Number Of Major Life Events Research Articles

One-year predictors of PTSD symptoms, anxiety, and depression in SARS-CoV-2 survivors: psychological flexibility and major life events as main predictive factors.

The COVID-19 pandemic held considerable health-related outcomes worldwide, including mental health challenges, with elevated risk of psychiatric sequelae. This study aimed to test the longitudinal (1 year) predictive role of psychosocial factors on post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms in SARS-CoV-2 survivors (N = 209 at T1; N = 61; attrition rate 70.83%), through Pearson's correlation analyses and longitudinal multiple regression analyses. Participants (age M = 35.4, SD = 10.1) completed online self-report questionnaires of psychosocial variables, PTSD, anxiety, and depression. Depression and anxiety symptoms were increased, and 42% of survivors presented clinically meaningful PTSD symptoms. PTSD symptoms were longitudinally predicted by having children (β = 0.32, p < 0.01), number of recent major life events (β = 0.34, p < 0.01), and psychological flexibility (β = -0.36, p < 0.01). Number of major life events (β = 0.29, p < 0.05) and psychological flexibility (β = -0.29, p < 0.05) predicted anxiety. Number of recent major life events (β = 0.32, p < 0.01) was the sole predictor of depressive symptoms. Psychosocial variables contribute to the long-term harmful effects of the COVID-19 pandemic on psychopathological symptoms. These results suggest that, during the pandemic, mental health was impacted by both socio-contextual factors and individual self-regulatory skills, namely the ability to respond flexibily to contextual cues and guide behavior according to the direct experience. Specifically, results point out the importance of societal incentives to reduce parental burden and socioeconomic losses, as well as to promote adaptive psychological skills such as psychological flexibility.

Stress-Related Immune Response and Selenium Status in Autoimmune Thyroid Disease Patients.

Autoimmune thyroid disease (AITD), including Graves' disease (GD) or Hashimoto's thyroiditis (HT), occurs due to genetic susceptibility and environmental factors, among which the role of stressful events remains controversial. This study investigated the relationship between the number and impact of stressful life events in AITD patients with selenium status, and the Th1/Th2/Th17 immune response. The study population included three groups: HT (n = 47), GD (n = 13), and a control group (n = 49). Thyroid function parameters, autoantibody levels, and the plasma levels of cytokines, selenium, selenoprotein P (SeP), and glutathione peroxidase 3 (GPx) activity were measured. Participants filled out the Life Experiences Survey. No significant differences in the number of stressful life events were found among the patients with HT, GD, and the controls. A higher (median (interquartile range)) negative stress level (8 (4-12)) than a positive stress level (3 (1-9)) was found in the HT group. The HT group showed a correlation between SeP and the positive stress level: rs = -0.296, p = 0.048, and the GD group between GPx and the negative stress level (rs = -0.702, p = 0.011). Significant positive correlations between thyroid peroxidase antibody level and the total number of major life events (p = 0.023), the number of major life events in the last 7-12 months, and the number of major life events with no impact and a negative stress level were found. We suggest that the measurements of Th2-related cytokines and selenoproteins could be used as biomarkers for the development of AITD in cases where stress is considered a component cause of the pathogenic mechanism of the disease.

DIVERSITY MATTERS: INTERSECTIONAL INEQUITIES IN HEALTH AND WELL-BEING THROUGH AGING

Abstract Different positions within social hierarchies receive unequal access to resources, leading to health disparities in later life (Agenor, 2020). Research addressing inequities must increasingly account for the many social categorizations (e.g., race, gender, socioeconomic status) that affect individuals‘ lived experiences. This symposium examines the role of intersecting social contexts on health and well-being across the life course. Surachman and colleagues use the U.S.-based National Growth and Health Study to examine the intersectionality between early life socioeconomic context and race on women’s metabolic syndrome severity. Their findings have implications for societal factors leading to accelerated aging across young adulthood and early midlife. Koffer and colleagues use the U.S.-based Study of Women’s Health Across the Nation to demonstrate differential midlife exposure to types and number of major life events across race/ethnicity and education. They subsequently find that major life events increase risk of cardiovascular disease events, indicating the importance of studying the life experiences of diverse women across midlife. Drewelies and colleagues use the Germany-based Berlin Aging Study II to look at the associations among multidomain identity and social background factors on physical, cognitive, and psychological aging. Implications from their work demonstrate the interplay of diversity on health and well-being in older adulthood. Conjointly, findings indicate that intersectional identities play an important role in shaping key outcomes of human functioning across adulthood and aging. Dr. Deborah Carr will critically discuss the three contributions from a life course perspective and provide considerations for future research and policy promoting equity for diverse older adults.

