Stronger endocrine responses after brief psychological stress in women at familial risk of breast cancer

Exploration of possible sex bias in acute social stress research: a semi-systematic review

Stress can have a significant impact on the daily lives of individuals and can increase vulnerability to a number of medical conditions. This study aims to estimate the ratio of male to female participants in acute social stress research in healthy individuals. We examined original research articles published over the last 20 years. Each article was screened to determine the total number of female and male participants. We extracted data from 124 articles involving a total of 9539 participants. A total of 4221 (44.2%) participants were female, 5056 (53.0%) were male and 262 (2.7%) were unreported. Articles incorporating only females were significantly underrepresented compared to articles incorporating only males. Forty articles (63.5%) which presented data from both females and males, failed to analyse and interpret the results by sex, a significant methodological limitation. In conclusion, in the literature published over the last 20 years, female participants are significantly underrepresented. In the studies where females are represented, severe methodological limitations are apparent. Researchers should be conscious of sexual dimorphism, menstrual phase and use of hormonal contraception, which may impact the interpretation of their results.

Social-evaluative threat: Stress response stages and influences of biological sex and neuroticism

Social-evaluative threat (SET) - when the self could be negatively judged by others - can cause pronounced responses in the different stress systems: threat/challenge appraisal, the sympathetic (SNS) and parasympathetic (PNS) nervous systems, experienced motivation and affect, and the hypothalamus-pituitary-adrenal (HPA) axis. Here, we utilize a four-stage stress response model to shed light on the complex associations between different stress responses, where earlier stages are hypothesized to predict later stages. Additionally, we take into account important moderators, such as biological sex (controlling for menstrual cycle phase), personality traits (neuroticism and extraversion), and baseline stress levels. Thirty-seven men and 30 women in their luteal phase participated in an impromptu public speaking task to induce SET. Stress responses in four different stages were measured using: self-reported appraisal (threat or challenge, stage 1: S1), cardiovascular measures (pre-ejection period as SNS index, respiratory sinus arrhythmia as PNS index, S2), self-reported motivation and affect (state approach motivation, state anxiety, S3) and endocrine measures (cortisol as HPA index, S4). Stress reactivity was calculated by subtracting individual peaks from baseline. Results showed that SET induced pronounced stress reactivity in stages two to four. Against expectations, self-reported appraisal (S1) or motivation and affect (S3) did not predict later stress reactivity. As hypothesized, increased SNS (but not PNS) reactivity (S2) predicted increased HPA reactivity (S4). Bayesian model comparison confirmed the absence of sex differences in stress reactivity, likely due to controlling for menstrual cycle phase and sex differences in neuroticism levels. Higher trait neuroticism predicted blunted SNS (S2) and HPA (S4) reactivity, while higher baseline stress levels predicted blunted stages two and three reactivity overall. In conclusion, this rigorously controlled experiment partly supports and partly contradicts previous findings regarding associations between stress response stages, and offers new insight into the causes of blunted HPA responses in women.

The Integration of Emotional, Physiologic, and Communication Responses to Medical Oncology Surveillance Appointments During Breast Cancer Survivorship

BACKGROUND

Breast cancer survivors regularly interact with providers during routine surveillance medical oncology visits, discussing uncertainty and anxiety about potential cancer recurrence for many years after treatment. Physiologic alteration can also occur as a stress response, triggered by an upcoming surveillance visit. Survivor-provider communication can theoretically allay emotional distress.

OBJECTIVE

The aim of this study was to evaluate associations between emotional (uncertainty, anxiety, concerns about recurrence) and physiologic responses (cytokine levels, lymphocyte counts), and survivor-provider communication (women's plans for their visit, negotiation of decision-making roles).

METHODS

Twenty-seven community-dwelling breast cancer survivors participated. Blood specimens, and self-reported data focusing on the previous month, were collected immediately before and the morning after a regularly scheduled medical oncology visit.

RESULTS

Global concerns about cancer recurrence and acute anxiety and uncertainty were associated with changes in immune status before and after the visit. Postvisit natural killer cells increased in 70% of women, and uncertainty/anxiety decreased. Thirty-three percent of women reported a previous minor illness. Most women had a visit plan; 66% successfully negotiated decision-making roles with providers.

