Lifetime Stress Exposure and Health: A Review of Contemporary Assessment Methods and Biological Mechanisms

Protocol for project MHISS: Mental Health and Immunodynamics of Social Stress

Background

Growing evidence suggests that immune alterations may mediate the impact of stress on a plethora of negative psychological and somatic health outcomes. In particular, social stress has been demonstrated to be a particularly potent type of stress that modulates immune activity. Typically, this effect has been tested in the lab with acute social stressors. To build upon this research with greater external validity, we used the transition to college campuses for 1st year undergraduates as an ecologically valid social stressor in this novel, intensive longitudinal psychoneuroimmunology study.

Method

This NIMH-funded study collected data from 173 incoming 1st year students at a large public university in California, USA. Eligible participants were recruited using an online screener disseminated by the University registrar's office and had to be 17-19 years old, fluent in English, living on campus, not have self-selected any roommates, and have moved at least 100 miles to campus. Enrolled participants completed a baseline survey, daily self-report measures (3589 reports total), and blood draws every three days for 22 days (656 assayed samples), as well as an additional survey on the 22nd day. The start of the daily surveys was timed so that students' 7th survey was their first full day on campus (i.e., the day after move-in). We also describe sub-studies involving (a) diagnostic interviews at the end of students' 1st academic year, (b) extending the daily surveys to capture a full month for participants with a menstrual cycle, and (c) piloting a college transition resilience program.

Discussion

Consistent with recent calls from the NIMH Director, this study uses the transition to college as an ecologically valid stress paradigm, in combination with novel intensive longitudinal assessment of immunology, to characterize social stress-related changes in biopsychosocial functioning over time. Studies resulting from this project will shed light on the dynamic interplay between key psychoneuroimmunological processes, advance the methodological standards of this field, and help identify intervention opportunities to improve mental health on college campuses and beyond.

Acute Stress and Autoimmune Markers: Evaluating the Psychoneuroimmunology Axis in Firefighter Recruits

Chronic psychological stress is known to influence immune function and contribute to development of autoimmune disorders through dysregulated inflammatory responses. This study investigates relationships between acute stress, life trauma, and autoimmune salivary biomarkers in firefighter recruits during psychophysical stress training. Salivary samples were collected from firefighter recruits during two stress tests to evaluate responses to acute stress. Samples were obtained at three time points-pre-stress, post-stress, and recovery-across both tests. Cortisol was measured to characterize acute stress response (ASR) profiles, while immune function was assessed through the analyzing C-reactive Protein (CRP), Complement C4 (C4), Pigment Epithelium Derived Factor (PEDF), and Serum Amyloid P (SAP). Results showed significant changes in CRP, C4, and PEDF after stress inoculation. Higher previous life trauma was associated with lower baseline cortisol (r = -0.489) and delay in cortisol recovery (r = 0.514), suggesting a learned biological response, potentially protective against stress-induced dysregulation. Cluster analysis revealed four distinct cortisol ASR profiles which were found to have significantly different past life trauma (p = 0.031). These findings suggest that trauma history influences stress biomarker dynamics, potentially reflecting individualized adaptive or maladaptive responses. The insights gained may inform strategies to enhance stress resilience and mitigate autoimmune risk among high-stress populations.

Lifetime Stressor Severity and Diurnal Cortisol in Older African American Adults: A Comparison of Three Theoretical Models

Multiple theoretical models have been proposed to explain how stressor exposure across the life course relates to the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, as indexed by daily cortisol secretion. However, this association remains understudied in African Americans. The present study tested three competing models of stressor severity across the lifespan and diurnal cortisol secretion in a sample of 203 older African American adults. The cumulative model emphasizes total stressor severity across the lifespan, the biological embedding model emphasizes early-life stressor severity, and the sensitization model instead emphasizes the interaction between early-life and recent stressor severity. Lifetime stressor severity was assessed using the Stress and Adversity Inventory for Adults (Adult STRAIN). Analyses did not support any of the three models tested but, rather, a stressor characteristics perspective, wherein the severity of exposure to specific stressor characteristics was associated with blunted diurnal cortisol slopes. Sensitivity analyses revealed that early life stressor count, rather than severity, was associated with blunted diurnal cortisol slopes. Rather than supporting one of the three competing models of stressor severity, our findings provide preliminary evidence for a stressor characteristics approach and the biological embedding model when examining how lifetime stressor exposure affects HPA-axis activity.

Altered Sensory and Stress Responses in Atopic Dermatitis: Effects of Acute Stress on Lesional and Non-Lesional Skin

Itch and pain are both mediated by small sensory fibres. Atopic dermatitis (AD) patients usually report stress-induced flares, but the impact of stress on sensory fibres in lesional and non-lesional skin remains inconclusive. This observational study assessed the effect of acute stress on sensory profiles in subjects with AD (n = 18) and healthy controls (HC, n = 21). Participants completed clinical and psychological questionnaires, and quantitative sensory testing was performed on lesional and non-lesional skin in AD and healthy skin in HC. Assessments were done before and after the Montreal Imaging Stress Task, an acute stress protocol. Stress responses were evaluated by anxiety ratings, heart rate (HR) and salivary cortisol (CORT). Cortisol binding globulin (CBG) was quantified as an indirect measure for circulating CORT. AD participants reported higher anxiety, depression and stress perception than HC. HR was similar between groups, but AD participants showed a blunted CORT response post-stress and lower CBG levels, suggesting altered stress regulation. Acute stress reduced cold sensitivity in HC and non-lesional AD skin but had no effect on lesions. These findings indicate that the effects of stress on small fibres depend on the condition of the skin and emphasise the sensory alterations experienced by AD patients.

How Anxiety State Influences Speech Parameters: A Network Analysis Study from a Real Stressed Scenario

Background/Objectives: Voice analysis has shown promise in anxiety assessment, yet traditional approaches examining isolated acoustic features yield inconsistent results. This study aimed to explore the relationship between anxiety states and vocal parameters from a network perspective in ecologically valid settings. Methods: A cross-sectional study was conducted with 316 undergraduate students (191 males, 125 females; mean age 20.3 ± 0.85 years) who completed a standardized picture description task while their speech was recorded. Participants were categorized into low-anxiety (n = 119) and high-anxiety (n = 197) groups based on self-reported anxiety ratings. Five acoustic parameters-jitter, fundamental frequency (F0), formant frequencies (F1/F2), intensity, and speech rate-were analyzed using network analysis. Results: Network analysis revealed a robust negative relationship between jitter and state anxiety, with jitter as the sole speech parameter consistently linked to state anxiety in the total group. Additionally, higher anxiety levels were associated with a coupling between intensity and F1/F2, whereas the low-anxiety network displayed a sparser organization without intensity and F1/F2 connection. Conclusions: Anxiety could be recognized by speech parameter networks in ecological settings. The distinct pattern with the negative jitter-anxiety relationship in the total network and the connection between intensity and F1/2 in high-anxiety states suggest potential speech markers for anxiety assessment. These findings suggest that state anxiety may directly influence jitter and fundamentally restructure the relationships among speech features, highlighting the importance of examining jitter and speech parameter interactions rather than isolated values in speech detection of anxiety.