Long-term sickness absence in a working population: development and validation of a risk prediction model in a large Dutch prospective cohort

BackgroundSocietal expenditures on work-disability benefits is high in most Western countries. As a precursor of long-term work restrictions, long-term sickness absence (LTSA) is under continuous attention of policy makers. Different healthcare professionals can play a role in identification of persons at risk of LTSA but are not well trained. A risk prediction model can support risk stratification to initiate preventative interventions. Unfortunately, current models lack generalizability or do not include a comprehensive set of potential predictors for LTSA. This study is set out to develop and validate a multivariable risk prediction model for LTSA in the coming year in a working population aged 45–64 years.MethodsData from 11,221 working persons included in the prospective Study on Transitions in Employment, Ability and Motivation (STREAM) conducted in the Netherlands were used to develop a multivariable risk prediction model for LTSA lasting ≥28 accumulated working days in the coming year. Missing data were imputed using multiple imputation. A full statistical model including 27 pre-selected predictors was reduced to a practical model using backward stepwise elimination in a logistic regression analysis across all imputed datasets. Predictive performance of the final model was evaluated using the Area Under the Curve (AUC), calibration plots and the Hosmer-Lemeshow (H&L) test. External validation was performed in a second cohort of 5604 newly recruited working persons.ResultsEleven variables in the final model predicted LTSA: older age, female gender, lower level of education, poor self-rated physical health, low weekly physical activity, high self-rated physical job load, knowledge and skills not matching the job, high number of major life events in the previous year, poor self-rated work ability, high number of sickness absence days in the previous year and being self-employed. The model showed good discrimination (AUC 0.76 (interquartile range 0.75–0.76)) and good calibration in the external validation cohort (H&L test: p = 0.41).ConclusionsThis multivariable risk prediction model distinguishes well between older workers with high- and low-risk for LTSA in the coming year. Being easy to administer, it can support healthcare professionals in determining which persons should be targeted for tailored preventative interventions.

The buffer role of psychological flexibility against the impact of major life events on depression symptoms

PurposeMajor life events have been positively associated with depression symptoms. Although psychological flexibility has been associated with adaptive coping skills and negatively linked with depression symptoms, it remains unclear whether psychological flexibility may be a protective process against the pervasive impact of major life events. Thus, the present study aimed to explore the moderating effect of psychological flexibility on the association between the cumulative number of major life events and their negative appraisal with depression symptoms.MethodsFour hundred and one participants (280 females and 121 males), aged between 18 and 65-years old, completed a set of self‐report measures assessing the number of major life events that had occurred in the previous 12 months and their appraisal, as well as psychological flexibility, and depression symptoms.ResultsCorrelation analyses showed a negative and strong association between psychological flexibility and depression symptoms. Path analyses revealed that psychological flexibility attenuated the effect of the cumulative number of major life events and their perceived negative impact on depression symptoms.ConclusionsThis study highlights the buffer role of psychological flexibility on the association of number of major life events and their negative appraisal, with depression symptoms. These findings suggest that being able to be in contact with the present moment with an accepting and non‐judging attitude towards internal experiences, and to engage in valued‐based action, may protect individuals against the negative impact of major life events with regards to depression symptoms.

The mediating role of shame and fear of compassion on the relationship between major life events and depressive symptoms

An extensive body of research has showed the impact of major life events on depressive symptoms. However, the underlying psychological processes that contribute to this association are still unclear. The present study aims to explore the mediating role of external shame and fears of receiving compassion on the associations of the number of major life events and their appraisals by the individual with depressive symptoms. Participants were 400 Portuguese-speaking adults from the general population (121 men and 279 women) with ages between 18 and 65 years, that completed self-report measures. Correlation analysis showed significant and positive associations between the number of major life events that occurred in the previous year and the positive and negative appraisal of such events, external shame, fears of receiving compassion, and depressive symptoms. Path analysis revealed that external shame and fears of receiving compassion fully mediated the effects of number of life events on depressive symptoms. Furthermore, results showed a direct effect of negative appraisal of major life events on depressive symptoms. This study sheds light on the psychological processes that may underlie the relationship between the cumulative number of major life events and depressive symptoms. Specifically, it suggests that the occurrence of major life events can impact on depressive symptoms when associated with feelings of shame and fears of receiving compassion from others.

