Cohen's Perceived Stress Scale Research Articles

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively. A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F). N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29months (SD 5.3) and C-TRF (N = 989) at 32.6months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026). Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

Obesity and Hair Cortisol: Relationships Varied Between Low-Income Preschoolers and Mothers

Literature on the relationship between hair cortisol concentration (HCC) and body mass index (BMI) is scarce and inconsistent in both preschoolers and parents. Thus, the study aimed to examine the relationships among HCC, perceived distress, coping, and BMI among low-income Head Start preschoolers and mothers. A cross-sectional, correlational study was conducted with a non-random sample of 35 mother-preschooler dyads. Height and weight were measured using a ShorrBoard Stadiometer and a Seca portable electronic scale, respectively. HCC was extracted using the enzyme immunoassay approach. Mothers' perceived distress and coping were assessed by Cohen's Perceived Stress Scale. Mothers' mean age was 29.74years, and preschoolers' mean age was 4.69years. The sample included 17% Hispanic, 54% Black, and 60% single mothers; and 23% Hispanic and 60% Black preschoolers. Compared to mothers in low HCC group (< 4.1pg/mg), mothers in high HCC group (≥ 4.1pg/mg) had lower BMI (B = - 4.62, p = .049). The indirect effects of mothers' HCC on BMI via perceived distress and coping was 15% of the total effects. Preschoolers with mothers in high HCC group had significantly lower BMI z-score than those with mothers in low HCC group (B = - 0.94, p = .043). Preschoolers' HCC had a small positive correlation with their BMI z-score (B = 0.01, p = .112). Relationships between HCC and BMI varied between low-income mothers and preschoolers. A stress management component may need to be integrated into future obesity interventions. Given the limitation of small sample size and cross-sectional study design, the findings need to be interpreted with caution, and further investigation is warranted.

Social, Financial and Psychological Stress During an Emerging Pandemic: Preliminary Observations from a Population Web-Based Longitudinal Survey on COVID-19

Background: Understanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions. Methods: This population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen's Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates. Findings: 6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (pInterpretation: Cross-sectional analyses showed a significant increase from average low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with an increase in stress may be informative for intervention development.Trial Registration: ClinicalTrials.gov (NCT04369690)Funding Statement: None.Declaration of Interests: All authors declare that no competing interests exist.Ethics Approval Statement: This study was approved by the Clinical Trials Ontario - Qualified Research Ethics Board via the Ottawa Health Science Network (Protocol #2131).

Effect of academic stress on physical activity level and cognitive functions in first year medical students: An observational study

Background: Newly admitted medical students experience a different curriculum, which can be a stressor and may be the reason of stress during student life. Stress may affect physiological, psychological and cognitive functions of the students.&#x0D; Aims and Objective: Aim of the study was to assess the effect of academic stress on physical activity level and cognitive functions in first year medical students.&#x0D; Materials and Methods: This observational study was conducted on 30 healthy newly admitted medical students (18 -25 years). The data was collected thrice, baseline, after two months and after four months. Stress was assessed by using DASS and Cohen perceived stress scale (PSS). GPAQ was used to estimate the physical activity level. And cognitive functions were assessed by using subjective method (MMSE questionnaire) and objective method (P300).&#x0D; Results: No significant difference of mean values of age, height, weight, BMI, physical activity level, DASS score, PSS and P300 latency were observed over the time to which recording was taken. The mean score of PAL represents the high physical activity. But the score of DASS and PSS represent severe and moderate stress level respectively. The significant difference was seen in the mean values of MMSE score and P300 amplitude over the time to which recording taken.&#x0D; Conclusion: The present study results we can conclude that students have stress during their academic period. And this stress might be helpful in potentiating the cognitive functions with the optimum physical activity.

