Perceived Stress Questionnaire Research Articles

Effectiveness of a mindfulness-based walking programme in reducing symptoms of stress–a randomised controlled trial

Summary: Background: Distress reduces quality of life and induces the development and negative progress of diseases. It is therefore a current topic of public interest. Mind-body medicine and physical exercise have shown to reduce symptoms of stress. The aim of this randomized, controlled study was to investigate the effectiveness of a mindfulness based walking program in patients with distress. Methods: Participants aged between 18-65 years with high distress levels (self-assessment on a 10 mm visual analogue scale > 4 mm) were included. Participants were randomized into an intervention group which received a mindfulness based walk taking place twice a week over a period of four weeks or a waiting-list control group which received no study intervention. Outcome parameters were assessed at baseline, after 4 and 12 weeks. The primary outcome parameter was Cohen’s Perceived Stress Scale (PSS) after 4 weeks. Secondary outcome parameter included the Perceived Stress Questionnaire (PSQ), the visual analogue scale (VAS) and SF-36 to measure health related quality of life after 4 and 12 weeks. The statistical comparison of groups was performed by analysis of covariance on the intention-to-treat population adjusted for baseline differences. Results: Seventy-four participants were randomized in the study, 36 (32 female, 52.3 ± 8.6 years) were allocated to the intervention and 38 (35 female, 49.5 ± 8.8years) to the control group. After 4 weeks the adjusted mean of the PSS was with 24.2 (95 % CI: 22.2 – 26.2) significantly (p < 0.001) lower in the intervention group compared to the control group (32.0; 30.1 – 33.9). After 12 weeks the PSS of the intervention group was with 25.8 (23.6 – 28.0) vs. 29.2 (27.0 -31.3) still significantly (p = 0.038) better. Also the PSQ in the intervention group was significantly better after 4 weeks (p < 0.001) and after 12 weeks (p = 0.018) compared with control. Significant group differences were also found after 4 weeks for the VAS (p = 0.008) and the SF-36 Mental Components Score (p = 0.020) in favor of the intervention group. Discussion: Participating in a mindfulness based walking program reduced subjective symptoms of distress compared to no study intervention. Further studies with more study participants should include an active treatment control group and aim to measure the effects of walking and mindfulness separately.

Development of the Brief Inventory of Perceived Stress

To provide a measure of perceived stress that is psychometrically superior to existing instruments and novel in dimensionality. At 4-week intervals over 48 weeks, patients with multiple sclerosis (N = 138) completed 26 items from the Perceived Stress Scale (PSS) and the Perceived Stress Questionnaire (PSQ). Extant factor analytic models of the PSS fit poorly. A new measure using nine PSS and PSQ items, the Brief Inventory of Perceived Stress (BIPS), demonstrated good fit, construct validity, and stability with 3 factors: Lack of Control, Pushed, and Conflict and Imposition. Items commonly used to measure perceived stress may have a more sophisticated underlying structure than previously thought. The BIPS's multidimensionality and longitudinal stability offer potential benefits in conceptualization and outcome prediction.

Psychological comorbidity in patients with chronic tinnitus: analysis and comparison with chronic pain, asthma or atopic dermatitis patients

To determine the prevalence and severity of psychological comorbidity in patients with chronic tinnitus in comparison with other chronic illnesses, namely chronic pain, chronic asthma and atopic dermatitis. Psychological diagnoses were done according to ICD-10 Chapter V(F). Subjective impairment was evaluated using 5 psychometric questionnaires: tinnitus questionnaire, Berlin mood questionnaire, sense of coherence (SOC-L9) and perceived stress questionnaire. Sleep disturbance was measured by the subdomain 'exhaustion' of the Giessen physical complaints inventory. Somatoform or affective disorders were most frequent in all disease groups. Patients with chronic tinnitus had a stronger SOC and better subjective mood, stronger commitment, and less anger and anxious depression than the patients with chronic pain, chronic asthma or atopic dermatitis. However, in patients with higher tinnitus annoyance, psychological comorbidity was similar to that found in patients with other chronic diseases. Besides collecting medical and social history, special psychometric instruments should be used for the diagnosis of tinnitus patients. Based on relative high frequency of psychological comorbidity, we recommend interdisciplinary cooperation between otorhinolaryngologists and other specialists (psychosomatic medicine, psychology or psychiatry) during the treatment of tinnitus patients, especially when high degree of tinnitus annoyance is involved.