CONCLUSIONS

Triggered by an upcoming medical oncology visit, women experience uncertainty, anxiety, and altered immunity, potentially placing them at risk of disease exacerbations.

IMPLICATIONS FOR PRACTICE

Not all women respond similarly to a routine surveillance visit; thus, providers must determine who may be at increased risk of emotional distress and physiologic alteration. Survivor-provider communication facilitates immediate resolution of concerns. Explanations of symptom meaning reduce anxiety and uncertainty and by extension may help resolve immune alteration. Between visits, this could be done by nurse-operated telephone-based "help lines."

Pre-typhoon socioeconomic status factors predict post-typhoon psychiatric symptoms in a Vietnamese sample

PURPOSE

Exposure to natural disasters has been associated with increased risk for various forms of psychopathology. Evidence indicates that socioeconomic status (SES) may be important for understanding post-disaster psychiatric distress; however, studies of SES-relevant factors in non-Western, disaster-exposed samples are lacking. The primary aim of the current study was to examine the role of pre-typhoon SES-relevant factors in relation to post-typhoon psychiatric symptoms among Vietnamese individuals exposed to Typhoon Xangsane.

METHODS

In 2006, Typhoon Xangsane disrupted a mental health needs assessment in Vietnam in which the Self Reporting Questionnaire-20 (SRQ-20), and the Demographic and Health Surveys Wealth Index, a measure of SES created for use in low-income countries, were administered pre-typhoon. The SRQ-20 was re-administered post-typhoon.

RESULTS

Results of a linear mixed model indicated that the covariates of older age, female sex, and higher levels of pre-typhoon psychiatric symptoms were associated with higher levels of post-typhoon psychiatric symptoms. Analysis of SES indicators revealed that owning fewer consumer goods, having lower quality of household services, and having attained less education were associated with higher levels of post-typhoon symptoms, above and beyond the covariates, whereas quality of the household build, employment status, and insurance status were not related to post-typhoon psychiatric symptoms.

CONCLUSION

Even after controlling for demographic characteristics and pre-typhoon psychiatric symptoms, certain SES factors uniquely predicted post-typhoon psychiatric distress. These SES characteristics may be useful for identifying individuals in developing countries who are in need of early intervention following disaster exposure.

Psychoneuroimmunology and cancer: a decade of discovery, paradigm shifts, and methodological innovations

This article introduces the supplement Advances in Cancer and Brain, Behavior, and Immunity and outlines important discoveries, paradigm shifts, and methodological innovations that have emerged in the past decade to advance mechanistic and translational understanding of biobehavioral influences on tumor biology, cancer treatment-related sequelae, and cancer outcomes. We offer a heuristic framework for research on biobehavioral pathways in cancer. The shifting survivorship landscape is highlighted, and we propose that the changing demographics suggest prudent adoption of a life course perspective of cancer and cancer survivorship. We note opportunities for psychoneuroimmunology (PNI) research to ameliorate the long-term, unintended consequences of aggressive curative intent and call attention to the critical role of reciprocal translational pathways between animal and human studies. Lastly, we briefly summarize the articles included in this compilation and offer our perspectives on future research directions.

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.

Baseline psychological stress and ovarian norepinephrine levels negatively affect the outcome of in vitro fertilisation

OBJECTIVE

We determined the effect of baseline psychological stress and norepinephrine (NE) levels in the follicular fluid on the outcome of in vitro fertilisation (IVF).

METHODS

One hundred seven women with tubal factor infertility were evaluated before and during their first IVF treatment. On the first day of down-regulation, their psychological state was measured using the Zung Self-rating Anxiety (SAS) and Depression Scales (SDS), and defined as baseline psychological stress. On oocyte retrieval day, NE levels in the follicular fluid and peripheral plasma were measured by high-performance liquid chromatography.