Too stressed to self-regulate? Associations between stress, self-reported executive function, disinhibited eating, and BMI in women

Stress is associated with obesity. Executive Function (EF), a set of behavioral regulation capacities, may play a mediating role in this relation if lower EF increases disinhibited eating. Participants were 249 women who completed an online survey. We measured stress using Cohen's Perceived Stress Scale, EF using the Behavior Rating Inventory of Executive Function (BRIEF), disinhibited eating using the Three Factor Eating Questionnaire, and self-reported BMI. We used path analysis on this cross-sectional sample of women to test our hypothesis that higher stress is associated with reduced EF, greater disinhibited eating, and higher BMI and tested the indirect effects from stress to disinhibited eating and from stress to BMI. Stress was related to lower EF (β = 0.53 p < .001), lower EF was related to greater disinhibited eating (β = 0.34, p < .001), and disinhibited eating was related to higher BMI (β = 0.37, p < .001). There was an indirect effect of stress on disinhibited eating through EF (β = 0.18, SE = 0.04, p < .001) and an indirect effect of stress on BMI through EF and disinhibited eating (β = 0.07, SE = 0.02, p < .001). Women with higher stress may have higher BMI, in part due to reduced EF and disinhibited eating, suggesting that interventions designed to improve stress management and EF may also improve success with weight control, at least in this population of women.

Perceived Stress and Low-Back Pain Among Healthcare Workers: A Multi-Center Prospective Cohort Study

Objective: This study aimed to investigate the association between perceived stress and odds of low-back pain (LBP) in a population of Danish healthcare workers.Methods: Utilizing a prospective cohort design with 1-year follow-up, a total of 1,944 healthcare workers from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Using Cohen's Perceived Stress Scale, associations between baseline stress levels and LBP intensity (0–10 scale) at follow-up were modeled using cumulative logistic regression, accounting for clustering at the department level and adjusting for age, sex, baseline intensity of LBP, education, seniority, number of daily patient transfers, psychosocial work environment, and lifestyle factors.Results: For the entire population, moderate and high stress (reference: low stress) at baseline increased the odds of LBP at 1-year follow-up with odds ratios (ORs) of 1.39 (95% CI 1.13–1.71) and 1.99 (95% CI 1.49–2.66), respectively. Sensitivity analyses among female nurses showed similar results [i.e., OR 1.40 (95% CI 1.08–1.80) and OR 2.08 (95% CI 1.44–3.00) for moderate and high stress, respectively], while only high stress significantly increased the odds among those without LBP at baseline.Conclusions: Psychological stress increases the odds of LBP among healthcare workers. Identifying and diminishing work-related psychosocial stressors should be included in strategies that aim to prevent musculoskeletal disorders in this population.

Predictors for depression and perceived stress among a small island developing state university population

ABSTRACT The prevalence of depression remains particularly high among university students. Factors known to be associated with this high burden range from social to poor academic performance. Thus, this study sought to determine the prevalence and predictors of depression and perceived stress among university students attending a Caribbean university. This was a cross-sectional study involving 800 students. Depression was assessed using the 21-item Beck Depression Inventory (BDI) and perceived stress was assessed using the Cohen Perceived Stress Scale. Logistic regression models were used to examine the relationship between predictors on depression and perceived stress. The BDI score was 11.97 ± 8.77 with a prevalence of depression at 25.88% and perceived stress of 57.50%. Living or associating with family and friends, were significant predictors of depression while school, money and associating with family/friends were significant for perceived stress. Talking with someone and exercise were associated with a lower likelihood of depression, while eating, drinking alcohol and shopping were associated with reduced levels of perceived stress. The level of depression and perceived high stress in this populations was moderate compared to similar international populations. These findings can be used to inform and design future interventions to improve the mental health of university students.