Life, lifestyle and location: examining the complexities of psychological distress in young adult Indigenous and non-Indigenous Australians.

Mental health is fundamental to an individual's health and well-being. Mental health disorders affect a substantial portion of the Australian population, with the most vulnerable time in adolescence and young adulthood. Indigenous Australians fare worse than other Australians on almost every measure of physical and mental health. Cross-sectional data from young adults (21-27 years) participating in the Life Course Program, Northern Territory, Australia, is presented. Rates of psychological distress were high in remote and urban residing Indigenous and urban non-Indigenous young adults. This rate was more pronounced in young women, particularly in Indigenous remote and urban residing women. Young adults with high psychological distress also had lower levels of positive well-being, higher perceived stress levels, experienced a higher number of major life events and were at an increased risk of suicidal ideation and/or self-harm. This study supports the need for a continued focus on early screening and treatment at this vulnerable age. The significant association seen between psychological distress and other markers of emotional well-being, particularly risk of suicidal ideation and/or self-harm, highlights the need for a holistic approach to mental health assessment and treatment. A concerted focus on improving the environs of young adults by lowering levels of stress, improving access to adequate housing, educational and employment opportunity, will assist in improving the emotional health of young adults.

Is liability to recurrent major depressive disorder present before first episode onset in adolescence or acquired after the initial episode?

Many individuals who experience a major depressive episode will subsequently develop recurrent episodes. Although numerous studies have investigated predictors of recurrent episodes, methodological limitations have made it difficult to determine the extent to which liability to recurrent major depressive disorder (rMDD) exists prior to first onset or develops after first onset. This study used a prospective design in a community sample of adolescents to examine variables before and after first onset MDD as predictors of rMDD over a 12-year follow-up. Among 59 adolescents who experienced first onset MDD, 72.88% developed rMDD during the follow-up period. Parental history of rMDD and lifetime history of minor depression prior to MDD onset significantly predicted rMDD. These two effects replicated in ancillary analyses in an expanded sample of N = 205. Following MDD onset, a higher number of major life events significantly predicted rMDD. Liability to rMDD exists prior to MDD onset in the form of familial risk and less severe mood disturbances, whereas liability to rMDD in the form of elevated stress may develop following a first onset in adolescence.

Childhood Abuse and Fibroids

Childhood Abuse and Fibroids

Depressive Symptoms in Adolescents Living in Rural America

The purposes of this pilot study were to examine prevalence of depressive symptoms among rural adolescents and identify related social and environmental variables. A convenience sample of 299 14- to 18-year-old agriculture class students at 5 rural high schools in Kentucky and Iowa completed a survey that included demographic information, family farm history, experience with suicide, perception of school environment, and indicators of farm injuries and risky behaviors. Participants also completed the Center for Epidemiologic Studies Depression Scale (CES-D) as well as scales to assess the number of major life events in the last year, active coping use, and family closeness. The prevalence of a high level of depressive symptoms (CES-D > or = 16) in this sample was 34%. Nine percent had seriously considered suicide in the last year. Unlike previous reports, boys reported as many depressive symptoms as girls. Although the literature reports that engaging in risky behavior is associated with depressive symptoms, the only risky behavior linked with depressive symptoms in this sample was operating a 4-wheel all-terrain vehicle. Other predictors of depressive symptoms included poor family relationships and poor active coping. Interventions to identify and prevent depressive symptoms in rural adolescents are needed. Boosting active coping and improving family function may also prevent the development of clinical depression in rural adolescents.

Stressful major life events are associated with a higher frequency of cutaneous sensory symptoms: an empirical study of non-clinical subjects.

