Current Life Stress Research Articles

6.19 EARLY LIFE STRESS PREDICTS REWARD-RELATED BRAIN ACTIVATION IN SCHOOL-AGED CHILDREN

Dysfunction in neural reward processing systems is thought to underlie a range of psychopathology. Early life stress (ELS) probably contributes to the development of aberrant reward processing, although studies to date have focused almost exclusively on adolescents and adults, measuring ELS retrospectively and often failing to control for current life stress. Here, we examine the contribution of prospectively measured life stress in preschool-age children on reward-related neural function in school-age children, controlling for current life stress.

Prediction of diabetes distress among adults with type 2 diabetes

Diabetic patients will possibly be burdened with certain emotional distress level due to their health conditions. Emotional distress must be distinguished through observations on the general symptoms of depression and anxiety experienced by non-diabetic patients. Due to an insufficient amount of empirical works of research on the symptoms of diabetes distress in Iran, this research was conducted to investigate on diabetes distress and identify the factors which lead to the continuous distress among type 2 diabetic patients in the Iranian population. In order to appeal to the type 2 diabetic outpatients (n = 109), the Persian version of the Diabetes Distress Scale (DDS) was operated on a consecutive basis from May to August 2017 in all diabetes specialist hospitals in Kashan, Iran. With the application of full and trimmed methods on logistic regression, the comparison was made between the diabetic and the non-diabetic patients in terms of their behavioral (exercise) and biological variables (cholesterol level, blood pressure, and smoking status), including their demographic factors. It was found that males, unmarried individuals, low-income employees, diabetic patients who have been diagnosed for over 5 years, those whose previous family members were not suffered from diabetes, and individuals who are diagnosed with high-level cholesterol and blood pressure are most likely to have diabetes distress. A list of important, interactive, direct, and independent factors of diabetes distress has been developed. This will be useful for the identification of high-risk patient cohort through patient screening. Furthermore, the benefits of the assessment of both disease-related and current life stressors in medical care have been found by identifying the effects of high diabetes distress and biological factors.

The Dual Impact of Early and Concurrent Life Stress on Adults’ Diurnal Cortisol Patterns: A Prospective Study

Major life stress often produces a flat diurnal cortisol slope, an indicator of potential long-term health problems. Exposure to stress early in childhood or the accumulation of stress across the life span may be responsible for this pattern. However, the relative impact of life stress at different life stages on diurnal cortisol is unknown. Using a longitudinal sample of adults followed from birth, we examined three models of the effect of stress exposure on diurnal cortisol: the cumulative model, the biological-embedding model, and the sensitization model. As its name implies, the cumulative model focuses on cumulative life stress. In contrast, the biological-embedding model implicates early childhood stress, and the sensitization model posits that current life stress interacts with early life stress to produce flat diurnal cortisol slopes. Our analyses are consistent with the sensitization model, as they indicate that the combination of high stress exposure early in life and high current stress predict flat diurnal cortisol slopes. These novel findings advance understanding of diurnal cortisol patterns and point to avenues for intervention.

The importance of positive need fulfillment: Evidence from a sample of war-affected Sri Lankans.

There has been growing interest in understanding the psychological and social-environmental factors that facilitate adaptive functioning in populations affected by ethnopolitical warfare. In the current study, we tested the hypothesis that a brief measure incorporating local idioms of positive need fulfilment would predict functioning in a war-affected Sri Lankan population above and beyond psychopathology when controlling for demographic variables and current life stressors. A brief measure of positive need fulfillment was derived from qualitative data and administered to a sample of 163 Sri Lankans affected by the civil war. Positive need fulfillment was found to uniquely predict functioning after controlling for age, war-related life problems, and psychopathology as assessed by the Penn-RESIST-Peradeniya War Problems Questionnaire. These findings highlight the importance of both basic need support and the fostering of agency in addition to addressing mental health needs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Clinical Practice Guidelines for management of Sexual Disorders in Elderly.

Clinical Practice Guidelines for management of Sexual Disorders in Elderly.