Therapeutic Effects and Safety of Rhodiola rosea Extract WS® 1375 in Subjects with Life‐stress Symptoms – Results of an Open‐label Study

The trial was conducted to investigate the therapeutic effects and safety of a 4 week treatment with Rhodiola rosea extract WS® 1375 in subjects with life-stress symptoms. This was a multicentre, non-randomized, open-label, single-arm trial. One hundred and one subjects were enrolled in this clinical study and received the study drug at a dose of 200 mg twice daily for 4 weeks. Assessments with seven questionnaires included Numerical Analogue Scales of Subjective Stress Symptoms, Perceived Stress Questionnaire, Multidimensional Fatigue Inventory 20, Numbers Connecting Test, Sheehan Disability Scale and Clinical Global Impressions to cover various aspects of stress symptoms and adverse events. Invariably, all tests showed clinically relevant improvements with regard to stress symptoms, disability, functional impairment and overall therapeutic effect. Improvements were observed even after 3 days of treatment, as were continuing improvements after 1 and 4 weeks. Rhodiola rosea extract WS® 1375 was safe and generally well tolerated. Adverse events were mostly of mild intensity and no serious adverse events were reported. Rhodiola extract at a dose of 200 mg twice daily for 4 weeks is safe and effective in improving life-stress symptoms to a clinically relevant degree.

Study of the Influence of Psychological Factors in the Etiology of Vocal Nodules in Women

The role placed by certain psychological factors such as stress and personality on the development of vocal nodules has not yet been established. The aim of this case-control type study is to analyze the relationship between these psychological factors and the presence of vocal nodules while also considering the professional and social aspects of the subjects suffering from this pathology. The case group is made up of 50 patients diagnosed with vocal nodules and with at least 6 months of evolution. The control group is made up of 50 patients diagnosed with nasal respiratory insufficiency. All the patients were examined by laryngeal stroboscopy. For the personality study, the perceived stress, and the voice use, the Minnesota Multiphasic Personality Inventory-2, Levenstein Perceived Stress Questionnaire, and Goldman Voice Use Survey were used, respectively. The subjects with vocal nodules presented a mean perceived stress score of 0.41±0.09, which was higher than that of the control group (0.35±0.06), the differences observed being statistically significant (P<0.001). In the personality study (MMPI-2), the only scale that was associated with the presence of the vocal nodules was that of psychomotor acceleration. The mean score obtained for the scale was 51.64±8.25 in the vocal nodule group and 45.02±0.06 in the control group (P<0.001). In the analysis of voice use, the subjects with vocal nodules scored 9.31±1.36, which was significantly higher than the score of the control group (8.07±1.24; P<0.001). In addition, other variables were associated with the presence of vocal nodules, such as being young and working in professions considered to be of vocal risk. Perceived stress and personality features of hyperactivity and impulsivity are independent factors related to vocal nodules.

Short Telomeres in Depression and the General Population Are Associated with a Hypocortisolemic State

The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in stress regulation, and leukocyte telomere length (TL) has been suggested to represent a cumulative measure of stress. Depression is intimately related with stress and frequently exhibits a dysregulated HPA axis. We aimed to study the relationships between TL and biological and psychological facets of stress in recurrent major depressive disorder and controls. Leukocyte TL was measured in 91 subjects with recurrent major depressive disorder and 451 control subjects. Stress was assessed from both a biological perspective, by assessing HPA axis function with a weight-adjusted very-low-dose dexamethasone suppression test (DST), and a psychological perspective, with self-report questionnaires. TL was shorter among patients compared with control subjects (277 base pairs, p = .001). Overall, short TL was associated with a hypocortisolemic state (low post-DST cortisol and high percentage of cortisol reduction after the DST) among both patients and control subjects but more pronounced among patients. This state, which was overrepresented among patients, was characterized by high familial loading of affective disorders among patients (p = .001) and high C-reactive protein levels among control subjects (p = .040). TL was also inversely associated with stress measured with the Perceived Stress Questionnaire (r(s) = -.258, p = .003). Short TL is associated with depression and hypocortisolism. Because hypocortisolism has been shown to develop from chronic stress exposure, our findings corroborate the concept of TL as a cumulative measure of stress and provide novel insights into the detrimental role of stress in depressive illness and the general population.

Determinants of fatigue and stress.