Temporomandibular Disorders and Perceived Emotional Stress Among Medical and Dental Students Studying in a Private Medical Institution in Kathmandu, Nepal

Introduction: Temporomandibular disorder (TMD) is a collection of complex signs and symptoms that typically involves the temporomandibular joint (TMJ) and masticatory muscles. Multifactorial etiologies of TMD include occlusal disharmony, oral habits, dysfunction of masticatory muscles and adjacent structures, emotional stress, and extrinsic and intrinsic changes on TMJ structure. Stress has been inflicted as one of the major etiological factors for developing TMD.&#x0D; Materials and Methods: An observational cross-sectional study was conducted among the medical and dental undergraduate students and interns studying in Nepal Medical College and Teaching Hospital, Kathmandu, Nepal from January 2018 to February 2018. Fonseca Amnestic Index (FAI) was used to evaluate and characterize the TMD signs and symptoms. The stress factor was assessed by the Cohen Perceived Stress Scale (CPSS-10) which is a self-report measure of stress level which consists of 10 questionnaires in which the subjects respond on how much they suffer from the listed symptoms. Data were analyzed using the Statistical Package of Social Sciences (SPSS) Version 16.0. Association of different variables was tested, with Chi-square test, with a value less than 0.05 as statistically significant.&#x0D; Results: A total of 487 students had participated. Among them 32.4%were male and67.6%were female. Among the participants, 44.6%were from dental school (BDS), and 55.4%were from medical school (MBBS). The age group of the participants was 17 to 27 years. The prevalence of TMD was 50.3% in the study participants. Among the participants with TMD, 81.2% had mild TMD, 17.2% had moderate TMD and 1.6% had severe TMD. Out of the total participants, 16.4% had low stress, 76.6% had moderate stress and 7% had high stress. This study showed a statistically significant association between stress factor and temporomandibular disease (p &lt;0.001).&#x0D; Conclusion: Higher rate of TMD and level of stress has become common in medical and dental college students. Identifying the TMD at an early age can control or at least minimize its long-term effects. Moreover, identifying the stress factor highlights the importance of providing support programs and implementing preventive measures to help students.

Stress and Drug Use from Prepregnancy, During Pregnancy, to Postpartum.

To document changes of stress and illicit drug use among women from 4months prepregnancy to 6months postpartum. In a longitudinal study of drug use in family planning clinics, 121 women who became pregnant were matched with 202 women who did not become pregnant. Self-reported drug use, Cohen's Perceived Stress Scale, and open-ended stress questions were examined every 2months during the study period of time. Among drug-using pregnant women, drug use declined during 2nd and 3rd trimesters and increased immediately within 1 to 2months postpartum. Levels of perceived stress declined throughout pregnancy up to 2months postpartum, increased at 3 to 4months postpartum and then declined at 6months postpartum. In contrast, among nondrug-using pregnant women, stress remained stable until the 2nd trimester, increased from 3rd trimester to 1-2months postpartum, then declined continuously to 6months postpartum. For non-pregnant women, at the matched timeline, there was no clear pattern for changes of drug use and stress. Our study has illustrated a complex time course of changes of both perceived stress and drug use from prepregnancy through 6months postpartum. For drug-using pregnant women, pregnancy showed protective effect in reduction of both drug use and stress during pregnancy; and during postpartum, drug resumption peaked at 1-2months while stress peaked at 3-4months. If we can identify modifiable, pregnancy-related resiliency factors for both stress and drug use, we can begin to extend prevention efforts initiated during pregnancy into the postpartum period.

Do Low Self-Esteem and High Stress Lead to Burnout Among Health-Care Workers? Evidence From a Tertiary Hospital in Bangalore, India.

BackgroundLow self-esteem can be an issue among health-care workers due to the hierarchical medical system. Health-care workers are also in a high pressure environment that can lead to stress and burnout. This study was conducted to estimate the proportion of health-care workers with low self-esteem, high stress, and burnout and the factors associated with these in a private hospital in Bangalore city.MethodsThis cross-sectional study included a random sample of health-care workers of various cadres – doctors, nurses, nursing aides, technicians, and workers in ancillary departments such as laundry, dietary, central sterile supply department, and pharmacy, with probability proportional to size. Rosenberg Scale for Self-esteem, Cohen's Perceived Stress Scale, and Shirom–Melamed Burnout Measure were used as study tools.ResultsAmong the 306 health-care workers, there were high levels of low self-esteem (48.4%), stress (38.6%), and burnout (48.7%), with the lowest levels being among doctors. Those aged younger than 30 years had significantly lower self-esteem and greater stress.ConclusionsHealth-care workers with low self-esteem were nearly thrice more likely to suffer high stress, Odds Ratio (OR) = 2.84 (1.36–5.92), and those who were stressed had more than three times higher chance of experiencing burnout, OR = 3.6 (2.02–6.55). Path analysis showed that low self-esteem among health-care workers had a direct effect on burnout, as well as an indirect effect through stress (mediator variable). This study indicates the need for screening and counseling for low self-esteem, stress, and burnout as part of a periodic medical examination of all cadres of health workers.

