem among adolescents and young adults, and its increasing prevalence underscores the need for region-specific and age-specific interventions. Despite its increasing burden, comprehensive data on regional and longitudinal trends in MDD among adolescents are scarce. This study analyzed global, regional, and national trends in MDD incidence, prevalence, and disability-adjusted life years (DALYs) among individuals aged 10-24 from 1990 to 2021, while examining differences by gender, age, socio-demographic factors, and emerging risk factors to guide targeted mental health strategies.

METHODS

With data from the 2021 Global Burden of Disease Study, we conducted an analysis of age-standardized incidence, prevalence, and DALYs due to MDD by sex, age group, and 21 geographic regions with a special focus on sociodemographic index (SDI) levels, which measures development on a scale from low to high. Key risk factors, such as bullying and intimate partner violence, were also assessed in order to understand their contribution to the burden of MDD.

RESULTS

Between 1990 and 2021, the global burden of MDD increased substantially. Prevalence rose by 56.36% globally, particularly among men and young adults aged 20-24 years, with the largest increases observed in Eastern Sub-Saharan Africa (184.26% increase). Incidence grew by 56.11%, with Eastern Sub-Saharan Africa experiencing the steepest rise compared to slower increases in other regions. DALYs also increased by 56.32%, with the greatest burden observed in Eastern Sub-Saharan Africa. Bullying and intimate partner violence were leading contributors to DALYs across all regions. Bullying and childhood sexual abuse increased MDD-related DALYs, with bullying peaking at ages 10-14, while childhood sexual abuse had a higher impact on females, rising sharply after 2006. Post- 2020, all metrics (prevalence, incidence, and DALYs) rose sharply, particularly in high-SDI regions, likely due to the specific impacts of the COVID- 19 pandemic, such as prolonged lockdowns, increased social isolation, and disruptions to mental health services.

CONCLUSIONS

This study highlights the need for culturally sensitive mental health policies focusing on prevention and early intervention, while also providing insights to improve resource allocation and support further research on adolescent mental health.

TRIAL REGISTRATION

Not applicable.

The gender and age perspectives of allostatic load

The role of chronic stress in the development of chronic diseases, especially multimorbidity, through the pathways of increasing allostatic load, and finally, allostatic overload (the state when a compensatory mechanism is likely to fail) is being emphasized. However, allostatic load is a dynamic measure that changes depending on sex, gender, age, level and type of stress, experience of a stressful situation, and coping behaviors. Many other factors such as race, ethnicity, working environment, lifestyle, and circadian rhythm of sleep are also important. The aim of this paper was to synthesize the available information on allostatic load differences, especially those connected to sex/gender and age, and to provide a model for the future study of allostatic load, with a focus on these differences. By carefully studying allostatic load factors, we realized that many studies do not take this allostatic load difference into account in the analysis methods. In this paper, we also support the idea of further research to develop new allostatic load analysis strategies that will include all knowledge about sex/gender differences and that will, in more detail, explain numerous changeable social and educational factors that are currently accepted as biological ones. Furthermore, specific allostatic load biomarkers are expressed differently in different age groups, indicating that the discrepancies cannot be attributed solely to sex/gender disparities. This kind of approach can be valuable, not only for better explaining the differences in the frequency and age of onset of chronic diseases and multimorbidity, but also for the potential planning and development of preventive actions based on the aforementioned sex/gender and age disaparities, in order to prevent the most frequent diseases and to establish specific biomarker cut-off values for each sex/gender and age group.

Reduced hepatic AdipoR2 by increased glucocorticoid mediates effect of psychosocial stress to elevate serum cholesterol

Understanding the effects of psychosocial stress on serum cholesterol may offer valuable insights into the relationship between psychological disorders and endocrine diseases. However, these effects and their underlying mechanisms have not been elucidated yet. Here we show that serum corticosterone, total cholesterol and low-density lipoprotein cholesterol (LDL-C) are elevated in a mouse model of psychosocial stress. Furthermore, alterations occur in AdipoR2-mediated AMPK and PPARα signaling pathways in liver, accompanied by a decrease in LDL-C clearance and an increase in cholesterol synthesis. These changes are further verified in wild-type and AdipoR2 overexpression HepG2 cells incubated with cortisol and AdipoR agonist, and are finally confirmed by treating wild-type and hepatic-specific AdipoR2 overexpression mice with corticosterone. We conclude that increased glucocorticoid mediates the effects of psychosocial stress to elevate serum cholesterol by inhibiting AdipoR2-mediated AMPK and PPARα signaling to decrease LDL-C clearance and increase cholesterol synthesis in liver.