BackgroundFatigue can be triggered by previous perceived stress which may lead to impairment of performance and function. The purpose of the study was to investigate the relationship between fatigue and perceived stress.MethodHealth determinants including sociodemographic factors for associations between fatigue and perceived stress in the general population (N = 2,483) are outlined. Fatigue and stress were assessed with the Chalder Fatigue Scale (CFS) and the Perceived Stress Questionnaire (PSQ).ResultsWithin the general population, 25.9% of male and 34.5% of female respondents reported moderate fatigue during the last six months; 9.7% of subjects reported substantial fatigue lasting six months or longer. An adjusted regression analysis (R2corr = .28, p < .001) showed that fatigue is highest associated with perceived stress and self-perceived health status. The following factors were correlated with increased rates of fatigue and perceived stress: female gender, divorce/separation, low social class and poor health status.ConclusionWe conclude that the two conditions overlap most in terms of socio-economic status and self-perceived health status.

Healthy Workplaces: The Effects of Nature Contact at Work on Employee Stress and Health

Cultivating healthy workplaces is a critical aspect of comprehensive worksite health promotion. The influence of healthy workplace exposures on employee health outcomes warrants research attention. To date, it is unknown if nature contact in the workplace is related to employee stress and health. This study was designed to examine the effects of nature contact experienced at work on employee stress and health. Office staff at a southeastern university (n = 503, 30% response rate) participated in the cross-sectional study. We used a 16-item workplace environment questionnaire, the Nature Contact Questionnaire, to comprehensively measure, for the first time, nature contact at work. The Perceived Stress Questionnaire and 13 established health and behavioral items assessed the dependent variables, general perceived stress, stress-related health behaviors, and stress-related health outcomes. There was a significant, negative association between nature contact and stress and nature contact and general health complaints. The results indicate that as workday nature contact increased, perceived stress and generalized health complaints decreased. The findings suggest that nature contact is a healthy workplace exposure. Increasing nature contact at work may offer a simple population-based approach to enhance workplace health promotion efforts. Future researchers should test the efficacy of nature-contact workplace stress interventions.

Anxiety and Psychological Stress in Acute Severe Ulcerative Colitis: Prevalence and Effect on Outcome

Introduction There is increasing evidence that psychological stress and associated mood disorders are linked with, and adversely affect the course of IBD. The authors hypothesise that: (1) anxiety and stress are more common in acute severe ulcerative colitis (ASUC) than in patients with inactive UC; (2) anxiety and stress are more common in patients presenting for the first time with UC; (3) anxiety and stress worsen outcome in ASUC. Methods 39 ASUC patients (aged 28 (18–74) years (median (range)); disease duration 10 (0–240) months), requiring hospital admission and intravenous hydrocortisone with a Baron9s sigmoidoscopic score ≥2, completed questionnaires to assess anxiety (Hospital Anxiety and Depression Score (HADS-A)) and stress levels (Perceived Stress Questionnaire: Recent, R-PSQ, General, G PSQ). Outcomes were assessed, using the Travis criteria (day 3) and colectomy rates at day 70, in relation to upper and lower tertiles of the anxiety and stress scores. In addition, the psychometric scores of the ASUC patients were compared to those of 27 outpatients with inactive UC. Results Patients with ASUC had higher stress levels (R-PSQ Index 0.52 (0.03) (mean (SEM)), G-PSQ 0.46 (0.03)) than in patients with inactive UC (0.35 (0.03), p=0.001, 0.39 (0.02), p=0.046, respectively) but there was no difference in anxiety scores (HADS-A 9.6 (0.8), 8.4 (0.7), p=0.9, respectively). However, in patients with ASUC, there was a positive correlation between stress and anxiety scores (R-PSQ, r2=0.27, p=0.0008; G-PSQ, r2=0.14, p=0.02)). Although stress scores were similar, anxiety levels were higher in the 11 newly presenting ASUC patients (12 (1.4)) than in those previously diagnosed (8.6 (0.9), p=0.049). There was no difference in those responding to intravenous hydrocortisone (by Travis criteria) or in day 70 colectomy rates between patients who were highly (upper tertile) anxious (Travis response 8/13, colectomy rate 2/13) or highly (upper tertile) stressed (R-PSQ: Travis response 8/12, colectomy rate 6/13; G-PSQ Travis response 5/13, colectomy rate 4/13) compared to those less (lower tertile) anxious (5/13, 3/13, respectively) or stressed (lower tertile) (R-PSQ, 5/13, 1/13; G-PSQ 5/12, 1/13, respectively). Conclusion Perceived stress levels are greater in patients with ASUC than in those in remission and anxiety scores are highest in patients newly presenting with UC, but neither stress nor anxiety influenced disease outcome.