Inconclusive evidence for associations between adverse experiences in adulthood and working memory performance

Decades of research have shown that adversity tends to be associated with lower working memory (WM) performance. This literature has mainly focused on impairments in the capacity to hold information available in WM for further processing. However, some recent adaptation-based studies suggest that certain types of adversity can leave intact, or even enhance, the ability to rapidly update information in WM. One key challenge is that WM capacity and updating tasks tend to covary, as both types of tasks require the creation and maintenance of bindings in WM; links between mental representations of information in WM. To estimate the associations between adversity and different processes in WM, we need to isolate variance in performance related to WM capacity from variance in performance related to updating ability. In this Registered Report, participants from the Dutch Longitudinal Internet studies for the Social Sciences (LISS) panel completed three WM tasks: two complex span tasks and a task measuring both binding and updating of information. In addition, we estimated participants' exposure to neighbourhood threat, material deprivation and unpredictability. We estimated associations between the three types of adversity and latent estimates of WM capacity and updating using structural equation modelling. We did not find consistent associations between adversity and WM capacity or updating, nor did we find evidence that the associations were practically equivalent to zero. Our results show that adversity researchers should account for overlap in WM tasks when estimating specific WM abilities.

Association of stressful life events with subjective age and the mediating role of depression: A cross-sectional study of older adults in China

OBJECTIVE

While previous studies have examined the relationship between stressful life events (SLEs) and subjective age (SA), the results were inconclusive and the mechanisms linking the association were unclear. This study investigated whether the experience of SLEs was associated with an older SA and the potential mediating role of depression linking this association in a cross-sectional study of older adults in China.

METHODS

Data were drawn from the 2018 China Longitudinal Aging Social Survey (CLASS), comprising 7643 participants aged 60 and older. The association between SLEs and SA was examined using multivariate linear regression, and the mediation effect of depression was evaluated.

RESULTS

Experiencing SLEs over the past year was associated with a 0.018 increase in proportional felt age (95 % CI: 0.012, 0.024) and a 0.011 increase in proportional look age (95 % CI: 0.005, 0.016), respectively. Depression appeared to be a significant mediator, accounting for 22.2 % and 27.3 % of the association of SLEs with proportional felt age and proportional look age, respectively.

CONCLUSION

Findings revealed that having SLEs was associated with an older SA, partially through the pathway of depression. More attention and appropriate intervention should be given to the older adults incurring SLEs to prevent the adverse effect of older SA.

Does stress from incarceration of family and friends contribute to signs of early vascular ageing in African American women?

BACKGROUND

Early vascular ageing (EVA) contributes to elevated risk of cardiovascular disease (CVD), which disproportionately affects African American women. Incarceration, an event disproportionately impacting African Americans, may be a stressor contributing to EVA in African American women. Further, the subjective perspective, commonly referred to as appraisal, of incarceration may also be important for health. We hypothesised that having family and/or friends incarcerated and appraising the incarceration as upsetting would be associated with indices of EVA.

METHODS

In a community-based cohort of African American women aged 30-46 living in Atlanta, Georgia (n=391), participants were asked, at baseline, about family and/or friend incarceration and to appraise how upsetting the incarceration was. Multivariable linear regression examined associations between: (1) family and/or friend incarceration and indices of EVA (pulse wave velocity, augmentation index, central systolic blood pressure (SBP) and pulse pressure amplification) and (2) appraisal of incarceration and EVA indices.

RESULTS

45% of participants (n=174) reported having a loved one incarcerated, and 59% (n=102) reported the incarceration as upsetting. Having a loved one incarcerated was associated with a higher central SBP (b=4.30; 95% CI 1.61, 6.99) and augmentation index (b=2.29; 95% CI 0.26, 4.33). Appraisal of incarceration was only associated with central SBP.

CONCLUSIONS

Family or friend incarceration was highly prevalent in this cohort of African American women and associated with indices of EVA. Mass incarceration of others may affect the physical health of African American women which may contribute to CVD disparities.

A compassion microintervention targeting stress reactivity among sexual minority women and transgender/nonbinary people: Study protocol for a randomized controlled trial

OBJECTIVE

Sexual minority women (SMW) and transgender and/or nonbinary (TNB) people report more adverse health outcomes (e.g., depression, anxiety, posttraumatic stress, substance use) relative to heterosexual, cisgender people, often due to the additional stress burden from experiencing stigma. Physiological and emotional stress reactivity are mechanisms through which high cumulative stress contributes to adverse health outcomes. The randomized controlled trial (RCT) described in this study protocol examines whether a single-session compassion microintervention may attenuate physiological and emotional stress reactivity to the minority stress Trier Social Stress Test (MS-TSST) among SMW/TNB people. This study will also examine whether the compassion microintervention reduces depression, anxiety, posttraumatic stress symptoms, and substance use from baseline to one-month follow-up, and assess microintervention acceptability.

METHODS

This protocol describes a two-arm parallel RCT. Participants are recruited online and at in-person events (e.g., Pride events). Participants complete baseline measures online (e.g., demographics, anxiety symptoms) and then complete an in-person lab visit that includes the compassion microintervention (or no training control). Immediately after the intervention period, participants complete the MS-TSST. Measures of physiological (i.e., blood pressure, cortisol) and emotional (i.e., negative affect, state anxiety) reactivity are collected throughout the lab visit. Participants also complete a one-month follow-up survey. Participants randomized to the microintervention are invited to complete a semi-structured virtual interview about their experiences to assess acceptability.

CONCLUSION

Findings from this study could provide initial evidence that compassion microinterventions show promise in addressing stigma-related stress reactivity among SMW/TNB people.

CLINICALTRIALS

govregistration:NCT05949060.

Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory

Although stress and adversity are largely universal experiences, people exposed to greater hardship are at increased risk for negative health consequences. Recent studies identify accelerated biological aging as a mechanism that could explain how trauma and adversity gives rise to poor health, and advances in this area of study coincide with technological innovations in the measurement of biological aging, particularly epigenetic profiles consistent with accelerated aging derived from DNA methylation. In this review, we provide an overview of the current literature examining how adversity might accelerate biological aging, with a specific focus on social and health behaviors. The most extensive evidence in this area suggests that health-compromising behaviors, particularly smoking, may partially explain the association between adversity and accelerated aging. Although there is relatively less published support for the role of social behaviors, emerging evidence points to the importance of social connection as a mechanism for future study. Our review highlights the need to determine the extent to which the associations from adversity to accelerated aging are consistent with causal processes. As we consider these questions, the review emphasizes methodological approaches from the causal inference literature that can help deepen our understanding of how stress and trauma might result in poor health. The use of these methodologies will help provide evidence as to which behavioral interventions might slow aging and improve health, particularly among populations that more often experience adversity and trauma.

Psychological distress and uterine fibroids: a bidirectional two-sample mendelian randomization study

BACKGROUND

Observational data indicates a connection between emotional discomfort, such as anxiety and depression, and uterine fibroids (UFs). However, additional investigation is required to establish the causal relationship between them. Hence, we assessed the reciprocal causality between four psychological disorders and UFs utilizing two-sample Mendelian randomization (MR).

METHODS

To evaluate the causal relationship between four types of psychological distress (depressive symptoms, severe depression, anxiety or panic attacks, mood swings) and UFs, bidirectional two-sample MR was employed, utilizing single nucleotide polymorphisms (SNPs) associated with these conditions. Both univariate MR (UVMR) and multivariate MR (MVMR) primarily applied inverse variance weighted (IVW) as the method for estimating potential causal effects. Complementary approaches such as MR Egger, weighted median, simple mode, and weighted mode were utilized to validate the findings. To assess the robustness of our MR results, we conducted sensitivity analyses using Cochran's Q-test and the MR Egger intercept test.

