Hair cortisol and lifetime discrimination: Moderation by subjective social status

How intersectional identity and discrimination contribute to depressive symptoms and hair cortisol concentrations among low-income, racially and sexual diverse adults

Significant gaps remain in our understanding of how minority stress patterns health outcomes for adults at the intersection of ethnicity/ race and sexual orientation. In particular, little is known about how cumulative cortisol (measured via hair cortisol concentration as an indicator of chronic stress; HCC) and depressive symptoms are related to holding an intersectional minoritized identity (e.g., sexual minority people of color; SM-POC) and experiencing intersectional discrimination (e.g., heterosexism and racism). The current study examined the relationship between intersectional identity or discrimination and HCC or depressive symptoms. Participants were (N = 69) low-income, predominantly sexual minority and people of color in the Greater Los Angeles area. Participants completed self-report measures and provided a hair sample for cortisol assay. Intersectional identity was not associated with greater HCC or depressive symptoms. However, differences in HCC emerged based on discrimination type (F (2, 66) = 3.74, p = .03, η2= .10). Participants who reported intersectional heterosexism and racism had greater HCC concentrations (M = 30.71, SD = 29.71) than did participants who reported only a single type of discrimination (i.e., racism only or heterosexism only; M = 15.35, SD = 2.60, p = .03, 95 % CI = [2.01, 28.71]), or than participants who reported neither types (M = 12.40, SD = 16.11, p = .01, 95 % CI [4.85, 31.76]). There were no differences in depressive symptoms by discrimination type. These results provide initial empirical support to largely theoretical arguments about how to investigate mechanisms underlying disparities to understand why and how minority stress is patterned. Findings showing associations between intersectional discrimination and HCC, but not depressive symptoms, provide potential support for theories about examining allostatic load markers to identify stress-related etiological mechanisms linked to health disparities among minoritized populations.

Racism and hypothalamic-pituitary-adrenal axis functioning in childhood as risks for health disparities across the lifespan

Racism is a primary social determinant of health and chronic stressor that affects the physical and mental health of People of Color and Indigenous Individuals (POCI) and perpetuates racial and ethnic health disparities. Despite the impact of racism on POCI, the mechanisms through which experiences of racism result in negative health outcomes remain understudied, in particular among children. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is one of the possible mechanisms. Frequent and prolonged exposure to chronic stressors may result in dysregulation of the HPA axis, and in turn cause adverse physical and psychological health outcomes for POCI children. This paper argues for the importance of examining HPA axis dysregulation as a mechanism that links racism during early childhood to negative health outcomes over the lifespan. Several studies have explored the relationship between racism and HPA axis dysregulation during adulthood and adolescence and have found associations between racism and salivary and hair cortisol. Recent studies have identified racial and ethnic differences in cortisol levels during early childhood, but only one study, to our knowledge, explored whether the differences are attributed to racism. In this paper, we conduct a review of the existing literature on the links between racism and HPA axis dysregulation during adulthood and adolescence given the dearth of studies exploring this relationship during early childhood. We also highlight the importance of utilizing an intersectionality framework in the study of racism and health to provide a more comprehensive and nuanced understanding of health disparities among and within racial/ethnic groups. Using this evidence along with consideration of relevant models, we propose how HPA axis dysregulation identified early in life may foreshadow children's increased risk for negative health outcomes from racism and other systems of oppression and signal the need for prevention and intervention.

Belonging Exacerbates the Relations Between Racial Climate Stress and Physiological Dysregulation

OBJECTIVE

Belonging is often considered a buffer against the physical and emotional consequences of discrimination and racial climate stress Youth Soc. 48(5):649-72, 2016. However, recent research suggests that feelings of belonging toward an institution can be detrimental when an individual feels discriminated against by the same institution to which one feels a sense of connection J Behav Med. 44(4):571-8, 2021. Therefore, the present study aimed to investigate the moderating role of institutional belonging in the relationship between racial climate stress and health, as indexed by allostatic load (AL), a multi-system indicator of physiological dysregulation.

METHODS

In a sample of Black and White college students (N = 150; White = 82; Black = 68), self-reported racial climate stress, institutional belonging, and various demographic variables were collected. An AL composite was also collected, comprised of six biological measures of the SAM system, HPA axis, cardiovascular system, and metabolic system. Multiple regression analyses were conducted to explore the relationships between these variables.