Psychological stress resulting from stressful major life events is known to exacerbate a wide range of skin disorders. To examine the relationship between stressful major life events and dermatological symptoms among a non-clinical sample. A cross-sectional survey. Community-based subjects from London, Ontario, Canada were recruited from the local university, schools and churches. Out of 600 consecutive, consenting volunteers 316 subjects [73 men and 243 women; age 38.7 +/- 14.8 (mean +/- SD) years; marital status 54% married; race 94%'white'] completed the survey for this study. The exclusion criterion was a history of a major dermatological or medical disorder. The number of major life events experienced over the previous 6 months measured using the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe, and the frequency and severity of a range of cutaneous symptoms ('burning', 'crawling sensation', 'tingling', 'pricking' or 'pins and needles', 'pain', 'tenderness' of skin, 'numbness', 'moderate to severe itching', and 'easy bruising') that the subject may have experienced over the previous month. The most frequently reported body region affected was the scalp (59.5%) and the most frequently reported symptom was itching (69.3%). The total number of major life events experienced over the previous 6 months correlated with the severity of the individual cutaneous symptoms (0.22 < or = Pearson r < or = 0.41, P < 0.001) and with the total cutaneous symptom severity score (sum of all cutaneous severity ratings) (Pearson r = 0.40, P < 0.001). This correlation remained significant after the possible confounding effect of psychological factors on cutaneous symptoms was partialled out statistically (partial r = 0.19, P = 0.001). We observed a direct correlation between the number of major life events experienced over the previous 6 months and cutaneous symptoms experienced over the previous 1 month by non-clinical subjects. The correlation remained significant after the effect of psychological factors was partialled out, suggesting that this relationship holds even if the subject does not acknowledge psychological distress in reaction to the major life event.

Major life events as antecedents to hip fracture.

This study sought to determine whether the number of antecedent life events reported in the year before hip fracture among elderly patients was normal for the population from which these patients derive. Major life events are events such as births, deaths, major financial dealings, and major health changes. Life events reported in the year before a fall and hip fracture for 111 hip fracture patients were compared with those of a control sample of 90 nonfracture, community-dwelling ambulatory elderly. The total number of life events was higher in the hip fracture group (p = 0.0001) than in the community control group. Fracture was also associated with the number of events experienced (adjusted OR, 2.1; 95% CI, 1.6-2.7; p < 0.0007), notwithstanding age, marital status, and education. Older persons who had sustained a fall-related traumatic hip fracture experienced an increased number of major life events compared with a nonfracture population sample of community-dwelling elderly controls.

Psychological and endocrine correlates of chronic pelvic pain associated with adhesions

Chronic pelvic pain (CPP) is a frequent and often unexplained gynecological complaint. We attempted to evaluate stress history, psychological features and hypothalamic-pituitary-adrenal (HPA) axis Junction in a group of patients suffering from CPP associated with pelvic adhesions. We recruited 10 patients with CPP and adhesions and 14 painfree, infertile control patients who underwent gynecological examination and diagnostic laparoscopy in a general hospital Psychological assessment included structured interviews on sexual and physical abuse experiences and major life events as well as questionnaires on pain characteristics and depression, lb evaluate HPA axis Junction, we measured plasma adrenocorticotropin (ACTH) and salivary cortisol responses to the administration of 100 μg human corticotropin-releasing factor (CRF). Results revealed high, but not statistically increased, prevalence rates of sexual and physical abuse for patients with CPP and adhesions as compared to controls. Patients with CPP and adhesions reported a significantly higher total number of major life events. Mean depression scores were normal in both groups. Patients with CPP and adhesions demonstrated normal plasma ACTH, but decreased salivary cortisol levels in the CRF stimulation test. These preliminary findings suggest that stress and neuroendocrine changes may also contribute to the pathophysiology of CPP with an identified organic correlate.

Abuse-related posttraumatic stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in women with chronic pelvic pain.