RESULTS

On the first day of down-regulation, nearly 10% of the women with tubal factor infertility reported that they were experiencing both anxiety and depression. This baseline psychological stress was lower in pregnant (3.7%) than in non-pregnant women (15.7%, p<0.05). On oocyte retrieval day, the NE levels in follicular fluid were almost twice the amount seen in peripheral plasma, but did not differ in pregnant and non-pregnant women (p>0.05). NE levels in follicular fluid were negatively associated with the percentage of good quality embryos (r= -0.62, p<0.05).

CONCLUSIONS

Baseline psychological stress (both anxiety and depression) may negatively influence the clinical pregnancy rate of IVF treatment in women with tubal factor infertility. Furthermore, follicular NE levels are negatively associated with the percentage of good quality embryos.

Maladaptive intestinal epithelial responses to life stress may predispose healthy women to gut mucosal inflammation

BACKGROUND & AIMS

Irritable bowel syndrome (IBS), a highly prevalent disorder among women, has been associated with life stress, but the peripheral mechanisms involved remain largely unexplored.

METHODS

A 20-cm jejunal segment perfusion was performed in 2 groups of young healthy women, equilibrated by menstrual phase, experiencing either low (LS; n = 13) or moderate background stress (MS; n = 11). Intestinal effluents were collected every 15 minutes, for 30 minutes under basal conditions, and for 1 hour after cold pain stress. Cardiovascular and psychological response, changes in circulating stress and gonadal hormones, and epithelial function (net water flux, albumin output and luminal release of tryptase and alpha-defensins) to cold stress were determined.

RESULTS

Cold pain induced a psychological response stronger in the MS than in the LS group, but similar increases in heart rate, blood pressure, adrenocorticotrophic hormone, and cortisol, whereas estradiol and progesterone remained unaltered. Notably, the jejunal epithelium of MS females showed a chloride-related decrease in peak secretory response (Delta[15-0 minutes]: LS, 97.5 [68.4-135.0]; MS, 48.8 [36.6-65.0] microL/min/cm; P < .001) combined with a marked enhancement of albumin permeability (LS(AUC), 6.35 [0.9-9.6]; MS(AUC), 13.97 [8.3-23.1] mg/60 min; P = .008) after cold stress. Epithelial response in both groups was associated with similar increases in luminal tryptase and alpha-defensins release.

CONCLUSIONS

Increased exposure to life events determines a defective jejunal epithelial response to incoming stimuli. This abnormal response may represent an initial step in the development of prolonged mucosal dysfunction, a finding that could be linked to enhanced susceptibility for IBS.

Associations among Salivary Cortisol, Melatonin, Catecholamines, Sleep Quality and Stress in Women with Breast Cancer and Healthy Controls

Dysregulations in several biological systems in breast cancer patients have been reported, including abnormalities in endocrine and sympathetic nervous system indices, as well as psychological disturbances and sleep disorders. The purpose of this exploratory study was to compare women with breast cancer to healthy control women on measures of salivary cortisol, urinary catecholamines, overnight urinary melatonin, and self-reported sleep quality, symptoms of stress, depression, anxiety and mood disturbance, to determine if discernable patterns of dysregulations across systems were apparent. Thirty-three women were tested in each group, with an average age of approximately 52 years, primarily Caucasian and well-educated. Forty percent of the women with breast cancer had stage 2 disease and they were an average of 1.36 years post-diagnosis. Women with breast cancer had significantly higher levels of disturbance on all the psychological indices, but there were no differences between groups on any of the biological measures, with the exception that the control women had higher dopamine values than the participants with breast cancer. None of the psychological scores were correlated with the biological measures. These results are consistent with other studies of early-stage breast cancer and highlight the importance of considering disease characteristics when investigating endocrine and sympathetic nervous system functioning.

Breast Cancer Risk and Immune Responses in Healthy Women

PURPOSE/OBJECTIVES

To summarize the findings of objective and subjective breast cancer risk assessments and their association with psychological distress and immune responses in healthy women with a family history of breast cancer.

DATA SOURCES

Published articles and book chapters.