RESULTS

Results demonstrated no main effect of racial climate stress on AL but did show a significant interaction between racial climate stress and belonging, such that the positive relationship between racial climate stress and AL was significant only for those who also felt high levels of institutional belonging (β int = .05, p = .006, 95% CI = 0.01 - 0.08).

CONCLUSIONS

Feeling a sense of belonging may have negative physiological consequences for those who experience racial climate stress in a college setting.

Prosocial reputation and stress among contemporary hunter-gatherers: the Hadza case

It has been suggested that having a reputation for being prosocial is a critical part of social status across all human societies. It has also been argued that prosocial behavior confers benefits, whether physiological, such as stress reduction, or social, such as building allies or becoming more popular. Here, we investigate the relationship between helping reputation (being named as someone others would go to for help), and hair-derived chronic stress (hair cortisol concentration). In a sample of 77 women and 62 men, we found that perceived helping reputation was not related to chronic stress. Overall, the results of our study suggest that, in an egalitarian society with fluid camp membership and widely practiced generosity such as the Hadza, helping reputation does not necessarily boost stress-related health benefits through prestige-signaling mechanisms observed in hierarchical, large-scale societies.

Black-White differences in perceived lifetime discrimination by education and income in the MIDUS Study in the U.S

There is growing evidence on the negative effects of perceived discrimination on health outcomes and their interactions with indicators of socioeconomic status. However, less has been studied on whether income and education lead individuals of a different race to encounter different discriminatory experiences in their lifetime. Using data from the national survey of the Midlife Development in the United States-MIDUS 1 (1995-1996) and MIDUS Refresher (2011-2014)-on eight measures of perceived lifetime discrimination, this study compares discriminatory experiences of Black and White persons in two time periods. We applied generalized structural equation models and generalized linear models to test multiplicative effects of income and education by race on lifetime discrimination. In both periods, we find substantive disparities between White and Black people in all types of lifetime discrimination, with Black people reporting much higher levels of discrimination. Such disparities exacerbated in the top cohorts of society, yet these associations have changed in time, with White individuals reporting increasing levels of discrimination. Results show that, for Black people in the mid-1990s, perceived discrimination increased as education and income increased. This finding persisted for education by the early 2010s; income effects changed as now both, low- and high-income Black people, reported the highest levels of discrimination. These findings highlight a policy conundrum, given that increasing income and education represent a desirable course of action to improve overall discrimination and health outcomes. Yet, we show that they may unintendingly exacerbate racial disparities in discrimination. We also show that the U.S. is moving toward a stagnation period in health outcomes improvement, with racial disparities in discrimination shrinking at the expense of a deterioration of whites' lifetime discriminatory experiences. Our results highlight the need for a multi-systems policy approach to prevent all forms of discrimination including those due to historical, institutional, legal, and sociopolitical structures.

Threat versus deprivation in mother's childhood: Differential relations to hair cortisol and psychopathology in pregnancy

BACKGROUND

The negative effects of childhood maltreatment can be intergenerational, and the prenatal period may play an important role in this intergenerational transmission. Maternal hypothalamic-pituitary-adrenal (HPA) axis dysfunction and maternal psychopathology represent two mechanisms through which the effects of childhood maltreatment are hypothesized to be transmitted across generations.

OBJECTIVE

This study first sought to extend prior research on pathways of intergenerational transmission by examining whether mothers' childhood experiences of abuse versus neglect differentially relate to maternal HPA activity and to maternal psychopathology during the prenatal period. Second, exploratory analyses examined the links between maternal variables and their State Protective Service involvement as a parent, as an indicator of maladaptive caregiving.

METHODS

During the third trimester of pregnancy, 51 women reported on experiences of childhood maltreatment, on State Protective Service involvement as an adult parent, and on current depressive and post-traumatic stress symptoms, and provided a hair sample for cortisol assay.

RESULTS

Regression analyses indicated that greater severity of abuse, but not neglect, in childhood was associated with higher maternal depressive symptoms (β = 0.488, p = .020). In contrast, greater severity of neglect, but not abuse, in mothers' childhood was associated with lower maternal hair cortisol concentration (β = -0.437, p = .031). Lower maternal hair cortisol concentration, but not maternal psychopathology or severity of childhood abuse or neglect, in turn, was associated with State Protective Service involvement (β = -0.785, p < .001).