Bloody stressed! A systematic review of the associations between adulthood psychological stress and menstrual cycle irregularity

Regular menstruation is a key indicator of general health and irregular menstrual parameters have been associated with elevated risk of adverse health outcomes. While psychological stress is believed to contribute to abnormal menstruation, little is known of the effects of discrete psychological stressors, including the COVID-19 pandemic, on menstrual function. A systematic database search was performed and studies investigating the relation between psychological stress and menstrual cycle irregularity in otherwise healthy adults were included. Two independent investigators completed abstract and full-text screening, data extraction, and risk of bias assessment. In the 41 included studies, a variety of stressors were assessed, namely COVID-19 pandemic stress, academic stress, and occupational stress. Our review found most studies report an association between psychological stress and menstrual dysfunction, with the most common disruptions being irregular menstruation and abnormal menstrual flow. Our findings also underlined notable discrepancies in the operational definitions used in the study of menstrual disorders. These observations emphasize the importance of psychological stress as a modifiable risk factor associated with irregular menstruation.

Gender differences in the relationship between medical students' emotional intelligence and stress coping: a cross-sectional study

BACKGROUND

Given the increasing stress levels among medical students due to the impact of COVID-19, it is crucial to effectively reduce their stress levels for their future development. To better understand medical students' stress coping, this study investigated how their emotional intelligence is related to stress coping and whether this relationship is moderated by gender differences.

METHODS

A cross-sectional study was conducted. A random sample of 744 medical students from Hebei Province, China, was investigated via an emotional intelligence scale and stress coping questionnaire from March-May 2023. The response rate was 93%. SPSS and Mplus statistical software were used for the data analysis.

RESULTS

The self-emotional appraisal of medical students had a significant negative effect on avoidant coping (β = -0.173, CI 95% = [-0.243, -0.099], p < .001). However, the other dimensions of emotional intelligence (others' emotional appraisal, use of emotion, and regulation of emotion) had a significant positive impact on the active coping of female medical students (β = 0.146, CI 95% = [0.082,0.214], p < .001; β = 0.235, CI 95% = [0.167,0.304], p < .001; β = 0.165, CI 95% = [0.084,0.247], p < .001). In contrast to those of female medical students, other dimensions of emotional intelligence had a significant positive impact on the avoidant coping of male medical students (β = -0.161, CI 95% = [-0.284, -0.062]; p < 0.01; β = 0.126, CI 95% = [0.043,0.246], p < 0.001; β = 0.159, CI 95% = [0.054,0.277], p < 0.05; β = -0.221, CI 95% = [-0.363, -0.129], p < 0.001). Moreover, the use of emotion had a significant positive impact on the active coping of male medical students (β = 0.272, CI 95% = [0.182,0.382], p < .001). Furthermore, gender differences had a moderating effect on the relationship between emotional intelligence dimensions and stress coping (β = 0.178; CI 95% = [0.068,0.292]; p < 0.05). Others' emotional appraisal has a greater impact on female students' active coping. In addition, with increasing regulation of emotion ability, female medical students reduce avoidant coping (β = 0.169, CI 95% = [0.002,0.326]; p < 0.05).

CONCLUSIONS

The current study revealed that gender is a significant moderator of the relationship between medical students' emotional intelligence and stress coping. These findings may help medical colleges focus on gender differences when improving medical students' ability to cope with stress.

[Depression in the field of tension of gender roles]

BACKGROUND

The distribution of depression and suicidal ideation by gender reveals a gender paradox: women are at least twice as likely to be diagnosed with depressive disorders but have a lower suicide rate than men. In contrast, the suicide rate of men is at least three times higher than women, while the prevalence of depressive disorders is only half as high. Although these differences have long been known the reasons for this paradox are still not fully understood.

AIM OF THE ARTICLE AND METHOD

The aim of this narrative review article is to discuss possible explanatory models regarding gender differences in depressive disorders. Aspects related to stress processing and traumatization are considered as well as sociological and biological factors. This article summarizes information that was considered particularly relevant in the interdisciplinary dialogue regarding possible explanatory factors for gender differences in depressive disorders.

RESULTS

The summarized studies indicate that women and men differ in certain aspects of stress processing and trauma exposure but men do not have a lower risk of disease as a result. On the contrary, the frequency of depressive disorders in men seems to be underestimated due to an atypical symptom manifestation.

DISCUSSION

The implementation of knowledge about gender-specific vulnerability in the training of physicians and psychotherapists, the systematic assessment of gender beyond binary classifications as well as further diversity domains in research and healthcare as well as gender-sensitive and diversity-sensitive prevention strategies could contribute to the resolution of the gender paradox.