DATA SYNTHESIS

Healthy women with a family history of breast cancer have shown decreased immune responses (i.e., low natural killer cell activity and low Th1 cytokine production), exaggerated biophysiologic reactivity to stimuli, and increased psychological distress.

CONCLUSIONS

Objective and subjective breast cancer risk is associated with impaired immune responses and exaggerated biophysiologic responses in healthy women with a family history of breast cancer. Increased psychological distress can contribute further to negative immune responses. Additional studies are warranted to substantiate and extend the findings based on more comprehensive assessments of objective and subjective breast cancer risk.

IMPLICATIONS FOR NURSING

Biophysiologic assessment is a useful approach for nurses in early identification of women at risk for breast cancer and developing appropriate strategies to reduce the risk.

[Psychological stress, immune function and disease development. The psychoneuroimmunologic perspective]

Interdisciplinary psychoneuroimmunological (PNI) research increasingly demonstrates clinically relevant interrelations between psychological stressors and the onset or progression of chronic diseases. Disturbances of the bi-directional interaction between the nervous system, the immune system and the endocrine system have been hypothesized to be implicated in several diseases. Here, we review evidence from psychoneuroimmunology within the theoretical framework of allostatic load to conceptualize some of these associations. Interdisciplinary PNI research investigating the importance of psychological stress for the higher incidence of infections, decreased responses to vaccinations and delayed wound healing is reviewed. Furthermore, the literature supporting similar associations with regard to progression of oncological diseases and autoimmune disorders is reviewed with a focus on breast cancer and multiple sclerosis. The accumulating evidence regarding the importance of neuroendocrine-immune interaction in these diseases may thus lead to novel insights into pathogenetic mechanisms and could contribute to the development of novel preventive and therapeutic strategies.

Should fertilization treatment start with reducing stress?

In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. These techniques include hormonal stimulation, ICSI, gamete intra-Fallopian transfer (GIFT) and IVF, and their cost is, on average, considerable. There is substantial initial evidence that the psychological disposition of the parents-to-be influences their fertility and thus the outcome of fertilization techniques. Many fertility treatments include consultation with a psychologist and do try to keep the stress produced by the treatment itself to a minimum, using concurrent therapy. However, the accumulating evidence points to the need to program medical fertility treatment, bearing in mind both chronic and acute stress levels, and to treat for their reduction before commencing the (actual) fertility treatment. There is ample evidence that lower stress levels mean better female and male natural fertility, though there is as yet no conclusive experimental evidence that lower stress levels result in better fertility treatment outcome. However, first reducing stress may diminish the number of treatment cycles needed before pregnancy is obtained, may prepare the couple for an initial failure of treatment or even make the more invasive techniques unnecessary. Primary psychological treatment for trait and state stress, being a less invasive method than IVF, ICSI or GIFT, is to be applied whenever indicated. Also, treatment and therapy to reduce stress, and in so doing enhance fertility, do not provoke the ethical and religious objections raised by infertility treatments.

The Detrimental Effects of Allostasis: Allostatic Load as a Measure of Cumulative Stress

Since its inception in the 1980s, through further developments during the 1990s, and continuing today, the paradigm of allostatic load (AL) has becomed an important paradigm for predicting senescence and mortality. AL is a cumulative measure of the effects of multiple stressors and the process of responding to stressors on the soma. AL measurements of individuals is being tested on various samples and species and being reported across a variety of medical and social science journals. From the ISI Web of Science, all articles published between January 2000 and June 2005 with AL in any default category were obtained and transferred to Endnote. These articles, categorized as theory/review or data-driven, human or animal, and variability in risk factors used to estimate AL, are reviewed here. Only two of 90 reports were published in anthropological journals, likely, at least partly, because research on AL has focused more on western, industrialized populations where data are more easily obtained. From 2000-2005, 12 of 42 data-driven reports focused on elderly humans. Studies of animal models also are common (0 in 2000, but 4 in 2004 covering 21 species). During the last year, multiple additional potential physiological variables have been tested as measures of AL (10 to 20 in any one article). In the past half decade, AL also has been introduced to a wide range of disciplines, including psychology, anthropology, gerontology, veterinary medicine, and medical specialties, as a viable research theme. AL appears to provide a useful method for determining cumulative somatic stress such as that seen with senescence and frailty at older ages.