CONCLUSIONS

Findings extend prior work by suggesting that childhood abuse and neglect may have different sequelae for mothers during pregnancy and that these sequelae may have different relations to parenting.

Recruitment and Feasibility of Hair Cortisol Collection in a Sample of Ethnically and Sexually Diverse, Low-Income Adults: A Qualitative Community-Partnered Participatory Research Study

The current study describes how a community-partnered participatory research (CPPR) model was used to enhance hair cortisol research engagement among low-income adults of diverse ethnicities and sexual and gender identities. Participants' reported motivations and concerns surrounding providing a hair sample are also described. Participants from a larger longitudinal study were invited to provide a hair sample and/or complete acceptability interviews. Results indicated that 71% of all persons (N=133) contacted participated in the current study, of whom 82% provided hair samples. Several themes emerged from the interviews indicating that participants were motivated to provide a hair sample due to internal and external factors; however, concerns about mistrust of research remained. Thus, collecting biospecimens in research with underserved groups requires careful consideration of benefits and risks to the individual and their communities. Our results provide guidelines for engaging low-income racially/ethnically and sexually diverse community members in biospecimen research to understand stress-health relationships.

Chronic stress predicts post-traumatic stress disorder symptoms via executive function deficits among urban American Indian children

Little is known about how chronic exposure to stress affects mental health among American Indian (AI) children. The current study aimed to fill this gap by exploring if hair cortisol concentration (HCC), an indicator of chronic stress, predicted post-traumatic stress disorder (PTSD) symptoms through deficits in executive function (EF) skills commonly referred to as inhibitory control, working memory, and cognitive flexibility. A total of 163 urban AI children between 8- and 15-years old participated in the study (92 girls, 56.4%; M_age = 11.19, SD = 1.98). Chronic stress was measured as the concentration of cortisol in children's hair. EF deficits and PTSD symptoms were reported by primary caregivers using the Behavior Rating Inventory of Executive Function and the Trauma Symptom Checklist for Young Children. The results demonstrated that higher HCC was indirectly associated with more PTSD symptoms through deficits in EF skills. Specifically, higher levels of HCC were related to more symptoms of PTSD arousal through impaired working memory, and more symptoms of PTSD avoidance and Intrusion through deficits in cognitive flexibility. The findings suggest interventions that reduce or buffer chronic stress, or that focus on improving EF skills, may promote not only cognitive development but also the mental health of AI children.

Sociodemographics and chronic stress in mother-toddler dyads living in poverty

Experiencing chronic stress early in life is associated with later health disparities, and poverty may be a significant stressor for both mothers and children. With a sample of primarily Black and White mothers (N = 75) and toddlers (N = 71) living in poverty in the United States, we examined the direct relations between sociodemographic conditions of poverty and chronic physiological stress. Mothers completed questionnaires on sociodemographics, including mother/toddler race, mother's education, father's education, poverty level, economic hardship, marital status, unemployment status, and toddler sex. Physiological chronic stress was measured by assaying the cortisol content of 4 cm samples of hair cut from the posterior vertex of mothers and toddlers (20-24 months of age) to represent 4 months of stress. Mothers' and toddlers' chronic stress was significantly, moderately, and positively associated. Toddlers had a trending relationship of moderately higher chronic stress if they were Black compared to not Black. Mothers had significantly, moderately higher chronic stress if they were Black or had a Black toddler (compared to not Black), not married (compared to married), or were working (compared to not working). The findings suggest that these mothers, simultaneously navigating poverty and parenting a toddler, need resources to reduce chronic stress.