RESULTS

The results of our UVMR analysis suggest that genetic predispositions to depressive symptoms (Odds Ratio [OR] = 1.563, 95% Confidence Interval [CI] = 1.209-2.021, P = 0.001) and major depressive disorder (MDD) (OR = 1.176, 95% CI = 1.044-1.324, P = 0.007) are associated with an increased risk of UFs. Moreover, the IVW model showed a nominally significant positive correlation between mood swings (OR: 1.578; 95% CI: 1.062-2.345; P = 0.024) and UFs risk. However, our analysis did not establish a causal relationship between UFs and the four types of psychological distress. Even after adjusting for confounders like body mass index (BMI), smoking, alcohol consumption, and number of live births in the MVMR, the causal link between MDD and UFs remained significant (OR = 1.217, 95% CI = 1.039-1.425, P = 0.015).

CONCLUSIONS

Our study presents evidence supporting the causal relationship between genetic susceptibility to MDD and the incidence of UFs. These findings highlight the significance of addressing psychological health issues, particularly depression, in both the prevention and treatment of UFs.

Factors influencing postpartum depression in Saudi women: a cross-sectional descriptive study

PURPOSE

This study aimed to investigate the prevalence of postpartum depression (PPD) and stress, as well as factors influencing PPD, among women in Saudi Arabia.

METHODS

This study employed a cross-sectional online survey and recruited participants during postpartum visits to the Clinic of Gynecology and Obstetrics in Al-Khobar, Saudi Arabia. Data collection was done using Arabic versions of the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, and a sociodemographics and obstetric history questionnaire. Descriptive and inferential analyses were conducted, including multiple linear regression using a stepwise method.

RESULTS

Data from the 270 participants showed low levels of postpartum depressive symptoms with a mean score of 2.54±4.5 and low levels of perceived stress with a mean score of 2.49±6.2. While 94.4% of the participants reported low levels of stress and PPD, 5.6% reported elevated levels (≥10 for PPD, ≥14 for stress). The stepwise regression analysis showed significant results (p<.001), accounting for 34% of the variance in PPD. The factors significantly influencing PPD included the type of family, stress, number of abortions, disease during pregnancy, and family income. Importantly, perceived stress emerged as a factor influencing PPD.

CONCLUSION

Although the majority of participants exhibited low levels of PPD, about 1 in 18 showed elevated levels. The identification of significant influencing factors highlights the need for targeted interventions to effectively address mental health concerns in postpartum women.

How much stressful life events really matter? Conceptual and methodological difficulties in assessing the impact of self-reported events on adolescents' subjective stress

Numerous studies have pointed to the strong impact of stressful life events on subjective stress and indirectly on the adolescents' mental health. However, the results of many such studies contain bias caused by the choice of measurement method or an incomplete theoretical framework. To estimate the extent of possible bias when using self-reports, we conducted research on a representative sample of 2201 Croatian adolescents aged 14-18 years. Using manipulation we examined the influence of measurement method and the number of constructs included in the model on the variance of subjective stress explained by stressful events. Structural equation modelling indicated that different measurement methods, occurrence-based and severity-based, provide a marked discrepancy in the impact size estimation. The occurrence-based method provided estimates of a much smaller proportion of the explained variance (6%-25%) compared to the severity-based approach, which estimated the explained variance in the range of 25%-55% depending on the model. The complexity of the tested models additionally contributed to the variation in the estimates. It is recommended that when using self-reports to measure stressful life events, occurrence-based and severity-based methods are used simultaneously and that impact estimates are expressed within intervals.

Lifetime adversity predicts depression, anxiety, and cognitive impairment in a nationally representative sample of older adults in the United States

OBJECTIVE

Although life stress and adversity are well-known risk factors for mental health problems and cognitive impairment among older adults, limited research has comprehensively examined the impact of both childhood and adulthood adversity on psychiatric and cognitive impairment symptoms over a prolonged period. To address this issue, we investigated how lifetime adversity exposure is related to symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the United States.

METHOD

We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3496 individuals (59.9% female), aged ≥64 years old (Mage = 76.0 ± 7.6 years in 2016). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities, and later-life depression, anxiety, and cognitive impairment.

RESULTS

Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Moreover, experiencing one childhood adversity (vs. none) was associated with a 17.4% increased risk of adulthood adversity. Finally, as hypothesized, childhood adversity exposure was related to experiencing more depression and anxiety symptoms in later life, whereas adulthood stressor exposure predicted more cognitive impairment as well as more depression and anxiety symptoms.

DISCUSSION

These findings demonstrate significant associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help healthcare professionals and policymakers identify individuals who could potentially benefit from interventions designed to reduce stress and enhance resilience.

Differential effects of COVID-19 stressor types on mental health and moderating roles of coping strategies

Stress exposure often leads to poor mental health, but whether certain types of stressors predict differential levels of mental health symptoms and whether coping differentially moderates these associations remain untested. This study examined whether COVID-19 stressor types (financial-, activity-, and infection-related) differentially predicted subsequent mental health (general distress, posttraumatic stress symptoms (PTSS), and positive states of mind) and whether different types of coping moderated these relationships. In April, 2020, questionnaires assessing the impact of COVID-19 on daily life were administered to an adult sample across the US (N = 1,546); 861 (55.7%) of whom completed questionnaires one month later. Nearly all stressor types independently predicted each aspect of mental health. Behavioral disengagement moderated links between both activity- and infection-related stressors and mental health. Seeking emotional social support moderated links between infection-related stressors and both general distress and positive states of mind as well as activity-related stressors and general distress. Positive reappraisal moderated links between financial-related stressors and positive states of mind. Acceptance coping predicted better mental health but was not a significant moderator. Stressor types and coping strategies are important determinants of effects of COVID-19 on mental health; our findings suggest possible screening and intervention implications and directions for future research.

Empowering Strategies for Lifestyle Interventions, Diet Modifications, and Environmental Practices for Uterine Fibroid Prevention; Unveiling the LIFE UP Awareness

Uterine fibroids (UFs) are the most common prevalent benign tumor among women of reproductive age, disproportionately affecting women of color. This paper introduces an innovative management strategy for UFs, emphasizing the curbing of disease prevention and progression. Traditionally, medical intervention is deferred until advanced stages, necessitating invasive surgeries such as hysterectomy or myomectomy, leading to high recurrence rates and increased healthcare costs. The strategy, outlined in this review, emphasizes UF disease management and is named LIFE UP awareness-standing for Lifestyle Interventions, Food Modifications, and Environmental Practices for UF Prevention. These cost-effective, safe, and accessible measures hold the potential to prevent UFs, improve overall reproductive health, reduce the need for invasive procedures, and generate substantial cost savings for both individuals and healthcare systems. This review underscores the importance of a proactive UF management method, paving the way for future research and policy initiatives in this domain.