Abstract PR15: Do segregated neighborhoods buffer the stressful effects of low coping among Black breast cancer survivors?

Abstract Black women diagnosed with breast cancer have worse outcomes compared to White women, and variation in social and psychosocial factors might play a role in this racial disparity. African American (AA) residential segregation is hypothesized to result from racial discrimination, economic inequality, and social network characteristics where the exchange of social capital influences individual mobility patterns. Accordingly, whether segregation exerts a negative or positive influence on psychosocial outcomes, such as perceived stress, might depend on additional intra- (e.g., coping) and interpersonal (e.g., social support) social characteristics. This study investigated whether AA residential segregation, coping and social support were associated with perceived stress among Black breast cancer survivors. Individual-level data were from the Women's Circle of Health Follow-up Study, an ongoing breast cancer survivor cohort of Black women residing in New Jersey (NJ). Perceived stress (Cohen's Perceived Stress Scale, 10-item [PSS-10]), coping (Brief Resilient Coping, 4-item), and social support (Functional Assessment of Chronic Illness Therapy-Breast cancer, 7-item) were measured in follow-up questionnaires (average time since cancer diagnosis = 22.6 months). AA Gini Indices of segregation (0-100) were linked to participants' zip code of residence at baseline questionnaire (average time since cancer diagnosis = 13.0 months). Potential demographic, socioeconomic, and health behavior confounders were from the baseline questionnaire. Multilevel linear regression models were used to estimate relationships between segregation, coping, social support and perceived stress. The follow-up questionnaire was completed by 533 breast cancer survivors, 530 of whom had complete PSS-10 data (sum score mean=15.1, standard deviation [SD]=7.0). The typical participant lived in highly segregated zip codes (median=70.7, range=23.8-92.9). The relationship between coping and perceived stress depended on zip code level AA segregation: among lower segregation zip codes (Gini=62) PSS-10 increased 1.6 points (95% CI: 0.9- 2.3, P &amp;lt;0.001) for each SD decrease in coping ability, but among higher segregation zip codes (Gini=78) PSS-10 increased only 0.7 points (95% CI: 0.02-1.4, P=0.04) for each SD decrease in coping ability. Moreover, adjustment for social support decreased the magnitude of the associations between coping and PSS-10. AA segregation, coping, and social support might act together to influence perceived stress of Black breast cancer survivors in NJ. This abstract is also being presented as Poster C067. Citation Format: Jesse J. Plascak, Laxmi Chavali, Adana A.M. Llanos-Wilson, Bonnie Qin, Kitaw Demissie, Chi-Chen Hong, Elisa V. Bandera. Do segregated neighborhoods buffer the stressful effects of low coping among Black breast cancer survivors? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR15.

Perceived Stress and Dietary Behavior of Adolescent Girls

Abstract Objectives The study was designed to examine the relationship between stress and dietary behavior of female students (15–18 years). Methods A total of 300 adolescent girls (15–18 yrs.) were selected from Junior college, Hyderabad. A structured questionnaire had been used to collect the general profile of the adolescent girls. Height and weight of the subjects were measured by standardized methods. The food frequency questionnaire and 24 hour recall (3 days) has also been taken. Cohen's perceived stress scale was used to assess the stress levels among the adolescent girls. Results Over half of the students were found some level of stress, 13% were suffering from severe stress levels, 30.0% had moderate stress and another 15.6% had mild stress. Students who have experienced severe to moderate levels of stress were more likely to eat cereal products (P &amp;lt; 0.05), fried items and the highly processed food items (P &amp;lt; 0.05). The mean intake of fruits and vegetables was significantly low (P &amp;lt; 0.05) among the students having severe and moderate stress. The carbohydrate and fat intake was found significantly (P &amp;lt; 0.05) higher among the severe and moderately stressed students. Conclusions These results show a clear difference in food selection patterns between stressed and non-stressed female students with stress being a more significant predictor of unhealthy food selection. Further research is needed using a qualitative approach to understand how stress and eating behaviour are related among adolescent students. Funding Sources It's a cross sectional study, no funds received from any organizations or institute.