Solving Medical Mysteries: Hidden Stresses and Unexplained Symptoms

Bodily distress syndrome (medically unexplained symptoms and chronic functional syndromes in North America) is common, but few healthcare professionals have had formal training about its psychosocial causes. A systematic approach to diagnosis and treatment based on experience with over 7000 of these patients is described. Psychotherapists can improve outcomes with assessment for and treatment of current life stresses, the prolonged impact of adversity in childhood and somatic presentations of depression, post-traumatic stress, and anxiety disorders.

Associations among adolescent sleep problems, emotion regulation, and affective disorders: Findings from a nationally representative sample

Sleep problems in youth reliably forecast the development of anxiety and mood disorders, presumably due to increased emotional difficulties. However, precise emotional mechanisms have yet to be delineated. The current study investigated how sleep problems in adolescence are associated with different emotion regulation strategies, and how sleep and psychiatric risk may be indirectly associated via poor emotion regulation. This study utilized data from the National Comorbidity Survey-Adolescent Supplement, a nationally representative sample from the United States (N = 10,148; age range 13–18 years). A diagnostic interview determined if adolescents qualified for a mood or anxiety disorder within the past year. Participants provided reports of their sleep, emotion regulation, and current life stress. Adolescents who reported greater sleep problems were more likely to qualify for a mood or anxiety disorder and generally reported poorer emotion regulation strategy use, even when accounting for demographic characteristics and current stress. Specifically, adolescents with greater sleep problems reported less problem solving, and greater avoidance, suppression, rumination, and acceptance. Sleep problems were indirectly associated with anxiety disorders through greater suppression and rumination, and indirectly associated with mood disorders through greater rumination and lower problem solving. Although cross-sectional, this study extends current research by suggesting that certain emotion regulation strategies may be more difficult for youth struggling with sleep problems, and provides initial evidence that poor emotion regulation may be one factor contributing to sleep-based psychiatric risk. These findings can inform more efficacious intervention efforts.

An Exploration of Latina/o Respondent Scores on the Personality Assessment Inventory

Despite broad agreement regarding the need for multicultural considerations in applied practice, to date there continues to be a relative scarcity of research on underrepresented groups and personality assessment. This exploratory study is an initial comparison of non-clinical Latino (N = 97) and European American (EA) (N = 123) college students on selected scales of the Personality Assessment Inventory (PAI; Morey 1991). Latinos were hypothesized to produce higher scores than EAs on PAI scales reflecting worldview, spirituality, fatalism, family orientation, interpersonal style, experience of stress, and social environment. The selected PAI scales addressed socially desirable responding (Positive Impression Management - PIM); approach to completing the PAI (Infrequency - INF); health concerns (Somatic Complaints - SOM); traumatic and phobic endorsement (Anxiety Related Disorders - ARD); hypervigilance, persecution, and resentment (Paranoia - PAR); unusual and bizarre conceptions and beliefs (Schizophrenia - SCZ); perceived lack of social support (Non-Support - NON); current or recent life stressors (Stress - STR); relational style (Interpersonal Warmth - WRM); and an overall measure of psychological distress (Mean Clinical Elevation - MCE). Results revealed Latinos produced significantly higher scores than EAs on the INF, ARD, PAR, SCZ, NON, and STR scales. Contrary to hypothesis, EAs produced higher WRM scores. Overall, even in this non-clinical student sample, when compared to EAs, the Latino participants produced scores indicative of greater psychological distress and psychopathology (MCE). This exploratory study can inform future research with Latinos and the PAI and offers considerations and cautions for clinical use of the measure.