Leveraging the Metaverse for Enhanced Longevity as a Component of Health 4.0

In this review, we describe evidence that supports building a metaverse to promote healthy longevity. We propose that the metaverse offers several physical advantages (architecture, music, and nature), social (accessibility, affordability, community-building, and relief of social anxiety), and therapeutic (immersive, anti-inflammatory, and adjunctive use in complementary and integrative medicine). Lifelogging by patients may help clinicians personalize interventions by matching data to therapeutic outcomes. Although the metaverse cannot entirely replace our current model of care, a strategic approach will ensure adequate resource allocation and value assessment. In a collaborative effort between Reulay, Inc and Mayo Clinic, we are building a platform for the delivery of personalized and idiographic interventions to promote healthy longevity. To this end, we are using specific science-informed art design to reduce stress and anxiety for patients, with the progressive addition of integrated care elements that connect to this framework and connect treatment response to biomarkers that are relevant to healthy longevity. This review is a commentary on the thought process behind this effort.

Fermented mixed grain ameliorates chronic stress-induced depression-like behavior and memory deficit

Fermented mixed grain (FG) has beneficial anti-cancer, antioxidant, and anti-inflammatory effects. In this study, we investigated the effects of FG on gut inflammation, brain dysfunction, and anxiety/depression-like behavior induced by unpredictable chronic mild stress (UCMS) in mice. Mice were administered mixed grain or FG for 3 weeks and were then exposed to UCMS for 4 weeks. FG administration ameliorated stress-induced anxiety/despair-like behavior. FG administration also prevented UCMS-induced memory impairment. Additionally, the mRNA levels of 5-HTR1A and IL-6 were restored to normal levels in the brains of FG-administered mice. FG administration also inhibited intestinal damage in stressed mice compared with that in the UCMS (without FG) group. These results suggest that FG can alleviate stress-induced intestinal damage, brain dysfunction, and cognitive impairment.

Examining a Healthy Lifestyle as a Moderator of the Relationship between Psychological Distress and Cognitive Decline among Older Adults in the NuAge Study

INTRODUCTION

The objective of this study was to examine whether a healthy lifestyle composite score of social engagement, physical activity, and Mediterranean diet adherence moderates the association between psychological distress and global cognitive decline among cognitively healthy older adults (67+ years of age at baseline).

METHODS

A total of 1,272 cognitively intact older adults (Mage = 74.1 ± 4.1 years, 51.9% female) in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) completed a series of self-reported questionnaires to measure psychological distress and lifestyle behaviors, and the Modified Mini-Mental Examination (3MS) to assess cognitive performance at baseline and annually over 3 years.

RESULTS

Controlling for sociodemographic and health-related characteristics, greater psychological distress was associated with steeper cognitive decline over time among males (B = -0.07, 95% CI: [-0.12, -0.02]), but not females (B = 0.008, 95% CI: [0.03, 0.04]). Although a healthy lifestyle composite score did not statistically significantly moderate the distress-cognition relationship (B = -0.005, 95% CI: [-0.02, 0.01]), there was an association between higher psychological distress and greater cognitive decline at low levels of social engagement (B = -0.05, 95% CI: [-0.09, -0.006]), but not at high levels of social engagement (B = 0.02, 95% CI: [-0.03, 0.07]).

CONCLUSION

This study suggests that the potentially harmful impact of stress on cognitive function may be malleable through specific healthy lifestyle behaviors and emphasizes the importance of taking a sex-based approach to cognitive aging research.

Heightened neural activity and functional connectivity responses to social rejection in female adolescents at risk for depression: Testing the Social Signal Transduction Theory of Depression

BACKGROUND

Although social rejection is among the strongest proximal precipitants of major depressive disorder (MDD), little is known about the underlying neurobiological mechanisms and whether neural sensitivity to social rejection may help explain differences in MDD risk. To address this issue, we tested whether neural responses to social threat differed in female adolescents at high vs. low maternal risk for MDD.

METHOD

Female adolescents with (high-risk; n = 22, Mage = 14.68) and without (low-risk; n = 30, Mage = 15.07) a maternal history of depression were experimentally exposed to negative and neutral social evaluation while undergoing an fMRI scan. Neural responses were assessed by event-related activity and functional connectivity, as well as multivoxel pattern analysis. Activity and functional connectivity analyses focused on a priori-selected regions of interest implicated in self-referential processing and emotion regulation.

RESULTS

Compared to low-risk female adolescents, high-risk female adolescents exhibited greater increases in self-reported depression and social disconnection following social evaluation. Moreover, compared to low-risk female adolescents, high-risk female adolescents exhibited greater amygdala responses to negative social evaluation and a differential pattern of functional connectivity in brain regions related to emotion regulation, self-referential processing, and negative affect. Additionally, these markers of neural threat reactivity were related to depressive symptoms.

LIMITATIONS

A cross-sectional study design and relatively small, Western sample.

CONCLUSIONS

These results suggest that exaggerated neural reactivity to social threat-and an atypical pattern of related functional connectivity-is evident in individuals with a preclinical risk factor for depression. Targeting such responding may thus be a fruitful strategy for preventing depression in at-risk youth.

COVID-19 pandemic stress and cancer symptom burden

OBJECTIVES

In a sample of patients with cancer (n=1145) who were assessed during the height of the COVID-19 pandemic, latent profile analysis was used to identify subgroups of patients with distinct stress profiles and to evaluate for differences in demographic and clinical characteristics and symptom severity scores among these subgroups.

METHODS

Patients completed measures of cancer-specific and COVID-19 stress, global stress, social isolation, loneliness, depression, state and trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. Differences among the subgroups in study measures were evaluated using parametric and non-parametric tests.

RESULTS

Using clinically meaningful cut-off scores for the stress measures, four distinct stress profiles were identified (ie, none class (51.3%); low stress and moderate loneliness class (24.4%), high stress and moderate loneliness class (14.0%), and very high stress and moderately high loneliness class (high, 10.3%)). Risk factors associated with membership in the high class included: younger age, lower annual household income, lower functional status and higher comorbidity burden. The two worst stress profiles reported clinically meaningful levels of all of the common symptoms associated with cancer and its treatments.

CONCLUSION

Findings from this study, obtained prior to the availability of COVID-19 vaccines and anti-viral medications, provide important 'benchmark data' to evaluate for changes in stress and symptom burden in patients with cancer in the postvaccine era and in patients with long COVID-19.

Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy

BACKGROUND

Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life.

OBJECTIVES

Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics.

METHODS

Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses.

RESULTS

Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function.

CONCLUSIONS

Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers.

IMPLICATIONS FOR PRACTICE

Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

California Stress, Trauma, and Resilience Study (CalSTARS) protocol: A multiomics-based cross-sectional investigation and randomized controlled trial to elucidate the biology of ACEs and test a precision intervention for reducing stress and enhancing resilience

Adverse Childhood Experiences (ACEs) are very common and presently implicated in 9 out of 10 leading causes of death in the United States. Despite this fact, our mechanistic understanding of how ACEs impact health is limited. Moreover, interventions for reducing stress presently use a one-size-fits-all approach that involves no treatment tailoring or precision. To address these issues, we developed a combined cross-sectional study and randomized controlled trial, called the California Stress, Trauma, and Resilience Study (CalSTARS), to (a) characterize how ACEs influence multisystem biological functioning in adults with all levels of ACE burden and current perceived stress, using multiomics and other complementary approaches, and (b) test the efficacy of our new California Precision Intervention for Stress and Resilience (PRECISE) in adults with elevated perceived stress levels who have experienced the full range of ACEs. The primary trial outcome is perceived stress, and the secondary outcomes span a variety of psychological, emotional, biological, and behavioral variables, as assessed using self-report measures, wearable technologies, and extensive biospecimens (i.e. DNA, saliva, blood, urine, & stool) that will be subjected to genomic, transcriptomic, proteomic, metabolomic, lipidomic, immunomic, and metagenomic/microbiome analysis. In this protocol paper, we describe the scientific gaps motivating this study as well as the sample, study design, procedures, measures, and planned analyses. Ultimately, our goal is to leverage the power of cutting-edge tools from psychology, multiomics, precision medicine, and translational bioinformatics to identify social, molecular, and immunological processes that can be targeted to reduce stress-related disease risk and enhance biopsychosocial resilience in individuals and communities worldwide.