Hair cortisol concentrations among urban and rural-dwelling mother-child dyads, La Romana, Dominican Republic

Hair cortisol concentrations (HCC) were studied in mother-child dyads of La Romana, Dominican Republic (DR), a low-income city, and of the surrounding bateyes, sugarcane plantation villages with inhabitants frequently of Haitian descent. Populations of low socioeconomic status (SES) experience hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Urban communities may be increasingly exposed to stressors such as crime and concentrated poverty whereas rural communities may be devoid of important community resources. As a result, the experience of stress in poverty may differ by place of residence. The goal of this study was to examine differences in HCC among urban and rural-dwelling mother-child dyads in socioeconomically disadvantaged communities surrounding La Romana, DR. Forty-five mother/child dyads were enrolled in La Romana and 45 at several bateyes surrounding La Romana. Mothers were ≥18 years and children were between 7 and 14 years. Mothers self-reported perceived stress and demographic factors. Hair samples were collected from mothers and children, and HCC was assessed using enzyme-linked immunosorbent assays. General linear models examined associations between socioeconomic factors and HCC, and between maternal and child HCC. HCC were measured in 88 maternal and 87 child samples (N = 175). Mothers living in a batey had higher HCC than those living in La Romana (p = 0.001). HCC was positively associated among maternal-child dyads (p = 0.001). Further, Haitian-born mothers as a population who frequently live in a rural batey experienced higher HCC (p = 0.025) that may partially be explained by discriminatory practices in the DR. This research helps to elucidate the impact of urban and rural environmental settings on HCC.Lay summaryThis study focuses on chronic stress, measured by hair cortisol levels, among a low-income population of Dominican and Haitian mother-child pairs who live in urban and rural settings. We found that Haitian-born mothers, who frequently live in a rural batey, had higher hair cortisol levels than Dominican born mothers. Hair cortisol levels between mothers and their children were positively associated. This study addresses the impact of urban and rural environments on the stress response among socioeconomically disadvantaged persons living in an upper middle income country who bear an excessive burden of psychosocial stress.

Discrimination and hair cortisol concentration among asian, latinx and white young adults

Discrimination is a form of chronic stress and hair cortisol concentration is an emerging biomarker of chronic stress. In a sample of 83 first-year college students (age x⋅⋅−=17.65, SD=48, 69% female, 84% United States-born, 24% Asian, 21% Latinx, and 55% White), the current study investigates associations between hair cortisol concentration with discrimination stress assessed across two timeframes: past year and past two weeks. Significant associations were observed for past year discrimination and hair cortisol concentration levels, but not for discrimination over the past two weeks. The current study contributes to a growing body of evidence linking discrimination stress exposure to neuroendocrine functioning.

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Analyzes hair cortisol concentration (HCC) to measure chronic discrimination.

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HCC was significantly associated with discrimination over the past year.

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HCC was not associated with discrimination over the past 2 weeks.

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Highlights HCC as a neuroendocrine biomarker of discrimination.

Lower hair cortisol among patients with sickle cell disease may indicate decreased adrenal reserves

INTRODUCTION

Sickle cell disease (SCD) is a chronic illness that presents with a wide range of phenotypic variation. Stress may be a contributing factor to differences that are found in this population.

OBJECTIVES

Our objective is to determine the relationship between hair cortisol content (HCC), a biomarker of stress, and other clinical measures in individuals with SCD.

METHODS

We collected hair samples and other clinical measures from 73 subjects with SCD (mean age: 39 ± 12 years, 63% female).

RESULTS

HCC was lower among individuals who had greater than 30% hemoglobin S, compared with those who had less than 30% hemoglobin S (W=272.5, P=0.01). Lower HCC was also associated with report of not being on a chronic transfusion program (β=48.34, SE=14.09, P=0.001) and higher ferritin levels (β=-0.006, SE=0.002, P=0.02). Furthermore, HCC was significantly correlated with serum cortisol (r_s=0.26, P=0.03) and corticosterone (r_s=0.29, P=0.01). We also observed a consistent pattern of low steroid values among our population.

CONCLUSION

Our findings suggest that individuals with higher hemoglobin S and ferritin, both markers of severe SCD, may have decreased cortisol levels. This is consistent with the relationship we observed between higher HCC among individuals who are on a chronic blood transfusion program, which typically increases quality of life. Our results suggest that hair cortisol may be an indicator in patients with SCD who could be at risk for developing adrenal insufficiency. We recommend that clinicians treating patients with SCD follow the Endocrine Society guidelines for testing for adrenal insufficiency and treat accordingly.