Diet Quality and Depression in A Midlife Biracial Cohort of Women: The Role of Stress And Early Life Adversity

Abstract Objectives Stress exposure may impose an altered physiological state to modify relations between diet and the brain. We investigate if current perceived stress and childhood trauma might moderate diet quality and depression risk associations in women. Methods Preliminary data for white and black women (n = 326, mean age: 39 y) taking part in the National Growth and Health Study follow-up were analyzed by multiple logistic regression models. Women at-risk for depression (score ≥ 16) were identified by the CES-D scale. Alternative Healthy Eating Index (AHEI)-2010 scores (continuous) were calculated from 3-day food records (averaged). Current perceived stress (scoring in the top tertile on Cohen's Perceived Stress Scale; here ≥20) and past childhood trauma (any exposure to physical abuse, sexual abuse, or a household member afflicted with addiction) were examined as effect modifiers (binary). Interaction terms between AHEI scores and each stress measure were tested in crude and final logistic models adjusted for race, income, and health status. Subsequent marginal analyses evaluated significance of differences in predicted probability of depression risk between stressed and non-stressed groups over AHEI. Results Interactions between AHEI and high perceived stress (P = 0.03), past physical abuse (P = 0.08), and past sexual abuse (P = 0.04) were significant in crude models. After adjustment, AHEI with high stress (P = 0.04) and physical abuse (P = 0.09) maintained some significance. In crude and adjusted models, predicted probabilities of depression risk were significantly higher (P &amp;lt; 0.05) in high vs. low perceived stress women, as well as between women with past physical or sexual abuse vs. those without. However, these differences were only observed for AHEI scores above certain thresholds (in adjusted analyses: approx. AHEI ≥35 for high perceived stress, AHEI ≥58 for physical abuse, and AHEI ≥55 for sexual abuse). For AHEI scores outside those ranges, differences between predicted probabilities of depression were not seen (P &amp;gt; 0.05). Prior living with addiction did not modify diet-depression relations (P &amp;gt; 0.05). Conclusions Complex interplay between stress and adversity, diet quality, and depression in adult women exists, substantiating need for more research to understand underlying vulnerabilities and potential dietary intervention. Funding Sources NIH/NICHHD.

Four Weeks of Acute Intermittent Fasting Enhances Body Composition and Decreases Stress Levels in Healthy Individuals: A Pilot Study

IntroductionThe obesity epidemic affects nearly 78 million adults in the United States. Weight loss and improvement of body composition through physical activity and dietary modifications, can help decrease the risk for obesity‐related disease. Weight management programs are numerous, with an estimated 45 million Americans undertaking a diet each year. There are several different types of diets: such as those that emphasize consumption or an increase/decrease in protein, carbohydrates, fat, or amount of total daily calories. A novel, modified alternative method to caloric restriction is Intermittent Fasting.PurposeTo determine the acute effect of four weeks of Intermittent Fasting on body composition, stress levels, sleep quality, and quality of life.MethodsSixteen participants, 9 males and 7 females, with mean age 34.0 ± 11.7 years, completed a four‐week session of Intermittent Fasting. Participants were excluded if they had Diabetes or Metabolic Syndrome. The participants fasted for 16 hours from the time of their last meal of the evening to the start of their first meal the following day. Once the fast was broken, the participants were required to consume their normal daily caloric intake within an 8‐hour period, with no requirements on the number of meals. Participants did not make changes to their activity levels throughout the four weeks. Body composition was determined using the InBody 770 (InBody USA, Cerritos, CA). The Pittsburgh Sleep Quality Index and the Cohen Perceived Stress Scale were administered to determine sleep quality and self‐awareness of stress levels. Quality of Life was assessed using the 36‐Item Short Form Survey Instrument.ResultsFollowing four weeks of Intermittent Fasting, there were significant reductions in mean body fat percentage (26.2±2.5 vs. 25.4±2.5, p=0.01), visceral fat (cm2) (98.2±15.3 vs. 94.1±15.6, p=0.003), body fat mass (lbs) (47.5±6.6 vs. 46.2±6.9, p= 0.02), trunk fat (lbs) (25.2±3.5 vs. 24.2±3.5, p=0.001) and stress levels (14.1±1.9 vs. 11.0±1.4, p=0.03). There were no significant acute changes in sleep quality and overall quality of life.ConclusionIntermittent Fasting can be an effective option to help lower body fat and more importantly visceral fat. This in turn, could potentially aid in decreasing obesity‐related diseases. Our pilot study demonstrated potential health related benefits from an acute Intermittent Fasting program that could be incorporated into whole person wellness programs. Further research is needed to expand these positive findings over different time segments.