Decision‐making styles, stress and gender among investigators

PurposeThe purpose of this study is to analyze the relationship between police investigators' decision‐making styles, degree of judgmental self‐doubt and work conditions, on the one hand, and their wellbeing, stress, burnout tendency and sleep quality, on the other.Design/methodology/approachThe study concerns investigative police officers (n=203). Decision‐making styles were measured by Scott and Bruce's General Decision Making Style scale (GDMS), and judgmental self‐doubt by Mirels et al.'s Judgmental Self‐Doubt Scale (JSDS). Wellbeing was measured by the Satisfaction With Life scale (SWL), and stress and burnout tendency by the Perceived Stress Questionnaire (PSQ) and a scale for Performance Based Self‐Esteem (PBS). Questions on sleep quality and work conditions were also used.FindingsHigh values on the decision‐making styles Avoidant (tries to avoid making decisions) and Dependent (dependent on advice from others before important decisions) were associated with higher PBS, higher PSQ and poorer sleep quality. In addition, the Avoidant style was associated with lower SWL. Both the Dependent and the Avoidant styles were associated with higher influence experienced by others in the investigative work. Hierarchical regression analyses showed that JSDS explained the outcome measures better than the Dependent and the Avoidant decision‐making styles. Gender analyses showed that male investigators showed higher values on Rational decision‐making style (“exhaustive information search” and “logical evaluation of alternatives”) and female investigators higher values on the Dependent decision‐making style. Female investigators also evidenced a higher degree of stress and performance‐based self‐esteem.Research limitations/implicationsThe data were collected in a Swedish context and may not be fully generalizable to other countries.Practical implicationsThese results suggest the need to individualize training programs that seek to ameliorate stress and burnout.Originality/valueThis paper furthers understanding of the relation between decision‐making styles and wellbeing and stress in police investigators.

Body image quality of life in eating disorders.

Purpose:The objective was to examine how body image affects quality of life in an eating-disorder (ED) clinical sample, a non-ED clinical sample, and a nonclinical sample. We hypothesized that ED patients would show the worst body image quality of life. We also hypothesized that body image quality of life would have a stronger negative association with specific ED-related variables than with other psychological and psychopathological variables, mainly among ED patients. On the basis of previous studies, the influence of gender on the results was explored, too.Patients and methods:The final sample comprised 70 ED patients (mean age 22.65 ± 7.76 years; 59 women and 11 men); 106 were patients with other psychiatric disorders (mean age 28.20 ± 6.52; 67 women and 39 men), and 135 were university students (mean age 21.57 ± 2.58; 81 women and 54 men), with no psychiatric history. After having obtained informed consent, the following questionnaires were administered: Body Image Quality of Life Inventory-Spanish version (BIQLI-SP), Eating Disorders Inventory-2 (EDI-2), Perceived Stress Questionnaire (PSQ), Self-Esteem Scale (SES), and Symptom Checklist-90-Revised (SCL-90-R).Results:The ED patients’ ratings on the BIQLI-SP were the lowest and negatively scored (BIQLI-SP means: +20.18, +5.14, and −6.18, in the student group, the non-ED patient group, and the ED group, respectively). The effect of body image on quality of life was more negative in the ED group in all items of the BIQLI-SP. Body image quality of life was negatively associated with specific ED-related variables, more than with other psychological and psychopathological variables, but not especially among ED patients.Conclusion:Body image quality of life was affected not only by specific pathologies related to body image disturbances, but also by other psychopathological syndromes. Nevertheless, the greatest effect was related to ED, and seemed to be more negative among men. This finding is the opposite of that found in other groups studied previously.

Optimizing management of Crohn's disease within a project management framework: results of a pilot study.