Help-seeking and psychological distress in university students: Findings from a cross-sectional online survey in the UK

IntroductionWith most mental health disorders emerging in the later teenage years, university students are arguably an at-risk population with increased mental health support needs. This population is characterised by important, life-changing transitions (moving away from home, friends and family) and new potential stressors (including increased academic pressures and relational challenges). Research to examine determinants of mental health help-seeking behaviours in university students is needed to ensure emotional health needs are being met at this critical time.ObjectivesTo examine levels of psychological distress and mental health help-seeking behaviours in a sample of UK university students. By identifying factors associated with help seeking, we can better understand the mental health needs of this population and inform support provision.MethodsThis study draws on data from the social and emotional well-being in university students (SoWise) study, an online survey which aimed to examine risk and resilience for social and emotional well-being in young people attending a UK university.ResultsWhole sample analysis (n = 461) showed help seeking was significantly associated with psychological distress, current life stressors and anxious attachment and not associated with perceived mental health stigma. Sub-group analysis (n = 171) suggests being female and older significantly predicted help seeking in students with mild/moderate psychological distress.ConclusionsYounger males with mild/moderate psychological distress are less likely to seek mental health support and represent an “invisible” at risk group. Results also suggest that global anti-stigma campaigns in universities may not prove effective in encouraging help seeking.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effects of Pride and Regret on Geriatric Depression: A Cross-Cultural Study With Mixed-Methods Approaches.

Pride and regret are self-conscious emotions that develop later in life and become a source of emotional struggle. This cross-cultural study examined the effect of the content and intensity of self-conscious emotions on Geriatric Depression Scale (GDS) scores. Among a convenience sample of 234 older adults (130 in the United States and 104 in South Korea), the contents and intensities of both life regrets and pride were examined. Although a greater variety of regrets was cited by Americans, overall Korean respondents reported higher intensity of regret. Regrets that were related to leisure and addiction among Americans and health and career among Koreans were predictors of the GDS scores. Pride in leisure activities for Americans and altruism among Koreans could alleviate depression. While regrets and pride explained a small amount of the variance in the GDS scores, current life stressors greatly contributed to geriatric depression.

Abstract B26: Health-related quality of life in black breast cancer patients with Triple Negative Breast Cancer (TNBC)

Abstract Purpose: Black women are more likely to develop early onset (age ≤50 years) breast cancer and have the lowest five year cause specific survival rate of any U.S. racial or ethnic group. The disparity in incidence and survival can be attributed partially to the higher rate of triple negative breast cancer (TNBC) in Blacks. Yet, little is known about health-related quality of life (HRQOL) among Black women with TNBC. Guided by the Contextual Model of HRQOL, the purpose of these analyses is to examine factors associated with HRQOL in patients with TNBC and non-TNBC. Methods: Black women with invasive breast cancer at age ≤50 years and diagnosed between 2009-2012 were recruited through the Florida State Cancer Registry as part of a population-based case-only study to investigate etiology and outcomes of early-onset invasive breast cancer (n=456). A subset of participants (n=355) consented to complete additional study questions assessing those sociodemographic, clinical, and psychosocial variables selected based on the Contextual Model. The Functional Assessment of Cancer Treatment-Breast (FACT-G) was used to assess HRQOL. Descriptive analyses included those participants confirmed to have either TN or non-TN disease (n=330); univariable and multivariable analyses included participants who met the aforementioned criteria and completed baseline HRQOL data (n=299). Results: Participants in the TNBC and non-TNBC group were similar (p>0.05) with respect to age (TNBC: 41.4 ±5.9 years; non-TNBC: 42.2 ±6.5) and time since diagnosis (TNBC: 18.5 ±7.0 months; non-TNBC: 19.8±10.1). TNBC participants had lower mean FACT-G total scores (71 ± 22.3) compared to non-TNBC (77 ± 21.6) participants (p<0.05). In the TNBC group, variables significantly associated in multivariable analysis with FACT-G scores included: current health, role limitation, anxiety, income, life stress, collectivism, and fatalism (p<0.05). These three individual-level factors (current health, role limitation, and anxiety) and four systemic-level factors (income, life stress, collectivism, and fatalism) explained 80% of the response variation in HRQOL. In the non-TNBC group, factors significantly associated in multivariable analysis with FACT-G scores included: current health, role limitation, anxiety, depressed affect, cancer worry, income, life stress, social support, and birth country (p<0.05). These five individual-level factors (current health, role limitation, anxiety, depressed affect, and cancer worry) and four system-level factors (income, birth country, life stress, and social support) accounted for 76% of the variation in HRQOL scores. Conclusions: The Contextual Model of HRQOL provides a useful framework for evaluating HRQOL in Black breast cancer patients; differences based on triple negative disease status suggest possible intervention targets to improve HRQOL in these women. Effective interventions should focus on reducing anxiety at the individual level, with additional consideration for depressed affect, cancer worry, and social support in the non-TNBC group. For patients with TNBC, interventions may include addressing fatalistic cognitions and collectivist attitudes that may adversely affect HRQOL. Citation Format: Susan T. Vadaparampil, Juliette Christie, Kristine Donovan, Jongphil Kim, Bianca Augusto, Cheryl Holt, Kimlin Ashing, Chanita Hughes Halbert, Tuya Pal. Health-related quality of life in black breast cancer patients with Triple Negative Breast Cancer (TNBC). [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B26.