Posttraumatic stress associated with cancer history and BRCA1/2 genetic testing

OBJECTIVE

A subset of women who are at elevated cancer risk due to family history exhibit evidence of cancer-specific distress. These stress responses may represent symptoms of posttraumatic stress disorder (PTSD). The present study assessed rates of PTSD related to personal or family cancer history and BRCA1/2 testing.

METHODS

Participants were 84 women enrolled in a larger project focused on genetic testing decisions. Semistructured diagnostic interviews were used to identify instances of threshold and subthreshold PTSD.

RESULTS

Results indicated that 16.7% of the women reported current threshold or subthreshold PTSD related to personal or family cancer history. An additional 26.2% reported past-only cancer-related threshold or subthreshold PTSD. Of the 65 women who received BRCA1/2 results and completed the test-related PTSD module, only 7.7% reported threshold or subthreshold PTSD related to the genetic testing process. However, when rates were examined based on carrier status, 25.0% of BRCA1/2 carriers reported test-related threshold or subthreshold PTSD compared with only 10.0% of variants and 2.3% of noncarriers.

CONCLUSIONS

Results from this study suggest that both personal and family cancer diagnoses can be significant stressors for a subset of high-risk women. Rates of threshold and subthreshold PTSD related to genetic testing appear to be less common, although carriers may be at higher risk for significant posttraumatic symptoms.

Heightened cortisol responses to daily stress in working women at familial risk for breast cancer

Consistent with animal models and experimental studies with humans facing other 'background' stressors, women at familial risk for breast cancer have been reported to have stronger cortisol responses to laboratory stressors. To explore the relevance of these findings to daily life, we compared work-stress cortisol responses in women with >or=1 first-degree relative with breast cancer (FH+, n = 74) to women without this risk factor (FH-, n = 141). Repeated-measures ANOVA revealed a group by time interaction (p <or= 0.05) with FH+ women having higher (p <or= 0.05) urinary cortisol levels than FH- during work, but not at home or during sleep. They also had a higher percentage increase between nadir cortisol levels and work levels. These results provide evidence that the heightened cortisol responses of FH+ women also apply to daily life stressors, and suggest the need for additional research to explore the possibility that accentuated hypothalamic-pituitary-axis responses to such stressors may increase health risk for these women.

Depressive symptoms predict norepinephrine response to a psychological stressor task in Alzheimer's caregivers

OBJECTIVE

Increased depressive symptoms have been associated with increased basal plasma norepinephrine (NE), and may be associated with exaggerated NE response to stress. This exaggerated response may play a role in health consequences associated with caring for a loved-one with Alzheimer's disease. The current study examined the relations between the level of depressive symptoms in spousal caregivers and the physiological response to a psychological stress task.

METHODS

Fifty-five spousal caregivers (mean age 73 +/- 8 years) completed the depression subscale of the Brief Symptom Inventory (BSI). Plasma NE levels were assessed before and immediately after a speech stressor conducted at the caregiver's home. Hierarchical linear regression was used to determine whether caregiver depressive symptoms significantly improved prediction of change in NE levels beyond other factors theoretically and empirically related to NE.

RESULTS

Level of depressive symptoms significantly predicted post-stressor change in NE levels (p < .01), even when controlling for age, caregiver distress, presence of caregiver hypertension, and care recipient level of cognitive function. Higher levels of depressive symptoms were associated with a greater plasma NE response to the psychological stress task.

CONCLUSIONS

Depressive symptoms may act to exaggerate NE response to the stress of caregiving, potentially leading to an allostatic load that might predispose caregivers to negative health consequences, including cardiovascular morbidity.