Psychotherapy for Crohn's disease (CD) has focused on patients with psychological distress. Another approach to optimize management of CD is to target patients who do not exhibit psychological distress but engage in behaviors that undermine treatment efficacy / increase risk for flare. We sought to determine the feasibility/acceptability and estimate the effects of a program framed around Project Management (PM) principles on CD outcomes. Twenty-eight adults with quiescent CD without a history of psychiatric disorder were randomized to PM (n = 16) or treatment as usual (TAU; n = 12). Baseline and follow-up measures were Inflammatory Bowel Disease Questionnaire (IBDQ), Medication Adherence Scale (MAS), Perceived Stress Questionnaire (PSQ), and IBD Self-Efficacy Scale (IBD-SES). There were significant group × time effects favoring PM on IBDQ-Total Score (F(1) = 15.2, P = 0.001), IBDQ-Bowel (F(1) = 6.5, P = 0.02), and IBDQ-Systemic (F(1) = 9.3, P = 0.007) but not IBDQ-Emotional (F(1) = 1.9, P = ns) or IBDQ-Social (F(1) = 2.4, P = ns). There was a significant interaction effect favoring PM with respect to PSQ (F(1) = 8.4, P = 0.01) and IBD-SES (F(1) = 12.2, P = 0.003). There was no immediate change in MAS (F(1) = 4.3, P = ns). Moderate effect sizes (d > 0.30) were observed for IBDQ total score (d = 0.45), IBDQ bowel health (d = 0.45), and systemic health (d = 0.37). Effect sizes for PSQ (d = 0.13) and IBDSES (d = 0.17) were smaller. Behavioral programs that appeal to patients who may not seek psychotherapy for negative health behaviors may improve quality of life and potentially disease course and outcomes.

INSPIRE study: Does stress management improve the course of inflammatory bowel disease and disease-specific quality of life in distressed patients with ulcerative colitis or crohnʼs disease? A randomized controlled trial

The use of stress management psychotherapy is hypothesized to produce greater improvement in disease course and disease-specific quality of life (IBDQ) compared to usual medical care alone in patients with ulcerative colitis (UC) or Crohn's disease (CD) showing high levels of stress (based on the Perceived Stress Questionnaire [PSQ]). Fifty-eight patients with UC and 56 patients with CD who had experienced continuous disease activity or had relapsed over the previous 18 months, with an activity index for UC or CD ≥ 4, a PSQ ≥ 60, and without serious psychiatric disorders or other serious medical conditions were randomized to receive either treatment as usual (TAU) or TAU plus stress management psychotherapy. Psychotherapy consisted of three group sessions (psychoeducation, problem-solving, relaxation) and 6-9 individual sessions based on cognitive behavior therapy-related methods with 1-3 booster sessions at 6 and 12 months follow-up. Gastroenterologists blinded to intervention group assessed disease activity and course at baseline and at 3, 6, 12, and 18 months. Patients completed the IBDQ at baseline, 6, 12, and 18 months. The intervention did not improve disease or reduce relapse; however, it increased the IBDQ score (P = 0.009, mean differences 16.3 [SD 6.1]). On analysis of UC and CD separately, improvement of IBDQ was only found in the UC group. Stress management psychotherapy does not appear to improve disease course or reduce relapse in patients with IBD. It might improve quality of life, particularly in patients with UC.

Mood and nonmood components of perceived stress and exacerbation of Crohnʼs disease

Diverse psychological factors are involved in the pathophysiology of stress. In order to devise effective intervention strategies, it is important to elucidate which factors play the most important role in the association between psychological stress and exacerbation of Crohn's disease (CD). We hypothesized that the association between perceived stress and exacerbation of CD would remain after removal of mood and anxiety components, which are largely involved in stress perception. In all, 468 adults with CD were recruited and followed in different hospitals and private practices of Switzerland for 18 months. At inclusion, patients completed the Perceived Stress Questionnaire and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. During the follow-up, gastroenterologists assessed whether patients presented with a CD exacerbation. By means of binary logistic regression analysis, we estimated the factor by which one standard deviation of perceived stress would increase the odds of exacerbation of CD with and without controlling for anxiety and depression. The odds of exacerbation of CD increased by 1.85 times (95% confidence interval 1.43-2.40, P < 0.001) for 1 standard deviation of perceived stress. After removing the anxiety and depression components, the residuals of perceived stress were no longer associated with exacerbation of CD. The association between perceived stress and exacerbation of CD was fully attributable to the mood components, specifically anxiety and depression. Future interventional studies should evaluate the treatment of anxiety and depression as a strategy for potential prevention of CD exacerbations.