Although numerous organic conditions may cause chronic pelvic pain (CPP), diagnostic laparoscopy reveals a normal pelvis in many patients with CPP. However, psychological studies yield a high frequency of psychopathology and increased prevalences of chronic stress and traumatic life events, ie, sexual and physical abuse, in women with CPP, suggesting a relationship between posttraumatic stress disorder (PTSD) and CPP. As chronic stress and PTSD have been associated with specific alterations of the hypothalamic-pituitary-adrenal (HPA) axis, we explored stress history, psychopathology and HPA axis alterations in women with CPP. We recruited 16 patients with CPP and 14 painfree, infertile controls from a general hospital where diagnostic laparoscopy was performed. Psychological assessment included standardized interviews on clinical symptoms, abuse experiences and major life events as well as psychometric testing for PTSD-like symptoms and depression. Endocrinological evaluation involved determinations of diurnal salivary cortisol levels and hormonal responses to a corticotropin-releasing factor (CRF) stimulation test (100 microg human CRF) and a low-dose dexamethasone suppression test (0.5 mg). We observed increased prevalences of abuse experiences and PTSD in women with CPP as well as a higher total number of major life events, whereas the mean extent of depression was within the normal range. With respect to endocrine measures, women with CPP demonstrated normal to low diurnal salivary cortisol levels, normal plasma-adrenocorticotropin (ACTH), but reduced salivary cortisol levels in the CRF stimulation test, and an enhanced suppression of salivary cortisol by dexamethasone. Women with CPP demonstrate HPA axis alterations, that partly parallel and partly contrast neuroendocrine correlates of PTSD, but show marked similarity to findings in patients with other stress-related bodily disorders. These findings suggest that a lack of protective properties of cortisol may be of relevance for the development of bodily disorders in chronically stressed or traumatized individuals.

Psychoendocrinological observations in women with chronic pelvic pain.

Chronic pelvic pain (CPP) is a frequent gynecologic complaint accounting for many diagnostic laparoscopies performed in general hospitals. Numerous organic conditions can cause CPP such as endometriosis and adhesions. However, studies assessing the prevalence of organic disease in women with CPP yield an extreme variation in results, suggesting the absence of any organic correlate in many patients with CPP. (See ref. 1 for a review.) On the other hand, a constantly high prevalence of psychopathology has been reported in patients with CPP, especially with respect to depressive mood, anxiety, and somatization. (See ref. 2 for a review.) Recent studies revealed an enhanced prevalence of chronic stress and traumatic life events, particularly sexual and physical abuse, in women with CPP.3-s In summary, these results suggest that CPP might be a stress-related syndrome. As stress is frequently associated with activation of the hypothalamic-pituitaryadrenal (HPA) axis, we recently explored psychoendocrinological features of women with CPP. Pain-free patients who underwent diagnostic laparoscopy because of infertility were recruited as controls. A high proportion of women with CPP had experienced sexual and/or physical abuse and fulfilled diagnostic criteria for posttraumatic stress disorder (PTSD) according to DSM-111-R criteria. Furthermore, women with CPP reported an enhanced total number of major life events, while these patients were typically not depressed. To assess HPA function, endocrine challenge tests were performed. In the corticotropin-releasing factor (0 stimulation test, women with CPP demonstrated normal basal and stimulated plasma ACTH levels, but blunted salivary cortisol responses compared to those in pain-free, infertile control subjects. In the low dose dexamethasone suppression test, patients with CPP had markedly lower salivary cortisol levels than did pain-free, infertile control subjects. However, in the presence of adrenocortical hyporeactivity, the latter result is inconclusive with respect to feedback sensitivity of the HPA axis. (See ref. 6 for a detailed description.)

Social support, stress, and depressive symptoms among the elderly: Test of a process model.

Effects of social support, negative life events, and daily hassles on depressive symptoms were assessed in 301 adults aged 65 or older, in person 3 times at 6-month intervals and by mail questionnaires every month over a 12-month period. Initial social support predicted severity of depressive symptoms 12 months later. Social support and initial levels of depressive symptomatology predicted number of daily hassles but not number of major life events. Effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion of hassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with major life events. Daily hassles mediated the effects of major life events on subsequent depression. Results did not differ for men and women. Implications for models of the relations among social support, stress, and depression are discussed.

Social support, stress, and depressive symptoms among the elderly: Test of a process model.