Patterns of respiratory sinus arrhythmia and trajectories of anxiety and depressive symptoms in early adolescence

In children and adults, individual differences in patterns of respiratory sinus arrhythmia (RSA; i.e., interactions between resting RSA and RSA reactivity to stress) have emerged as a central predictor of internalizing symptoms. However, it is unclear whether individual differences in patterns of RSA also contribute to internalizing symptoms during the key developmental period of early adolescence, when rates of internalizing symptoms sharply increase. In the present multi-wave longitudinal study, we assessed whether patterns of RSA predicted trajectories of the two most common types of internalizing symptoms among adolescents: anxiety and depression. In the baseline session, we assessed RSA at rest and in response to a psychosocial stressor (Trier Social Stress Test [TSST]) in a sample of 75 early adolescents (Mage = 12.85). Youth then completed measures of anxiety and depressive symptoms at baseline and four times over approximately two years. Findings indicate that RSA patterns predicted trajectories of anxiety, but not depression. Specifically, region of significance analyses indicated that individuals with high resting RSA who demonstrated RSA augmentation to the lab stressor evinced decreasing anxiety over the follow-up period. In direct contrast, adolescents with high resting RSA in combination with RSA withdrawal to the stressor exhibited a trajectory of increasing anxiety. Findings provide preliminary evidence for understanding RSA as a developmentally salient risk or protective factor.

Using Ecological Momentary Assessments to Study How Daily Fluctuations in Psychological States Impact Stress, Well-Being, and Health

Despite great interest in how dynamic fluctuations in psychological states such as mood, social safety, energy, present-focused attention, and burnout impact stress, well-being, and health, most studies examining these constructs use retrospective assessments with relatively long time-lags. Here, we discuss how ecological momentary assessments (EMAs) address methodological issues associated with retrospective reports to help reveal dynamic associations between psychological states at small timescales that are often missed in stress and health research. In addition to helping researchers characterize daily and within-day fluctuations and temporal dynamics between different health-relevant processes, EMAs can elucidate mechanisms through which interventions reduce stress and enhance well-being. EMAs can also be used to identify changes that precede critical health events, which can in turn be used to deliver ecological momentary interventions, or just-in-time interventions, to help prevent such events from occurring. To enable this work, we provide examples of scales and single-item questions used in EMA studies, recommend study designs and statistical approaches that capitalize on EMA data, and discuss limitations of EMA methods. In doing so, we aim to demonstrate how, when used carefully, EMA methods are well poised to greatly advance our understanding of how intrapersonal dynamics affect stress levels, well-being, and human health.

Cumulative Stress Exposure and Cognitive Function Among Older Adults: The Moderating Role of a Healthy Lifestyle

OBJECTIVES

Although chronic stress is a risk factor for poor age-related cognitive health, there is limited research that has examined how cumulative stress across the lifespan affects cognitive aging. There may also be resilience factors that minimize the effects of cumulative stress on cognitive health. Engaging in a healthy lifestyle is protective against cognitive decline and may therefore interact with cumulative stress to buffer the stress-cognition relationship. The objective of the current study was to examine the moderating role of a healthy lifestyle, comprised of physical activity, social engagement, and sleep quality, in the relationship between cumulative stress exposure (CSE) and baseline and change in cognitive performance (global cognition, episodic memory, executive function) over 9 years among 1,297 older adults in the Midlife in the United States cohort (Mage = 69.0 ± 6.4, 57.8% female).

METHODS

CSE and healthy lifestyle behaviors were indexed using self-reported questionnaires at baseline, and cognitive function was assessed using a battery of standardized neuropsychological tests at baseline and follow-up.

RESULTS

Controlling for age, sex, education, race, marital status, employment status, hypertension, diabetes, and depression, higher CSE was associated with poorer baseline performance and slower decline over time in global cognition and executive function, but not episodic memory. A healthy lifestyle did not significantly moderate the relationship between cumulative stress and cognitive function. Exploratory analyses showed a significant cumulative stress-cognition relationship among females only.

DISCUSSION

This study lends support for a lifespan model of cognitive aging and suggests that the cognitive health consequences of stress extend beyond immediate timescales.

Monitoring Social Determinants of Health Assessing Patients and Communities

Because of the devastating health effects of social determinants of health (SDoH), it is important for the primary care provider to assess and monitor these types of stressors. This can be done via surveys, geomapping, or various biomarkers. To date, however, each of these methods is fraught with obstacles. There are currently are no validated "best" SDoH screening tools for use in clinical practice. Nor is geomapping, a perfect solution. Although mapping can collect location specific factors, it does not account for the fact that patients may live in one area, work in another and travel frequently to a third.

Psychological grit moderates the relation between lifetime stressor exposure and functional outcomes among HIV-seropositive and HIV-seronegative adults

The ability to maintain functional independence throughout the lifespan may be diminished among medically compromised and chronically stressed populations. People living with HIV are more likely to demonstrate functional impairment and report greater exposure to lifetime and chronic stressors than their seronegative counterparts. It is well-known that exposure to stressors and adversity is associated with functional impairment outcomes. However, to our knowledge, no studies have examined how protective factors such as psychological grit mitigate the negative effects of lifetime and chronic stressor exposure on functional impairment, and how this association differs by HIV-status. To address this issue, we studied associations between lifetime and chronic stressor exposure, grit, and functional impairment in 176 African American and non-Hispanic White HIV-seropositive (n = 100) and HIV-seronegative (n = 76) adults, aged 24-85 (M = 57.28, SD = 9.02). As hypothesised, HIV-seropositive status and lower grit, but not lifetime stressor exposure, were independently associated with more functional impairment. Moreover, there was a significant three-way interaction between HIV-status, grit, and lifetime stressor exposure, b = 0.07, p = 0.025, 95% CI [0.009, 0.135]. Specifically, lifetime stressor exposure was related to more functional impairment for HIV-seronegative-but not HIV-seropositive-adults who reported low levels of grit. These findings suggest that the protective effects of grit may differ across populations at risk for functional impairment.

Inadequate care and excessive overprotection during childhood are associated with the presence of diabetes mellitus in adulthood in a general Japanese population: a cross-sectional analysis from the Hisayama Study

OBJECTIVE

To investigate associations between parenting styles during childhood and diabetes in adulthood in a Japanese community.

METHODS

In 2011, 710 community-dwelling Japanese residents aged ≥ 40 years were assessed for the presence of diabetes and for their perceptions of the parenting style of their parents, as measured using the "care" and "overprotection" scales of the Parental Bonding Instrument. Care and overprotection scores for each parent were dichotomized by age-specific median values. Diabetes mellitus was defined as a fasting plasma glucose level of ≥ 7.0 mmol/L, a 2-h post-loaded glucose level of ≥ 11.1 mmol/L, HbA1c ≥ 6.5%, and/or the current use of insulin or oral glucose-lowering agents. The odds ratios (ORs) for prevalent diabetes were calculated using a logistic regression model.