The role of self-efficacy in inflammatory bowel disease management

Inflammatory bowel diseases (IBDs) require self-management skills that may be influenced by self-efficacy (SE). Self-efficacy represents an individual's perception of his or her ability to organize and execute the behaviors necessary to manage disease. The goal of this study was to develop a valid and reliable measure of IBD-specific SE that can be used in clinical and research contexts. One hundred and twenty-two adults with a verified IBD diagnosis participated in the study. Data were pooled from 2 sources: patients from an outpatient university gastroenterology clinic (n=42) and a sample of online respondents (n=80). All participants (N=122) completed the IBD Self-Efficacy Scale (IBD-SES) and the Inflammatory Bowel Disease Questionnaire. Additionally, online participants completed the Brief Symptom Inventory-18 and the Rosenberg Self-Esteem Scale, whereas those in the clinic sample completed the Perceived Health Competence Scale, the Perceived Stress Questionnaire, and the Short Form Version 2 Health Survey. The IBD-SES was initially constructed to identify 4 distinct theoretical domains of self-efficacy: (1) managing stress and emotions, (2) managing medical care, (3) managing symptoms and disease, and (4) maintaining remission. The 29-item IBD-SES has high internal consistency (r=0.96), high test-retest reliability (r=0.90), and demonstrates strong construct and concurrent validity with established measures. The IBD-SES is a critical first step toward addressing an important psychological construct that could influence treatment outcomes in IBD.

Body image and quality of life in a Spanish population

PurposeThe aim of the current study was to analyze the psychometric properties, factor structure, and internal consistency of the Spanish version of the Body Image Quality of Life Inventory (BIQLI-SP) as well as its test–retest reliability. Further objectives were to analyze different relationships with key dimensions of psychosocial functioning (ie, self-esteem, presence of psychopathological symptoms, eating and body image-related problems, and perceived stress) and to evaluate differences in body image quality of life due to gender.Patients and methodsThe sample comprised 417 students without any psychiatric history, recruited from the Pablo de Olavide University and the University of Seville. There were 140 men (33.57%) and 277 women (66.43%), and the mean age was 21.62 years (standard deviation = 5.12). After obtaining informed consent from all participants, the following questionnaires were administered: BIQLI, Eating Disorder Inventory-2 (EDI-2), Perceived Stress Questionnaire (PSQ), Self-Esteem Scale (SES), and Symptom Checklist-90-Revised (SCL-90-R).ResultsThe BIQLI-SP shows adequate psychometric properties, and it may be useful to determine the body image quality of life in different physical conditions. A more positive body image quality of life is associated with better self-esteem, better psychological wellbeing, and fewer eating-related dysfunctional attitudes, this being more evident among women.ConclusionThe BIQLI-SP may be useful to determine the body image quality of life in different contexts with regard to dermatology, cosmetic and reconstructive surgery, and endocrinology, among others. In these fields of study, a new trend has emerged to assess body image-related quality of life.

Regionale und individuelle Faktoren von Stresserleben in Deutschland: Ergebnisse einer repräsentativen Befragung mit dem Perceived Stress Questionnaire (PSQ)

The aim of the present study was to define, besides prevalence data, regional and individual factors of stress experience in a representative sample of the German general population. Regional factors were examined separately by federal state and the size of the political location. Individual factors were defined according to the severity of the stress experience as well as on the basis of central social factors such as family state, profession and earnings. The Perceived Stress Questionnaire (PSQ), a validated, self-evaluation process for recording a subjective representation of frequency estimates of stress experiences was used. Data acquisition was carried out by a market research institute in a multi-topic questionnaire (N=2,552). Households were selected by the random route procedure, target persons were also selected at random. The prevalence rate for an elevated stress experience was 14.5%, that for a very high stress experience 3.1% of the sample. People without education exhibited the highest rates of stress experience (36.8%), followed by the unemployed (30.6%). Individual and social factors that favour an increased stress experience are a subjectively poor state of health (OR: 3.42) or belonging to the lower social economic status (OR: 1.30). Furthermore, there are indications of regional factors such as size of the location as well as differences between the individual federal states. An east-west comparion did not show any significant differences with regard to stress experiences. In the light of the illness burden associated with chronic stress situations, preventative measures in cases of unemployment or low level of education should be given priority.