Providing Tobacco Treatment in a Community Mental Health Setting

Individuals with mental illnesses (MIs) are disproportionately affected by tobacco-related disease burden because of higher tobacco use prevalence and poor tobacco treatment outcomes. This pilot study examines the outcomes of delivering an evidence-based tobacco treatment program (the Cooper-Clayton program) in a community mental health setting. A prospective nonequivalent group design was used to assess outcomes. This study included 47 participants, of which 19 were in a community mental health setting and 28 were from two non-mental-health settings. Information on sociodemographic (gender, age, educational level, and current life stressors) and medical, MI, substance use, and tobacco use and cessation histories were obtained. Program completion and smoking cessation at the end of treatment (verified with expired carbon monoxide monitoring) were assessed. The program consists of combining behavioral counseling with nicotine replacement therapy for 12 weeks. Participants from the mental health setting were significantly less educated, had greater medical comorbidities, had greater psychiatric and mental health histories, and had greater perceived secondhand tobacco smoke exposure as compared with those from the non-mental-health settings. Thirty-two percent of the participants (6/19) completed the program in the mental health site as compared with 68% (19/28) from the non-mental-health site. None of those from the mental health site achieved cessation as compared with 68% of those from non-mental-health sites. The differential outcomes of evidence-based tobacco treatment programs in non-mental-health versus mental health settings may suggest the need to modify existing tobacco treatment approaches for those with MIs in community settings.

FKBP5 genotype interacts with early life trauma to predict heavy drinking in college students.

Alcohol use disorder (AUD) is debilitating and costly. Identification and better understanding of risk factors influencing the development of AUD remain a research priority. Although early life exposure to trauma increases the risk of adulthood psychiatric disorders, including AUD, many individuals exposed to early life trauma do not develop psychopathology. Underlying genetic factors may contribute to differential sensitivity to trauma experienced in childhood. The hypothalamic-pituitary-adrenal (HPA) axis is susceptible to long-lasting changes in function following childhood trauma. Functional genetic variation within FKBP5, a gene encoding a modulator of HPA axis function, is associated with the development of psychiatric symptoms in adulthood, particularly among individuals exposed to trauma early in life. In the current study, we examined interactions between self-reported early life trauma, past-year life stress, past-year trauma, and a single nucleotide polymorphism (rs1360780) in FKBP5 on heavy alcohol consumption in a sample of 1,845 college students from two university settings. Although we found no effect of early life trauma on heavy drinking in rs1360780*T-allele carriers, rs1360780*C homozygotes exposed to early life trauma had a lower probability of heavy drinking compared to rs1360780*C homozygotes not exposed to early life trauma (P < 0.01). The absence of an interaction between either current life stress or past-year trauma, and FKBP5 genotype on heavy drinking suggests that there exists a developmental period of susceptibility to stress that is moderated by FKBP5 genotype. These findings implicate interactive effects of early life trauma and FKBP5 genetic variation on heavy drinking. © 2016 Wiley Periodicals, Inc.