Effects of social support, negative life events, and daily hassles on depressive symptoms were assessed in 301 adults aged 65 or older, in person 3 times at 6-month intervals and by mail questionnaires every month over a 12-month period. Initial social support predicted severity of depressive symptoms 12 months later. Social support and initial levels of depressive symptomatology predicted number of daily hassles but not number of major life events. Effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion of hassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with major life events. Daily hassles mediated the effects of major life events on subsequent depression. Results did not differ for men and women. Implications for models of the relations among social support, stress, and depression are discussed. In a substantial body of literature that has accumulated over the past 15 years, researchers have evaluated the relations among social support, stressful life events, and physical and mental health status. Two models of these relations have been proposed. According to the first, the buffering hypothesis, social support serves a protective role primarily during times of stress by enhancing adaptive coping behavior (Cobb, 1979). Thus an interaction is hypothesized between stress and social support in predicting physical and mental health, whereby the effect of stress on health-related variables varies depending on the level of social support. According to the second model, social support has positive effects on health and well-being in both the presence and the absence of stress. This direct effects model predicts that there is a positive relation between social support and physical and mental health that is independent of the effects of stress. Empirical research on the relations among stress, social support, and health has provided mixed support for the buffering hypothesis (for a recent review, see S. Cohen & Wills, 1985). Although some researchers have found that high levels of social support protect a person from the negative effects of high levels of stress, others have found that supportive relationships are associated with good physical and mental health regardless of the presence or absence of stress. In a relatively small number of studies, investigators have examined the effects of social support and stressful life events

A Path Analysis of Factors Predicting Children's Divorce Adjustment

Eighty-two mother-child pairs from divorced homes completed measures assessing life change events, marital hostility, parenting skills, parent adjustment, child behavior adjustment, and children's self-concept. A model was constructed to describe direct and indirect effects of causally ordered prior variables on positive and negative child outcomes. Path coefficients suggested the operation of both direct and mediated effects of background factors, postdivorce adjustment of the custodial parent, and current child-rearing environments on adaptive and maladaptive child outcome variables. The impact of age on children's postdivorce adjustment was found to be mediated by the number of major life events they reported. One causal path was found to be significant for several child outcomes: Mothers with more children reported better postdivorce adjustment in themselves, which in turn predicted better self-reported parental functioning. More effective parenting was positively associated with better social ...

Psychological stress and increases in urinary norepinephrine metabolites, platelet serotonin, and adrenal androgens in women with polycystic ovary syndrome

Twenty-three women with polycystic ovary syndrome, 10 women with hypothalamic-pituitary dysfunction, and 50 control subjects were studied in an attempt to investigate the prevalence of psychological stress and its possible relationship to various hormonal parameters. Norepinephrine (NE) excretion, as reflected by urinary 3-methoxy-4-hydroxyphenylglycol (MHPG), and urinary 3-methoxy-4-hydroxymandelic acid (VMA), platelet serotonin, plasma adrenocorticotrophic hormone (ACTH), urinary free cortisol, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), androstenedione (Adione), dehydroepiandrosterone (DHEA), its sulfate (DHEA-S), Δ5-androstenediol (Δ5-Adiol), testosterone (T), and unbound estradiol (E2) were measured. In addition, psychological stress was assessed by means of questionnaires modified from the Schedule of Recent Experiences, in which a Life Events Inventory was scored between 1 and 100. Women with polycystic ovary syndrome had significantly elevated levels of serum LH, LH:FSH ratios, unbound E2, Adione, DHEA, Δ5-Adiol, T, and DHEA-S (p < 0.01). The number of Major Life Events (events scored on the questionnaire above 60) was significantly higher in women with polycystic ovary syndrome than in control women and women with hypothalamic-pituitary dysfunction (p < 0.05). Urinary MHPG and platelet serotonin levels were also significantly higher in women with polycystic ovary syndrome (p < 0.05), whereas VMA was normal. Levels of plasma ACTH and urinary free cortisol were similar in all groups. There was a significant positive correlation between MHPG and DHEA-S, MHPG and LH, and LH and T levels in women with polycystic ovary syndrome and those with hypothalamic-pituitary dysfunction (p < 0.01). VMA also correlated with DHEA-S (p < 0.05). In conclusion, psychological stress may be more prevalent in women with polycystic ovary syndrome and may be associated with elevated levels of MHPG and platelet serotonin. Because we have found that MHPG, but not VMA, correlated with LH, and because both MHPG and VMA correlated with DHEA-S, we hypothesize here that psychological stress and neurotransmitter levels may be linked to some of the hormonal derangements, including inappropriate gonadotropin secretion and elevated adrenal androgen levels in women with polycystic ovary syndrome.