Race moderates the association of perceived everyday discrimination and hair cortisol concentration

The influence of discrimination on hypothalamic-pituitary-adrenal (HPA) axis function is considered to be more pronounced for racial minority versus majority groups, although empirical support for this argument is not strong. This study examined whether the association of perceived discrimination was more strongly associated with long-term, retrospective cortisol output (as measured by hair cortisol concentration [HCC]) among African American compared to White adults. Participants included 141 community-dwelling adults (72 White, 69 African American; mean age 45.8 years; 67% females). The Everyday Discrimination Scale assessed perceived discrimination. The first 3 cm of proximal scalp hair was analyzed for HCC using enzyme-linked immunoassay. Associations between race, perceived discrimination and HCC were examined using hierarchical multiple regression. African Americans had higher HCC than Whites, but both groups reported perceived discrimination with similar frequency. Race moderated the association between perceived discrimination and HCC (R2 interaction = 0.03, p = 0.007) such that perceived discrimination was positively associated with HCC among African Americans (β = 0.28, p = 0.007), but not Whites (β = -0.11, p = 0.274). Perceived discrimination did not mediate the association between race and HCC (β for indirect effect = 0.025, 95% CI [-.003, 0.087]). Although perceived discrimination did not differ between races, perceived discrimination was positively associated with retrospective levels of cortisol in scalp hair among African Americans but not Whites. This may suggest that characteristics of discrimination other than frequency are particularly salient to HPA axis function among African Americans (e.g. attribution, severity, historical context).LAY SUMMARYThis study found that greater perceived discrimination frequency was associated with greater long-term cortisol secretion (i.e. hair cortisol concentration) among African American compared to White adults. Both groups reported similar discrimination frequency, so the uniqueness of African Americans' experience with discrimination may be salient to HPA axis upregulation for this population.

Physiological Significance of Discrimination on Stress Markers, Obesity, and LDL Oxidation among a European American and African American Cohort of Females

BACKGROUND

Factors underlying physiological reactions from perceived discrimination and its relation to adverse health outcomes are not completely understood. The main purpose of this study was to test the hypothesis that experiences of discrimination (recent and lifetime) correlate with biomarkers of stress, oxidative stress, and obesity among adult females.

METHOD

Data on 62 females who self-identify as African American (AA; n = 31) or European American (EA; n = 31) aged 21-45 years were included. Discrimination experiences (recent and lifetime) were evaluated based on a validated instrument. Stress was assessed based on hair cortisol (HC) and salivary cortisol (SC), hsC-reactive protein (hsCRP), cardiovascular markers, and LDL-cholesterol oxidation. Obesity was measured based on BMI, waist circumference, and body fat percent. Multiple linear regression analyses were performed to evaluate the influence of experiences of discrimination.

RESULTS

Significant differences in experiences of discrimination were observed by race (p < 0.05) and were higher in AA females. Results for the multiple regression models assessing the contribution of discrimination indicate that hsCRP and pulse were significantly associated with recent experiences of discrimination, and SC, HC, hsCRP, diastolic blood pressure (DBP), and pulse were significantly associated with lifetime experiences of discrimination when adjusted for BMI and race (p < 0.05). Finally, oxidation of LDL-cholesterol was significantly associated with salivary cortisol (p = 0.0420) when adjusted by lifetime experiences of discrimination (p = 0.0366) but not for BMI (p = 0.6252).

CONCLUSION

In this cross-sectional study, AA females experienced more discrimination compared to EA females. Levels of recent and lifetime experiences of discrimination were associated with some stress biomarkers. Salivary cortisol was associated with oxidation of LDL-cholesterol with shorter lag times and increased risk for cardiovascular disease.

Prenatal maternal stress and child hair cortisol four years later: Evidence from a low-income sample

BACKGROUND

Maternal stress during pregnancy can influence the trajectory of fetal development, shaping offspring physiology and health in enduring ways. Some research implicates fetal programming of the hypothalamic-pituitary-adrenocortical (HPA) axis as a mediator of these effects. The present study is the first to examine child hair cortisol concentration (HCC) and maternal stress during pregnancy in a diverse, low-income sample.

METHODS

The sample consisted of 77 healthy, low-income (M annual income: $13,321), mother-children pairs (M child age = 3.81 years, SD = 0.43). The children were 57 % girls, 43 % boys. Mothers were 65 % Latina/Hispanic, 28 % Non-Hispanic White, 7% Black/African American. Maternal prenatal stress was measured with the Perceived Stress Scale administered by interview in the second and third trimesters, and again approximately four years later when child hair samples for assaying HCC were collected.