RESULTS

The prevalence of diabetes was 14.9%. Subjects with a high paternal overprotection score had a significantly greater likelihood of prevalent diabetes than those with a low paternal overprotection score after adjusting for confounders (OR 1.71, 95% confidence interval [CI] 1.06-2.77), while there was no significant association between paternal care and diabetes. Additionally, the multivariable-adjusted ORs for the presence of diabetes were significantly higher in subjects with a low maternal care score (OR 1.61, 95%CI 1.00-2.60) or in subjects with a high maternal overprotection score (OR 1.73, 95%CI 1.08-2.80). Moreover, the subjects with a low care score and high overprotection score for both their father and mother had a significantly higher multivariable-adjusted OR of diabetes than those with a high care score and low overprotection score for both parents (OR 2,12, 95%CI 1.14-3.95).

CONCLUSIONS

This study suggests that inadequate care and excessive overprotection during childhood may contribute to the development of diabetes in adulthood.

The Insidious Influence of Stress: An Integrated Model of Stress, Executive Control, and Psychopathology

Although exposure to acute stress undoubtedly contributes to psychopathology, most individuals do not develop psychopathology following stress exposure. To explain this, biological, emotional, and cognitive responses to stress have been implicated, but individual differences in executive control (i.e., top-down control of cognition and behavior) measured in response to stress has only recently emerged as a potential factor contributing to psychopathology. In this review, we introduce a model-the integrated model of stress, executive control, and psychopathology-positing how the impairing effects of acute stress on executive control can contribute to psychopathology. We link to research on biological, emotional, and cognitive processes, all of which can be impacted by executive control, to propose a framework for how poorer executive control under conditions of acute stress can contribute to psychopathology. This integrated model is intended to further our understanding of who is more susceptible to the negative consequences of stress.

From financial wealth shocks to ill-health: Allostatic load and overload

A number of studies have associated financial wealth changes with health-related outcomes arguing that the effect is due to psychological distress and is immediate. In this paper, I examine this relationship for cumulative shocks to the financial wealth of American retirees using the allostatic load model of pathways from stress to poor health. Wealth shocks are identified from Health and Retirement Study reports of stock ownership along with significant negative discontinuities in high-frequency S&P500 index data. I find that a one standard deviation increase in cumulative shocks over two years increases the probability of elevated blood pressure by 9.5%, increases waist circumference by 1.2% and the cholesterol ratio by 6.1% for those whose wealth is all in shares. My findings suggest that the combined effect of random shocks to financial wealth over time is salient for health outcomes. This is consistent with the allostatic load model in which repeated activation of stress responses leads to cumulative wear and tear on the body.

Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color

BACKGROUND

Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced.

PURPOSE

The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons.

METHOD

Participants were 285 ethnic/racial minority young adults (Mage  = 25.18 years old, SD = 1.94, age range = 19-29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation.

RESULTS

Multiple regression analyses indicated that experiencing more-and more severe-stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social-psychological characteristic.

CONCLUSION

Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.

Cardiovascular, self-report, and behavioral stress reactivity to the group-based Trier Social Stress Test with pandemic-related protocol adaptations

Research using stress induction protocols such as the Trier Social Stress Test (TSST) and the TSST for groups (TSST-G) during the coronavirus disease (COVID-19) pandemic has been challenging. While institutional review boards have provided guidance on returning to face-to-face research using COVID-19 adaptations (e.g., masking, social distancing), whether these adaptations influence the effectiveness of social-evaluative stress induction remains unknown. We conducted a secondary data analysis from a randomized controlled trial to establish whether using COVID-19 adaptations (i.e., masking, social distancing, and using a single large conference room for the duration of the experiment) to the TSST-G protocol was able to reliably induce stress across cardiovascular, self-report, and behavioral indices of stress. Young adults (N = 53) underwent the TSST-G with COVID-19 adaptations. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), self-reported, and behavioral responses to the TSST-G, and all variables indicated successful stress induction. Increases in SBP (18 mmHg) and DBP (14 mmHg) were similar in magnitude as those in standard in-person TSST protocols. Increases in HR (9 beats per minute) were smaller in magnitude than standard in-person TSST protocols, but slightly larger than increases documented in remote TSST protocols. The cardiovascular, self-report, and behavioral indices of stress reactivity provide confidence in the effectiveness of TSST-G with COVID-19 adaptations to reliably induce stress. In-person TSST protocols with COVID-19 adaptations represent an alternate option to remote TSST protocols for stress induction researchers to use during times when masking or social distancing are necessary.

Higher Stress in Oncology Patients is Associated With Cognitive and Evening Physical Fatigue Severity

CONTEXT

Cognitive and physical fatigue are common symptoms experienced by oncology patients. Exposure to stressful life events (SLE), cancer-related stressors, coping styles, and levels of resilience may influence the severity of both dimensions of fatigue.

OBJECTIVES

Evaluate for differences in global, cancer-specific, and cumulative life stress, as well as resilience and coping in oncology patients (n=1332) with distinct cognitive fatigue AND evening physical fatigue profiles.

METHODS

Latent profile analysis, which combined the two symptom scores, identified three subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles (i.e., Low, Moderate, High). Patients completed measures of global, cancer-specific, and cumulative life stress as well measures of resilience and coping. Differences among the latent classes in the various measures were evaluated using parametric and nonparametric tests.

RESULTS

Compared to Low class, the other two classes reported higher global and cancer-specific stress. In addition, they reported higher occurrence rates for sexual harassment and being forced to touch prior to 16 years of age. Compared to the other two classes, High class reported lower resilience scores and higher use of denial, substance use, and behavioral disengagement.

CONCLUSION

To decrease both cognitive and evening physical fatigue, clinicians need to assess for relevant stressors and initiate interventions to increase resilience and the use of engagement coping strategies. Additional research is warranted on the relative contribution of various social determinants of health to both cognitive and physical fatigue in oncology patients receiving chemotherapy.

Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses

Subjective stress severity appraisals have consistently emerged as better predictors of poor health than stressor exposure, but the reason for this is unclear. Subjective stress may better predict poor health for one of at least two reasons. First, because stressor exposure measures consider all stressors as equal, stress severity measures-which "weight" stressors by self-reported severity-might better predict poor health simply by not treating all stressors as being equally impactful. Second, subjective stress appraisals may index important individual differences in stress vulnerability. We tested these two possibilities in this preregistered, two-study manuscript. Across these two different studies, subjective stress severity was a better predictor of poor health than independently weighted stress severity or stressor exposure. These results demonstrate that, beyond weighting of stressful experiences, subjective stress severity indexes health-relevant individual differences. Moreover, the results suggest that subjective stress severity may be the preferred stress summary metric even when derived from imprecise stress assessment instruments.

Covid-19 Effects on Psychological Outcomes: How Do Gender Responses Differ?