Perceived stress and physiological dysregulation in older adults

We use a population-based representative sample of older Taiwanese to investigate links between respondents' perceived levels of stress and a broad set of biological measures. These biomarkers were collected at a single time (2000) and reflect sympathetic nervous system (SNS)-activity, hypothalamo-pituitary-adrenal (HPA)-activity, immune function, cardiovascular function, and metabolic pathways. We model the relationship between perceived stress and (1) extreme values for each of 16 individual biological indicators; and (2) a measure of cumulative physiological dysregulation based on the full set of biomarkers. We consider two measures of perceived stress, one derived from the 2000 interview and the second based on data from three interviews (1996-2000). Age and sex-adjusted models reveal significant associations between measures of perceived stress and extreme values of cortisol, triglycerides, interleukin-6 (IL-6), dehydroepiandrosterone sulphate (DHEAS) and fasting glucose. Examined individually, numerous biomarkers, including those pertaining to blood pressure and obesity, are not significantly related to perceived stress. Jointly, however, the measure of cumulative physiological dysregulation is associated with both the level of perceived stress at a given time and to a longitudinal measure of perceived stress. Some results suggest that the relationship between level of perceived stress and physiological response is stronger for women than men.

Psychosocial impact of parental cancer in adulthood: A conceptual and empirical review

This article reviews recent literature on the psychosocial aspects of parental cancer in adulthood. Overall, studies have shown that a sizable minority of adult children of cancer patients experience psychological distress in terms of anxiety, depression, and posttraumatic stress symptoms. Most research to date has focused on the first-degree female relatives of breast cancer patients, many of whom are daughters. Although distress reactions in this population are well documented, restrictive assumptions reflecting a vulnerability/deficit model of women limit scientific progress. In addition, the critical role of grown offspring caregivers of cancer patients deserves further investigation. Future research should examine the relations between intrapsychic and contextual factors that may influence psychological adjustment to parental cancer.

Stress and outcome success in IVF: the role of self-reports and endocrine variables

BACKGROUND

The aim of this study was to examine the associations between urinary levels of the stress hormones adrenaline, noradrenaline and cortisol during treatment with self reported stress, in order to investigate the mechanism for the previously observed negative association of anxiety and depression with the outcome of IVF/ICSI.

METHODS

In a multicentre prospective cohort study, women entering their first cycle of IVF/ICSI treatment were asked to participate. From each participant nocturnal urine samples were collected; pre-treatment, before oocyte retrieval and before embryo-transfer (ET), to assess hormonal concentrations. Additionally, two questionnaires were administered before the start of the treatment to measure anxiety and depression.

RESULTS

168 women completed the questionnaires and collected at least two urine specimens. A significant positive correlation between urinary adrenaline concentrations at baseline and ET and the scores on depression at baseline were found. In women with successful treatment, lower concentrations of adrenaline at oocyte retrieval and lower concentrations of adrenaline and noradrenaline at ET, compared with unsuccessful women, were found.

CONCLUSIONS

The significant positive association of adrenaline concentration with pregnancy and with depression suggested that this adrenal hormone could be one of the links in the complex relationship between psychosocial stress and outcome after IVF/ICSI.

Anxiety and salivary cortisol in symptomatic and nonsymptomatic panic patients and healthy volunteers performing simulated public speaking

Anxiety and salivary cortisol were measured in subjects performing simulated public speaking (SPS), a procedure that has been neurobiologically related to panic disorder. The subjects were divided into three groups: 18 symptomatic panic patients, 16 nonsymptomatic, drug-treated panic patients, and 17 healthy controls. In the experimental session, subjective anxiety (Visual Analogue Mood Scale) and the total score of the Bodily Symptom Scale (BSS) were higher in symptomatic patients than in controls, with nonsymptomatic patients in between. Measures of cortisol taken at home showed that the level was higher at 9:00 h than at 23:00 h in every group, indicating a normal circadian regulation of the hypothalamic-pituitary-adrenal (HPA) axis in panic patients. Also in every group, the level of cortisol was high at the beginning of the experimental session and decreased after 70 min. This fall parallels the decrease in anxiety and BSS ratings, and appears to reflect habituation of initial, anticipatory anxiety. Preparation and performance of speech raised anxiety and BSS scores to the initial levels, but failed to increase cortisol measured over 60 min, starting at the end of the speech. Therefore, SPS does not seem to activate the HPA axis, as reported in panic attacks.