RESULTS

On average maternal perceived stress increased significantly across pregnancy, then returned to lower levels 4 years after birth. Regression analysis revealed that child HCC was not significantly predicted by maternal perceived stress at either single prenatal time point. Exploratory analysis revealed evidence of a relation between increases in maternal prenatal stress from second to third trimester and child HCC four years later (r = .37, p =  .04).

CONCLUSIONS

These results suggest that measures of prenatal maternal stress at any one time point may not be predictive of offspring long-term HPA output in low-income child samples, but that increases in stress levels across pregnancy may provide important information undetected by individual time point measures.

Involvement of the central hypothalamic-pituitary-adrenal axis in hair growth and melanogenesis among different mouse strains

Stress has been demonstrated to play an important role in hair follicle function and the pathogenesis of some hair disorders. The central hypothalamic-pituitary-adrenal (HPA) axis is activated by stress stimuli, synthesizes and releases various components and eventually induces the pathogenesis and recurrence of peripheral diseases. Our aim is to compare the different responses under exposure of stress in hair follicle function among different mouse strains, and to detect the involvement of the central HPA axis after stress in hair follicle growth and melanogenesis. In this study, we exposed different mouse strains (C57BL/6, CBA/J, C3H/HeN, BALB/c and ICR) to a 21-day chronic restraint stress protocol and selected C57BL/6, CBA/J and BALB/c mice for further study because of their significant behavioral alterations. Then, we evaluated and compared the different responses and sensitivity to chronic restraint stress in hair follicle function and central HPA axis among the selected strains. The results showed that expression of POMC, CRF and GR mRNA and protein and serum levels of corticosterone were inhibited in response to stress. These findings suggested that chronic restraint stress may inhibit hair follicle growth and melanogenesis via regulating the key elements of the central HPA axis. In addition, the results revealed different mouse strains exhibit different responses in the central HPA axis and hair follicle after stress exposure. C57BL/6 might be the most sensitive strain among the three strains tested as well as an appropriate strain to study possible pathophysiological mechanisms by which the nervous system influences skin function and screen dermatological drugs suitable for psychotherapy. We believe the current study will provide some useful information for researchers who are interested in the bidirectional communication between the nervous and skin systems and the management of stress-induced cutaneous diseases.

Associations of perceived stress with the present and subsequent cortisol levels in fingernails among medical students: a prospective pilot study

Purpose

Cortisol in fingernails could retrospectively reflect cumulative stress over a long period. However, the association between fingernail cortisol and perceived stress needs to be validated. This exploratory study aimed to investigate the associations of perceived stress with the present and subsequent cortisol levels in fingernails of the subjective stress measurement among medical students.

Methods

Students were recruited from a medical university in Shenyang, China. The final sample consisted of 51 students (16 men, 35 women). On the Day 30 of our data and fingernail collection procedure, the 10-item Perceived Stress Scale was used to measure perceived stress. Fingernail samples were collected twice, on Days 15 (denoted as FD15) and 45 (denoted as FD45) of the procedure, and participants were asked to grow fingernails for 15 days in each collection. Cortisol was determined by an enzyme immunoassay method using the ELISA kit. Multiple linear regression was performed to examine the association between perceived stress and cortisol level. The Bonferroni correction was made for multiple comparisons.

Results

The level of cortisol was 5.65 pg/mg (SD =1.88) for FD15 and 5.41 pg/mg (SD =1.63) for FD45. Perceived stress was not associated with the cortisol level of FD15 (β=−0.014, P=0.924), but it was significantly and positively associated with the cortisol level of FD45 (β=0.436, P=0.003), which remained significant after Bonferroni correction. The associations between fingernail cortisol and demographic variables (gender, age, BMI, and physical activity) were not significant.

Conclusion

This study was the first to investigate fingernail cortisol in China. Perceived stress was positively associated with the subsequent cortisol levels in fingernails, but not the present. The findings suggested that fingernail cortisol could indicate stress exposure in the past. Furthermore, a simple and easy self-reported measure could reflect cumulative stress as measured by fingernail cortisol.