Trauma exposure and posttraumatic symptoms in Iraqi police recruits

ABSTRACTWhen civilians exposed to high levels of traumatic stress take on security roles, posttraumatic symptoms may affect their work functioning and vulnerability to the severe stress of security work. We aimed to investigate levels of trauma exposure and posttraumatic symptoms in police recruits from a high-conflict area (Iraq) relative to police from a culturally similar, low-conflict area (Jordan). Iraqi police recruits reported significantly higher levels of trauma exposure and posttraumatic stress disorder (PTSD) and dissociative symptoms than Jordanian police. Iraqi recruits and Jordanian police both reported high levels of current life stress. Among Iraqi police recruits, trauma exposure and current life stress were both significantly related to PTSD and dissociation symptoms. Results indicate that those in training for security positions in high violence areas should be screened for posttraumatic stress symptoms and provided appropriate support and mental health care.

Adolescent Life Stress and the Cortisol Awakening Response: The Moderating Roles of Attachment and Sex.

This longitudinal study investigated how past versus current life stresses relate to adolescents' cortisol awakening response (CAR), an index of hypothalamic-pituitary-adrenal activity. Ninety-nine adolescents reported previous year life stress at ages 12 and 18. At the second assessment, participants also provided self-reports of parent and peer attachment and 3days of cortisol samples. Current stress was associated with heightened CAR for both males and females, whereas past stress was associated with attenuated CAR for males. Attachment to peers buffered the relationship between past stress and attenuated CAR for all adolescents; attachment to parents was a buffer for male adolescents only. Results demonstrate the protective roles of adolescent relationships and highlight sex differences in biopsychosocial development across adolescence.

Diagnosis and treatment of medically unexplained symptoms and chronic functional syndromes.

Medically unexplained symptoms and chronic functional syndromes are common but few health care professionals have had formal training about their connection to psychosocial issues. A systematic approach to diagnosis and treatment is described that is based on published evidence and detailed interviews with more than 7,000 of these patients. This approach is designed to meet the needs of primary care teams using techniques for assessing and treating current life stresses, the prolonged impact of adversity in childhood and somatic presentations of depression, posttraumatic stress, and anxiety disorders. (PsycINFO Database Record

Abstract 584: The Association of Psychosocial Risk Factors with Subclinical Atherosclerosis in South Asians

Objective: South Asians (individuals from India, Pakistan, Bangladesh, Nepal, and Sri Lanka) are at higher risk of cardiovascular disease (CVD) than other ethnic groups, however this increased risk cannot be explained by traditional risk factors. We investigated the association of psychosocial risk factors with carotid intima media thickness (cIMT), a measure of subclinical CVD, in a community-based cohort of South Asians living in the United States. Methods: A total of 906 individuals from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, aged 40-83, were included in this cross-sectional analysis. High resolution B-mode ultrasonography was used to measure right and left common cIMT (CCA) and internal cIMT (ICA). Linear regression analyses were done to test the associations of the following psychosocial variables: anger, anxiety, depressive symptoms, current and prior 6-month life stress, social support, and everyday hassles with CCA and ICA. In a multivariable model, results were adjusted for the following traditional CVD risk factors: age, sex, systolic blood pressure, hypertension medication use, education, physical activity, diabetes, BMI, smoking, and total/HDL cholesterol ratio. Interaction effects between sex and psychosocial variables were also tested. Results: In age- and sex- adjusted analyses, current life stress and life stress over the past 6 months were positively associated with CCA [mean difference per 1-SD increase (CI) was 0.014 (0.001-0.028; p=0.042) and 0.015 (0.001-0.029; p=0.031), respectively], but were no longer significant after adjusting for other CVD covariates. There was a significant sex interaction with anxiety (p=0.044). Among men, anxiety was positively associated with CCA [mean difference per 1-SD increase (CI) was 0.021 (0.001-0.041; p=0.04) in age-adjusted analyses, and 0.022 (0.002-0.042; p=0.031) in a fully adjusted model]. ICA was not associated with any psychosocial factor. Conclusion: Compared to results in other ethnic groups, there was no significant association between trait anger and cIMT in South Asians. Anxiety was associated with CCA independent of traditional CVD risk factors in men alone.

A prospective biopsychosocial study of the persistent post-concussion symptoms following mild traumatic brain injury.