Oxaloacetate reduces emotional symptoms in premenstrual syndrome (PMS): results of a placebo-controlled, cross-over clinical trial.

ObjectivePremenstrual syndrome (PMS) affects millions of women. While over-the-counter products have helped with the physical symptoms of PMS, emotional symptoms have been less well supported. The objective of this trial was to measure the effect of an oxaloacetate/vitamin C combination on the major emotional symptoms of PMS, including depression, anxiety, perceived stress, aggression, and suicidal ideation.MethodsForty-eight women experiencing PMS completed a baseline survey comprising the Beck's Depression Inventory, Cohen Perceived Stress Scale, Generalized Anxiety Disorder Test, and Buss-Perry Aggression Questionnaire. After baseline measurements, participants were randomly assigned to take either 2 capsules of 100 mg oxaloacetate/150 mg ascorbic acid, or 2 capsules of rice flour (placebo) for their entire menstrual cycle. At menstruation, the women completed the 4 surveys again. The women then switched capsules in a cross-over design and continued the study for an additional menstrual cycle. The final assessment was repeated at menstruation. Statistical analysis of the 4 surveys was performed to examine efficacy.ResultsOxaloacetate/vitamin C supplementation during PMS significantly improved depression, perceived stress, anxiety, aggression, and suicidal ideation. The mean improvement in depression was 54.1%, 35.8% for perceived stress, 51.43% for generalized anxiety, and 17.8% for aggression. Suicidal ideation was reduced by 47.9%. All results were highly significant.ConclusionA combination of oxaloacetate and vitamin C supplementation helped to alleviate depression, anxiety, perceived stress, aggression, and suicidal ideation symptoms associated with PMS.Trial RegistrationClinicalTrials.gov Identifier: NCT03509714