The study aims at understanding the relationships between the fear of COVID-19 and perceived stress, wellbeing, and life satisfaction. The study also analyses the role of gender on the relationship of fear of COVID-19 with these study variables. For this, a cross-sectional study was conducted among 1125 participants in India, comprising 638 men and 487 women. Structural equation model was used to analyse the data. It was found that the fear of COVID-19 is positively related to perceived stress and negatively related to wellbeing and life satisfaction. It was also found that, these relationships are stronger among women than among men. The study shows the importance of psychiatric assessment during pandemic times and alerts policy makers and society in general, to take measures for ensuring mental health among people during times of crisis. Future studies can include longitudinal research for a comprehensive understanding of the psychological impacts of the pandemic.

Genetic Contribution of the Adrenergic, Cholinergic, and Serotonergic Systems to Leiomyoma Development and Treatment

The link between the autonomic nervous system and tumor biology is being unfold. We aim to study the contribution of genes of the adrenergic (ADBR2 - rs1042713, NM_000024.6:c.46G>A, NP_000015.2:p. Gly16Arg), cholinergic (CHRNA5 - rs16969968, NM_000745.3:c.1192G>A, NP_000736.2:p.Asp398Asn), and serotonergic systems (SLC6A4 - 5-HTTVNTR-intron2, HTR2A - rs6313, NM_000621.5:c.102C>T, NP_ 001365853 .1: p. Ser 34=) to gynecological tumorigenesis and their treatment by embolization. A total of 517 DNA samples from women were analyzed. Samples were genotyped by PCR, PCR-RFLP and EndPoint genotyping. Results show a statistically significant association between the AA genotype of the ADBR2 gene and GG genotype of the CHRNA5 gene with leiomyoma (OR = 2.311; p = 0.003 and OR = 2.165; p = 0.001, respectively), and the epistatic interaction between genotypes increases the risk (OR = 2.458; p= 0.043). The GG genotype (CHRNA5) shows a lower reduction of the volume of the main leiomyoma after treatment (p=0.015). Combination of the genotypes 12/12-AA (SLC6A4 - ADBR2) increases the risk to leiomyoma (OR = 2.540, p= 0.030). TT genotype of HTR2A gene in combination with any of the two risk genotypes (of ADBR2 or CHRNA5) increases substantially the risk (OR = 5.266, p = 0.006; OR = 6.364, p=0.007, respectively). We conclude that ADBR2 and CHRNA5 genes have a relevant role that is enhanced by the epistatic relationship with the genes HTR2A and SLC6A4. CHRNA5 gene may also be a modulator of the success of embolization. We confirm the contribution of the genetics of Autonomous Nervous System to tumor biology.

Prefrontal Cortex Volume Mediates the Relationship Between Lifetime Chronic Stressor Exposure and Cognition in People Living With and Without HIV

OBJECTIVE

Despite considerable research documenting how stress affects brain and neurobehavioral outcomes, few studies have assessed stressor exposure occurring over the entire life span, and no studies have investigated these associations in people living with HIV (PLWH), despite the high stress and disease burden experienced by this population. To address this issue, we examined how cumulative lifetime chronic stressor exposure related to cognition and brain integrity (i.e., gray matter volume) in White and African American PLWH and HIV-uninfected (HIV-) adults.

METHOD

Participants were 91 community-dwelling adults (47.3% PLWH) who completed a comprehensive interview assessing lifetime stressor exposure using the Stress and Adversity Inventory and underwent neuropsychological testing and structural magnetic resonance imaging. Regional brain volumes were derived from T1-weighted images processed through Freesurfer.

RESULTS

As hypothesized, greater lifetime chronic stressor exposure was related to worse global cognition ( b = -0.06, standard error [SE] = 0.03, p = .032), processing speed ( b = -0.04, SE = 0.14, p = .041), and executive functioning ( b = -0.06, SE = 0.02, p = .02), and smaller prefrontal cortex (PFC) volume ( b = -16.20, SE = 5.78, p = .007). HIV status did not moderate any of these associations. Moreover, results from mediation analyses demonstrated that the relationship between lifetime chronic stressor exposure and processing speed was fully mediated by PFC volume.

CONCLUSIONS

These results highlight the critical role of the PFC in the maintenance of processing speed abilities and its vulnerability to cumulative stressor exposure. Specifically, the negative impact of lifetime chronic stressor exposure on cognition-particularly functions reliant on frontal lobe integrity-may be partly driven by smaller volumes in the PFC.

Associations between Stigma, Cognitive Appraisals, Coping Strategies and Stress Responses among Japanese Women Undergoing Infertility Treatment

The number of infertility treatment cycles in Japan is the highest worldwide. Studies have shown that stigma is a predictor of stress-related symptoms including anxiety and depression in women undergoing infertility treatment. Stress management to prevent stress-related symptoms may be crucial; however, few studies have examined the model of stigma and stress responses. Based on the stress-coping model, we hypothesized that stigma threatens the identity of such women and that coping failure increases stress responses. We aimed to explore the role of cognitive appraisals and coping strategies as mediators of the association between the stigma of infertility and stress responses. In December 2021, we conducted a cross-sectional study in Japan, in which 254 women undergoing infertility treatment completed a web-based survey. Hierarchical multiple regression analysis was conducted to analyze the associations between stigma, cognitive appraisals, coping strategies, and stress responses. The results showed that explanatory power increased with each additional variable in the following order: stigma, cognitive appraisals, and coping. Participants with a high level of stigma evaluated it as threatening, and used self-blame and venting coping strategies, and showed higher stress responses. Conversely, participants who used positive reframing coping strategies exhibited lower stress responses. Based on this, effective strategies to address stigma and stress responses are necessitated.

Associations between lifetime stress exposure and the error-related negativity (ERN) differ based on stressor characteristics and exposure timing in young adults

Life stress increases risk for multiple forms of psychopathology, in part by altering neural processes involved in performance monitoring. However, the ways in which these stress-cognition effects are influenced by the specific timing and types of life stressors experienced remains poorly understood. To address this gap, we examined how different social-psychological characteristics and developmental timing of stressors are related to the error-related negativity (ERN), a negative-going deflection in the event-related potential (ERP) waveform that is observed from 0 to 100 ms following error commission. A sample of 203 emerging adults performed an ERN-eliciting arrow flanker task and completed an interview-based measure of lifetime stress exposure. Adjusting for stress severity during other developmental periods, there was a small-to-medium effect of stress on performance monitoring, such that more severe total stress exposure, as well as more severe social-evaluative stress in particular, experienced during early adolescence significantly predicted an enhanced ERN. These results suggest that early adolescence may be a sensitive developmental period during which stress exposure may result in lasting adaptations to neural networks implicated in performance monitoring.

Stress-induced biological aging: A review and guide for research priorities

Exposure to chronic adverse conditions, and the resultant activation of the neurobiological response cascade, has been associated with an increased risk of early onset of age-related disease and, recently, with an older biological age. This body of research has led to the hypothesis that exposure to stressful life experiences, when occurring repeatedly or over a prolonged period, may accelerate the rate at which the body ages. The mechanisms through which chronic psychosocial stress influences distinct biological aging pathways to alter rates of aging likely involve multiple layers in the physiological-molecular network. In this review, we integrate research using animal, human, and in vitro models to begin to delineate the distinct pathways through which chronic psychosocial stress may impact biological aging, as well as the neuroendocrine mediators (i.e., norepinephrine, epinephrine, and glucocorticoids) that may drive these effects. Findings highlight key connections between stress and aging, namely cellular metabolic activity, DNA damage, telomere length, cellular senescence, and inflammatory response patterns. We conclude with a guiding framework and conceptual model that outlines the most promising biological pathways by which chronic adverse conditions could accelerate aging and point to key missing gaps in knowledge where future research could best answer these pressing questions.