Salivary cortisol, stress, and health in primary caregivers (mothers) of children with cerebral palsy

This study evaluated level of salivary cortisol and perceived burden, stress and health of mothers and primary caregivers of children (4-11 years of age) with cerebral palsy (purpose group, n=37) and those for mothers of children of the same age without developmental problems (control group, n=38). Anthropometric and socioeconomic data were collected from the participants, who also completed the perceived stress questionnaire, the Burden Interview and the 36-Item Short Form Health Survey (SF-36). Cortisol level was assayed in saliva samples collected at various times in a single day and the area under the cortisol curve was then determined. Both groups presented low socioeconomic level and high, although equivalent, perceived stress index. However, the purpose group showed lower cortisol levels, as well as lower scores for many of the SF-36 domains related to physical well-being (physical functioning, role-physical, vitality, and general health) and social functioning. Nevertheless, bodily pain was also reported to be lower. For the control group, the area under the cortisol curve correlated negatively with mental health and social functioning. For the purpose group, where the burden is greater, no such correlation was found. It was concluded that mothers of healthy children leaving in unfavorable socioeconomic conditions face high levels of stress with the hypothalamus-pituitary-adrenal cortex axis function preserved. However, to the mothers of children with cerebral palsy, who live in even worse socioeconomic conditions and also have the burden of caring for a disabled child, the level of stress was overwhelming, to an extent that it impaired the hypothalamus-pituitary-adrenal cortex axis function, as well as reflecting negatively on certain aspects of their physical and psychological well-being. This must receive consideration during the treatment of the child, an approach which is in line with present day tendencies towards family-centered models of assistance to disabled children.

Psychosocial factors and metabolic parameters: Is there any association in elderly people? The Massa Lombarda Project

Objective: Several studies claim that psychophysical stress and depression contribute significantly to cardiovascular disease (CVD) development. The aim of our research is to discover and analyse a possible relationship between two psychosocial disorders (depression and perceived mental stress) and traditional cardiovascular risk markers. Methods: We selected 106 subjects (58 males and 48 females), mean age 79.5 ± 3.8-years old, from the Massa Lombarda Project, an epidemiological study, including 7000 north Italian adult subjects. We carried out anamnesis, clinical and blood tests. Then, we administered the Perceived Stress Questionnaire (PSQ range score 0–1) and the Self-Rating Depression Scale (SRDS range score 50–70 Z), as validated instruments for depression and stress evaluation, which focus on the individual's subjective perception and emotional response. Statistical descriptive and inferential analyses of data collected were performed. Results: The multiple linear regression analysis showed a negative correlation between PSQ index score and uric acid, low-density lipoprotein cholesterol (LDL-c), body mass index (BMI), systolic and diastolic blood pressure values, a positive and statistically significant correlation between PSQ index score and triglycerides (p < 0.05). We found an inverse relationship between Zung SRDS score and LDL-c, uric acid, glucose waist circumference values, this correlation was significant only for uric acid (p < 0.01). Besides, a positive and significant correlation between Zung SRDS and triglycerides (p < 0.05) was observed. Conclusion: We suppose that psycho-emotional stress and depression disorder, often diagnosed in elderly people, may influence different metabolic parameters (triglycerides, uric acid and BMI) that are involved in the complex process of metabolic syndrome.

Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients undergoing classical massage therapy

Cancer patients frequently suffer from psychological comorbidities such as depression and elevated stress. Previous studies could demonstrate that cancer patients benefit from massage therapy on the physical and psychological level. This pilot study investigates the effects of massage on depression, mood, perceived stress, and the Th1/Th2 ratio in breast cancer patients. Thirty-four breast cancer patients were randomly assigned to a massage group (n=17) and a control group (n=17). Patients of the massage group received two 30-min classical massages per week for 5 weeks. At baseline, at the end of the intervention period, and 6 weeks after the end of intervention, patients of both groups completed the Perceived Stress Questionnaire (PSQ), the Patient Health Questionnaire (PHQ), and the Berlin Mood Questionnaire (BFS) and blood was withdrawn for determining cytokine concentrations and the Th1/Th2 ratio. Twenty-nine patients were included in the statistical analysis. Depression (PHQ) and anxious depression (BSF) were significantly reduced immediately after massage compared to the control group. Stress (PSQ) and elevated mood (BSF) did not show significant alterations after massage therapy. Changes of cytokine concentrations and Th1/Th2 ratio were insignificant as well, although there was a slight shift towards Th1 in the massage group over time. Massage therapy is an efficient treatment for reducing depression in breast cancer patients. Insignificant results concerning immunological parameters, stress, and mood indicate that further research is needed to determine psychological and immunological changes under massage therapy.