This study examined multiple biopsychosocial factors relating to post-concussion symptom (PCS) reporting in patients with mild traumatic brain injuries (mTBI), including structural (computed tomography and magnetic resonance imaging [MRI]) and microstructural neuroimaging (diffusion tensor imaging [DTI]). Patients with mTBIs completed several questionnaires and cognitive testing at approximately one month (n=126) and one year (n=103) post-injury. At approximately three weeks post-injury, DTI was undertaken using a Siemens 3T scanner in a subgroup (n=71). Measures of fractional anisotropy were calculated for 16 regions of interest (ROIs) and measures of apparent diffusion coefficient were calculated for 10 ROIs. Patients were compared with healthy control subjects. Using International Classification of Diseases, Tenth Revision (ICD-10) PCS criteria and mild or greater symptom reporting, 59% of the mTBI sample met criteria at one month and 38% met criteria at one year. However, 31% of the healthy control sample also met criteria for the syndrome-illustrating a high false-positive rate. Significant predictors of ICD-10 PCS at one month were pre-injury mental health problems and the presence of extra-cranial bodily injuries. Being symptomatic at one month was a significant predictor of being symptomatic at one year, and depression was significantly related to PCS at both one month and one year. Intracranial abnormalities visible on MRI were present in 12.1% of this sample, and multifocal areas of unusual white matter as measured by DTI were present in 50.7% (compared with 12.4% of controls). Structural MRI abnormalities and microstructural white matter findings were not significantly associated with greater post-concussion symptom reporting. The personal experience and reporting of post-concussion symptoms is likely individualized, representing the cumulative effect of multiple variables, such as genetics, mental health history, current life stress, medical problems, chronic pain, depression, personality factors, and other psychosocial and environmental factors. The extent to which damage to the structure of the brain contributes to the persistence of post-concussion symptoms remains unclear.

PS2-5: The Impact of Diabetes Bundle Management on the Medical Cost of Diabetes: A Four-year Longitudinal Study

<0.001) age (OR = 0.83, P <0.001), Caucasian race (OR = 1.42, P <0.001), unemployment (OR = 2.98, P <0.001), high stressor exposure vs. low (OR = 2.61, P <0.001), low social support vs. high (OR = 1.73, P <0.001), history of drug rehabilitation (OR = 1.45, P <0.001), and higher Charlson comorbidity scores (OR = 1.17, P <0.001). Having SVR to HCV therapy, was protective for depression (OR = 0.77. P = 0.017). The best predictors of poor physical health included Caucasian race (OR = 1.46, P <0.001), unemployment (OR = 3.96, P <0.001), higher Charlson scores (OR = 1.28, P <0.001), high stressor exposure vs. low (OR = 1.78, P <0.001), and moderate social support vs. low (OR = 1.48, P <0.001). Counter to expectation, injection drug use history was protective of poor physical health (OR = 0.71, P < 0.001). Conclusions: Among HCV patients, the best predictors of depression and poor physical health were demographic factors, employment status, Charlson scores, current life stressors, and current social support. While SVR was protective for depression, HCV treatment history was generally not associated with mental health or physical health status, once other covariates were controlled.

The relationship between attachment style and postpartum depression

Although an increasing number of studies show an association between adult attachment style and mood disorders, the relationship between adult attachment style and depression associated with childbirth is largely unknown. This study investigated the association between women’s attachment style, postpartum depression (PPD), and other risk factors. During the 32nd week of pregnancy, 84 women were interviewed using the Attachment Style Interview. Participants also completed self-report questionnaires about reaction to pregnancy, family relationships, current life stresses, and symptoms of depression and anxiety. At one-month postpartum, they were evaluated for postpartum depressive symptoms using the Mini-International Neuropsychiatric Interview. Eighty-two women completed the second self-report questionnaires and were evaluated for PPD. The data of 76 women were eligible for analysis. PPD was present in 21%. An insecure attachment style was significantly related to depression. A multiple logistic regression analysis showed significant effects for insecure attachment, social economic status, and antenatal depression on PPD. Adding the insecure attachment style factor to the logistic model that predicted PPD increased the area under the curve to 0.87 (95% CI .77–.98; p < .05). The inclusion of attachment styles in assessments of perinatal depressive disorders could improve screening and the design of interventions.