Positive Cognitive Reappraisal in Stress Resilience, Mental Health, and Well-Being: A Comprehensive Systematic Review

Stress-related psychopathology is on the rise, and there is a pressing need for improved prevention strategies. Positive appraisal style, the tendency to appraise potentially threatening situations in a positive way, has been proposed to act as a key resilience mechanism and therefore offers a potential target for preventive approaches. In this article, we review n  =  99 studies investigating associations of positive cognitive reappraisal, an important sub-facet of positive appraisal style, with outcome-based resilience and relevant other outcomes, which are considered resilience-related. According to the studies reviewed, positive cognitive reappraisal moderates the relation between stressors and negative outcomes and is positively related to several resilience-related outcomes. It also mediates between other resilience factors and resilience, suggesting it is a proximal resilience factor.

Adverse childhood experiences, diabetes and associated conditions, preventive care practices and health care access: A population-based study

Our objective was to examine how Adverse Childhood Experiences (ACEs) are associated with diabetes mellitus, diabetes-related conditions, and preventive care practices. We used data from the Behavioral Risk Factor Surveillance System (BRFSS) 2009-2012, a cross-sectional, population-based survey, to assess ACEs, diabetes, and health care access in 179,375 adults. In those with diabetes (n = 21,007), we assessed the association of ACEs with myocardial infarction, stroke, and five Healthy People 2020 (HP2020) diabetes-related preventive-care objectives (n = 13,152). Healthcare access indicators included lack of a regular health care provider, insurance, and difficulty affording health care. Regression analyses adjusted for age, sex, and race. The adjusted odds ratio (AOR) of diabetes increased in a stepwise fashion by ACE exposure, ranging from 1.2 (95% CI 1.1-1.3) for 1 ACE to 1.7 (95% CI 1.6-1.9) for ≥4 ACEs, versus having no ACEs. In persons with diabetes, those with ≥4 ACEs had an elevated adjusted odds of myocardial infarction (AOR = 1.6, 95% CI 1.2-2.0) and stroke (AOR = 1.8, 95% CI 1.3-2.4), versus having no ACEs. ACEs were also associated with a reduction in the adjusted percent of HP2020 diabetes objectives met: 72.9% (95% CI 71.3-74.5) for those with no ACEs versus only 66.5% (95% CI 63.8-69.3%) for those with ≥4 ACEs (p = 0.0002). Finally, ACEs predicted worse health care access in a stepwise fashion for all indicators. In conclusion, ACEs are associated with greater prevalence of diabetes and associated disease conditions, and with meeting fewer HP2020 prevention goals. Implementing ACE screening and trauma-informed health care practices are thus recommended.

Maternal Stress and Human Milk Antibodies During the COVID-19 Pandemic

Importance

SARS-CoV-2-specific antibodies in human milk might protect the breastfed infant against COVID-19. One of the factors that may influence human milk antibodies is psychological stress, which is suggested to be increased in lactating women during the COVID-19 pandemic.

Objective

To determine whether psychological stress is increased in lactating women during the COVID-19 pandemic, and if maternal stress is associated with the level of SARS-CoV-2-specific antibodies in human milk.

Design

Population-based prospective cohort study.

Setting

Data collection took place in the Netherlands between October 2020 and February 2021.

Participants

Lactating women living in the Netherlands were eligible to participate in this study. In total, 2310 women were included.

Exposures

Stress exposure during the COVID-19 pandemic was determined using the Perceived Stress Scale (PSS) questionnaire and maternal lifetime stress was determined by the Life Stressor Checklist - revised (LSC-r) questionnaire.

Main Outcomes and Measures

Stress experience during the COVID-19 pandemic was compared with a pre-pandemic cohort. SARS-CoV-2-specific antibodies in human milk were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) with the Spike protein of SARS-CoV-2. The association between maternal stress and human milk antibodies was determined using a multiple regression model.

Results

The PSS score of lactating mothers was not increased during the pandemic compared to the PSS score in the prepandemic cohort. Six hundred ninety-one participants had SARS-CoV-2-specific antibodies and were included in the regression models to assess the association between maternal stress and human milk antibodies. No association was found between PSS scores and human milk antibodies. In contrast, the LSC-r score was negatively associated with SARS-CoV-2-specific IgA in human milk (β = 0.98, 95% CI: 0.96-0.997, p = 0.03).

Conclusions and Relevance

Our results suggest that lactating women in the Netherlands did not experience higher stress levels during the COVID-19 pandemic. Breastfed infants of mothers with high chronic stress levels receive lower amounts of antibodies through human milk, which possibly makes them more vulnerable to respiratory infections. This emphasizes the importance of psychological wellbeing during lactation.

Measuring Perceived Psychological Stress in Urban Built Environments Using Google Street View and Deep Learning

An urban built environment is an important part of the daily lives of urban residents. Correspondingly, a poor design can lead to psychological stress, which can be harmful to their psychological and physical well-being. The relationship between the urban built environment and the perceived psychological stress of residents is a significant in many disciplines. Further research is needed to determine the stress level experienced by residents in the built environment on a large scale and identify the relationship between the visual components of the built environment and perceived psychological stress. Recent developments in big data and deep learning technology mean that the technical support required to measure the perceived psychological stress of residents has now become available. In this context, this study explored a method for a rapid and large-scale determination of the perceived psychological stress among urban residents through a deep learning approach. An empirical study was conducted in Gangnam District, Seoul, South Korea, and the SegNet deep learning algorithm was used to segment and classify the visual elements of street views. In addition, a human-machine adversarial model using random forest as a framework was employed to score the perception of the perceived psychological stress in the built environment. Consequently, we found a strong spatial autocorrelation in the perceived psychological stress in space, with more low-low clusters in the urban traffic arteries and riverine areas in Gangnam district and more high-high clusters in the commercial and residential areas. We also analyzed the street view images for three types of stress perception (i.e., low, medium and high) and obtained the percentage of each street view element combination under different stresses. Using multiple linear regression, we found that walls and buildings cause psychological stress, whereas sky, trees and roads relieve it. Our analytical study integrates street view big data with deep learning and proposes an innovative method for measuring the perceived psychological stress of residents in the built environment. The research methodology and results can be a reference for urban planning and design from a human centered perspective.

Persistent Symptoms, Lyme Disease, and Prior Trauma

ABSTRACT

One prior study suggests that traumatic events before Lyme disease play an important role in symptom severity. We examined this hypothesis among 60 individuals with persistent symptoms after Lyme disease using validated measures of trauma history, mental and physical symptoms, and functional status. Analysis of variance with Tukey-Kramer multiple comparisons test revealed that a greater number of traumatic events were significantly associated with greater symptom severity on the scales of mood (stress, depression, and anxiety), cognition, multisystem symptom burden, and functional status (mental and physical), but not on measures of pain and fatigue. The effect sizes-meaningful but not large (0.17-0.29)-were mostly produced by comparison with individuals reporting multiple prior traumatic events, representing half of the posttreatment Lyme disease syndrome (PTLDS) group. In conclusion, although PTLDS may be exacerbated by past trauma, trauma plays a role in only a subgroup of PTLDS. Whether addressing prior trauma can improve outcomes in this subgroup requires study.