Psychological distress among healthy women with family histories of breast cancer: effects of recent life events

The experience of breast cancer in a close family member can be a major life stressor for many women as evidenced by various psychosocial and biological indicators. However, existing studies have found considerable variability in the levels of psychological distress among women with family histories of breast cancer (FHBC). Based on cognitive processing models, we examined moderating effects of recent life events on the impact of having a family member with breast cancer and psychological distress. Specifically, we hypothesized that negative recent life events would be associated with greater psychological distress and that positive recent life events would be associated with less psychological distress, and these patterns will be more prominent among women with FHBC than women without FHBC. Women with (FHBC+, N = 59) and women without (FHBC-, N = 94) FHBC completed measures of recent life events, cancer-specific distress (intrusion and avoidance) and general distress. Results indicated that among FHBC+ women, negative life events were associated with higher levels of breast cancer-specific intrusion and positive life events were associated with lower levels of breast cancer-specific avoidance. These results support the application of cognitive processing models for understanding variability in women's psychological adjustment to their FHBC. Psychological interventions designed to facilitate coping with negative life events and to increase the occurrence of positive events may be warranted.

Higher Beck depression scores predict delayed epinephrine recovery after acute psychological stress independent of baseline levels of stress and mood

Depressive symptoms in the non-clinical range have been linked to increased health risks. Recent theorizing raises the possibility that heightened physiologic responses to acute stress and/or slowed stress recovery in individuals with depressive symptoms may contribute to increased risk. We investigated stress-induced catecholamine responses and recovery patterns using a modified version of the Trier Social Stress Test (15 min) with a sample of 52 healthy women and compared subgroups with high normal versus low scores on the Beck Depression Inventory (BDI, median split) to 29 women randomly assigned to a non-stressed control group. The BDI-high normal and BDI-low groups showed similar acute increases in epinephrine immediately post stressor, but only the BDI-high normal group remained significantly elevated above control group levels during the recovery period. No differences were found in norepinephrine responses. Elevations in BDI scores within the normal range may selectively predict slower physiological recovery following acute stress.

Plasma volume restoration with salt tablets and water after bed rest prevents orthostatic hypotension and changes in supine hemodynamic and endocrine variables

Head-down bed rest changes the values of many cardiovascular and endocrine variables and also elicits significant hypovolemia. Because previous studies had not controlled for hypovolemia, it is unknown whether the reported changes were primary effects of bed rest or secondary effects of bed rest-induced hypovolemia. We hypothesized that restoring plasma volume with salt tablets and water after 12 days of head-down bed rest would result in an absence of hemodynamic and endocrine changes and a reduced incidence of orthostatic hypotension. In 10 men, we measured changes from pre-bed-rest to post-bed-rest in venous and arterial pressures; heart rate; stroke volume; cardiac output; vascular resistance; plasma norepinephrine, epinephrine, vasopressin, renin activity (PRA), and aldosterone responses to different tilt levels (0 degrees, -10 degrees, 20 degrees, 30 degrees, and 70 degrees); and plasma volume and platelet alpha2- and lymphocyte beta2-adrenoreceptor densities and affinities (0 degrees tilt only). Fluid loading at the end of bed rest restored plasma volume and resulted in the absence of post-bed-rest orthostatic hypotension and changes in supine hemodynamic and endocrine variables. Fluid loading did not prevent post-bed-rest increases in beta2-adrenoreceptor density or decreases in the aldosterone-to-PRA ratio (P = 0.05 for each). Heart rate, epinephrine, and PRA responses to upright tilt after bed rest were increased (P < 0.05), despite the fluid load. These results suggest that incidents of orthostatic hypotension and many of the changes in supine hemodynamic and endocrine variables in volume-depleted bed-rested subjects occur secondarily to the hypovolemia. Despite normovolemia after bed rest, beta2-adrenoreceptors were upregulated, and heart rate, epinephrine, and PRA responses to tilt were augmented, indicating that these changes are independent of volume depletion.