Maternal stress, low cervicovaginal β-defensin, and spontaneous preterm birth

Spontaneous preterm birth (sPTB) is a major contributor to infant mortality and its etiology remains poorly understood. Host immunity and maternal stress may play a role in the pathogenesis of sPTB but mechanisms are poorly delineated. Antimicrobial proteins in the cervicovaginal space, such as beta defensins, modulate immune responses to bacteria and have been shown to modulate the risk of sPTB from non-optimal microbiota. While stress is known to induce immunological changes, no study has examined the interplay between maternal stress and the immune response in association with sPTB. Our objectives were to determine whether psychosocial stress was associated with a mediator of the immune system in the cervicovaginal space, beta defensin-2, and to examine the combined impact of high stress and low cervicovaginal beta defensin-2 levels on the odds of sPTB. From the Motherhood & Microbiome cohort study (n=2000), we performed a secondary, nested case-control study, frequency matched by race/ethnicity, of 519 pregnant women (110 sPTB and 409 term). Stress and cervicovaginal beta defensin-2 levels were measured at 16-20 weeks of gestation. Stress was dichotomized at a score of 30 on Cohen's Perceived Stress Scale (PSS-14). We measured cervicovaginal beta defensin-2 levels with ELISA and dichotomized at the median. We modeled associations of high stress and low cervicovaginal beta defensin-2 levels using multivariable logistic regression. We also compared the proportion of women with high stress and low cervicovaginal beta defensin-2 levels among women with spontaneous preterm and term births using Chi-Square tests. We modeled adjusted associations of stress and cervicovaginal beta defensin-2 levels with odds of sPTB using logistic regression. The majority of the study population was non-Hispanic black (72.8%), insured by Medicaid (51.1%), and had a PSS-14 score < 30 (80.2%). High stress was associated with reduced adjusted odds of low beta defensin-2 levels (aOR 0.63, 95% CI: 0.38 -0.99). In a model adjusted for race and smoking, both high stress (aOR 1.72, 95% CI: 1.03-2.90) and low beta defensin-2 (aOR 1.58, 95% CI: 1.004-2.49) were associated with increased odds of sPTB. We then built a model of the four possible combinations of low and high stress and low and high beta defensin-2 levels with the odds of sPTB. Women with either high stress (aOR 1.37, 95% CI: 0.68 - 2.78) or low beta defensin-2 (aOR 1.40, 95% CI: 0.83-2.34), had slightly elevated but not significantly increased odds of sPTB compared to women with neither exposure. However, women with both high stress and low beta defensin-2 had significantly elevated odds of sPTB compared to women with neither exposure (aOR 3.16, 95 % CI: 1.46 - 6.84). High perceived stress and low cervicovaginal beta defensin-2 levels are associated with higher odds of sPTB, and when present concurrently, they result in the highest odds of sPTB in a largely non-Hispanic black cohort. Our findings warrant further work to examine social determinants of health and the host cervicovaginal immune responses that may modulate the pathogenesis of sPTB.

Comparison of stress levels among medical and dental students in the clinical years of training and their coping strategies.

To compare the stress levels among medical and dental students and to evaluate their coping strategies. The cross-sectional comparative study was conducted at the Liaquat College of Medicine and Dentistry, Karachi, from January to February 2018, and comprised medical students from 3rd, 4th and 5th years, and dental students of 3rd and 4th year. Cohen Perceived Stress Scale was used to collect data which was then analysed using SPSS 21. Of the 400 students approached, 281(70.25%) responded. There were 159(56.5%) medical and 122(43.4%) dental students. Also, 78(27.7%) students were males and 203(72.2%) were females. The stress level was moderate or high in 267(95%) students; 118(96.7%) dental, 149(93.7%) medical. Stress management strategies included meditation/praying 181(64.4%), spending some time to relax 180(64.1%) and sleeping 177(63%). Dental students had slightly higher stress level than medical students. The most common stress management strategy was meditation/praying.

Predictors of high achievers in Indian medical undergraduates: Association with emotional intelligence and perceived stress.

BACKGROUND:Today's Bachelor in Medicine, Bachelor in Surgery (MBBS) students will become Indian Medical Graduates in future. Emotional intelligence (EI) is an essential component in the making of an Indian Medical Graduate. There is increasing stress during medical training. The study was conducted to compare the association of EI score and perceived stress scale (PSS) among average and excellent undergraduate medical students. The secondary objective was to find the predictors of excellent academic performance.MATERIALS AND METHODS:This descriptive cross-sectional study was conducted after institutional ethics committee approval. All 522 consented students studying in 2nd, 4th, 7th, and 9th semesters filled up established pre-validated questionnaires ; Schutteself report EI test and Cohen's perceived stress scale. Sociodemographic details of the respondents were collected. Average attendance and marks of previous semester examinations of all included students were collected from academic cell of the institution. All students were grouped into three groups: average, good, and excellent performers from the marks collected. Comparison of EI scores and PSS scores was done between students in excellent and average groups using unpaired t-test.RESULTS:Of the 94.9% of respondents, 78.2% of the students were included in the study. The mean EI and PSS scores were 123 ± 14.5 and 22.8 ± 13.9, respectively. There was no statistically significant difference in EI scores between average and excellent performers ([123.8 ± 18.7] vs. [127.7 ± 16]; P – 0.089). Perceived stress was lower in excellent performers ([20.9 ± 11.1] vs. [24.8 ± 15.0]; P – 0.01). EI was associated with better performance in clinical year students. EI was negatively correlated to perceived stress.CONCLUSION:Our study provides predictors of excellent academic performances among Indian medical undergraduates. This study suggests introduction of extracurricular activities in ongoing undergraduate curricular syllabus. It imparts awareness among students about the importance of attending classes. This study bestows higher EI and lower perceived stress to better academic performance.

Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on Pediatric Resident Well-Being.

Objectives:This study aims to identify factors specific to the COVID-19 pandemic that affect resident physicians’ well-being, identify potential sources of anxiety, and assess for depression and stress among residents.Methods:A cross-sectional survey was performed in April 2020 that evaluated resident perceptions about COVID-19 pandemic, its impact on their personal lifestyle, and coping mechanisms adopted. The respondents also completed the Beck Depression Inventory-II (BDI-II) and Cohen Perceived Stress Scale (PSS-10).Results:Of 37 residents, 29 completed the survey for a response rate of 78%. We found that 50% of residents harbored increased anxiety due to the pandemic and reported fears of spreading disease. Factors that negatively impacted their well-being included social isolation from colleagues (78%), inability to engage in outdoor activities (82%), and social gatherings (86%). Residents expressed concern about the effect of the COVID-19 pandemic on their didactic education and clinical rotations. The mean PSS-10 total score was 17 (SD = 4.96, range = 0-33) and the mean BDI-II total score was 6.79 (SD = 6.00). Our residents adopted a number of coping mechanisms in response to COVID-19.Conclusions:We identified factors specific to the COVID-19 pandemic that adversely affected resident physician well-being. Trainees were concerned about the risk of developing COVID-19 and spreading this to their family. Residents also harbored anxiety regarding the effect of COVID-19 on their education. Lifestyle changes including social isolation also resulted in a negative effect on resident well-being. Developing strategies and resources directed to addressing these concerns may help support well-being and alleviate stress and anxiety.

Coping strategies and stress among resettled Bhutanese adults in Massachusetts.

Stress associated with attempts to integrate into a new culture is directly linked to mental health outcomes among refugees. However, there is a paucity of literature on how refugees cope to reduce their stress. This study assessed the association between coping strategies and perceived stress among resettled Bhutanese adults in Western Massachusetts. A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20-65 years residing in Massachusetts. Coping was measured with the 32-item Tobin Coping-Strategies Inventory-Short Form (CSI-SF). The 32-item CSI-SF includes 8 subscales: problem-solving, cognitive-structuring, express-emotions, social-contact, problem-avoidance, wishful thinking, self-criticism, and social-withdrawal, each with 4 items. Four composite constructs were created from subscales, namely, problem-focused engagement (problem solving + cognitive structuring), emotion-focused engagement (express emotions + social contact), problem-focused disengagement (problem avoidance + wishful thinking), and emotion-focused disengagement (self-criticism + social withdrawal). Perceived stress was measured with the 10-item Cohen Perceived Stress Scale. Associations of coping scores with perceived stress score (PSS) were assessed using multiple linear-regression analyses adjusting for sociodemographic, and lifestyle factors. The coping scores of 4 subscales were inversely associated with PSS including problem solving (β = -0.430, p ≤ .0001), cognitive structuring (β = -0.416, p = .0002), express emotions (β = -0.292, p = .004), and social contact (β = -0.448, p ≤ .0001). Two composite constructs of subscales, namely, problem-focused (β = -0.236, p ≤ .0001) and emotion-focused (β = -0.199, p = .0003) engagement coping strategies were inversely associated with PSS. Greater use of problem- or emotion-focused engagement coping strategies was associated with reduced PSS among Bhutanese, suggesting that problem-focused or emotion-focused stress management interventions hold promise for stress reduction among resettled Bhutanese. (PsycInfo Database Record (c) 2020 APA, all rights reserved).