Urinary catecholamine levels in daily life are elevated in women at familial risk of breast cancer

Recent experimental research has shown that women facing the chronic stress of being at familial risk of breast cancer have greater neuroendocrine reactivity responses to stressful laboratory tasks. Whether this enhanced stress response also occurs outside the laboratory under daily life conditions is unknown. In the present study, urinary epinephrine and norepinephrine excretion rates at work (e.g. 11:00 AM-3:00 PM), home (e.g. 6:00 PM-10:00 PM) and during sleep (e.g. 10:00 PM-6:00 AM) were compared between 73 employed women with family histories of breast cancer in first degree relatives (FH+; age=36.8+/-8.7) and 81 without such family histories (FH-; age=38.1+/-9.4). Differences in sympathetic adrenal medullary responses to an ordinary life stressor (work) were assessed in naturalistic settings. Repeated measures MANCOVA with family history group as a fixed factor, body mass index as a covariate and daily microenvironment (work, home and sleep) as a repeating factor were conducted to evaluate whether catecholamine excretion rates differed between FH+ and FH- groups. The results revealed that women with family histories of breast cancer had a higher rate of epinephrine excretion while at work (p<0.005). In addition, women in the FH+ group were also more reactive to the stress of work, showing a greater percentage of increase in both epinephrine and norepinephrine from sleep to work (p<0.05). The results also indicated that the chronic stress effects associated with a family history of breast cancer were moderated by BMI, such that their impact was more pronounced and apparent when women were not obese. These findings support the idea that the heightened neuroendocrine reactivity to experimental stressors in women at familial risk of breast cancer also occurs when women encounter stressors in ordinary life (work stress). Additional research to explore the health consequences of increased reactivity in women at familial risk of breast cancer, and perhaps in individuals at familial risk of other life-threatening disease, would appear warranted.

Tamoxifen is an estrogen antagonist on gonadotropin secretion and responsiveness of the hypothalamic-pituitary- adrenal axis in female monkeys

The selective estrogen receptor modulator, tamoxifen, effectively slows the progression of estrogen-positive breast cancer and reduces the possibility of this cancer developing in women at high risk. Despite the widespread acceptance of tamoxifen as a therapeutic agent for this disease, its effects on other estrogen-dependent pathways, particularly on neural circuits regulating brain function and peripheral hormone secretion, are poorly understood. The present study, using previously ovariectomized rhesus monkeys, examined the effects of tamoxifen, in both the presence and absence of estradiol replacement, on the reproductive and hypo-thalamic-pituitary-adrenal (HPA) axes. In Experiment 1, monkeys randomly assigned to three groups (n = 8 each) were treated with placebo and either two doses of estradiol, two doses of tamoxifen alone, or two doses of tamoxifen plus high-dose estradiol to assess the effects on negative feedback suppression of luteinizing hormone (LH). Both doses of tamoxifen effectively antagonized the negative feedback efficacy of estradiol on LH secretion. In contrast, neither the low- or high-dose tamoxifen alone had any effect on LH secretion, as concentrations during tamoxifen treatments were indistinguishable from those during placebo. In Experiment 2, females were randomly assigned to one of four treatment groups (placebo, n = 6; estradiol, n = 5; tamoxifen only, n = 5; or tamoxifen plus estradiol, n = 6) to assess the effects on glucocorticoid negative feedback and pituitary and adrenal responsiveness to exogenous corticotropin- releasing hormone (CRH). Tamoxifen also antagonized the facilitating effects of estradiol on basal and CRH-induced ACTH and cortisol secretion. However, this antagonism produced basal and CRH-stimulated cortisol and ACTH concentrations that were lower than placebo-treated females. Interestingly, tamoxifen in the absence of estradiol produced a similar diminution in ACTH and cortisol response. These data suggest that, in the presence of estradiol, tamoxifen not only antagonized estrogenic facilitation of HPA responsivity but also actually attenuated the response compared with the placebo-treatment condition. Taken together, these data indicate that tamoxifen acts as an estrogen antagonist on the neural circuits controlling the neuroendocrine regulation of the hypothalamic-pituitary-ovarian and adrenal axes in ovariectomized macaque females.