Stress-related Mental Health Problems Research Articles

Long-term mental health and resilience of the first responders in Japanese ground self-defense forces engaging body recovery after the great east Japan earthquake

Handling human remains is extremely difficult and stressful task, and it can contribute to the development of stress-related mental health problems. To prevent disaster from the development of mental disorders in first responders, it will be important to elucidate factors sustaining psychological well-being following the events requiring handling of human remains. Japanese Ground Self-Defense Forces (JGSDF) first responders (n = 146), involved in human remains recovery after the Great East Japan Earthquake (GEJE) participated. We examined the psychological resilience (S-H Resilience Test), depressive symptoms (SDS), and psychological distress (GHQ-28) 6 years after GEJE, in three groups; Group A: no contact no view of human remains, B: view only of human remains, and C: direct handling of human remains. S-H Resilience test evaluated the 3 subclasses of resilience; Social Support, Self Efficacy, Sociality. One-way ANOVA revealed the significant difference in resilience scores between Group B and C without any differences in depressive symptoms or psychological distress among the 3 groups. Multiple regression analyses revealed that depressive symptoms and resilience were associated with psychological distress in all participants. Path analyses showed that whereas one subtype of resilience indirectly reduced psychological distress through lower depressive symptoms in Group A (Social Support) and Group B (Sociality), both subtypes of resilience indirectly reduced psychological distress by lowering depressive symptoms in Group C. These findings suggest that exposure to higher stressful situation may decrease the psychological resilience based on the S-H Resilience test, and two subtypes of resilience may be necessary to sustain the psychological well-being.

Early-life stress and the gut microbiome: A comprehensive population-based investigation

Early-life stress (ELS) has been robustly associated with a range of poor mental and physical health outcomes. Recent studies implicate the gut microbiome in stress-related mental, cardio-metabolic and immune health problems, but research on humans is scarce and thus far often based on small, selected samples, often using retrospective reports of ELS. We examined associations between ELS and the human gut microbiome in a large, population-based study of children.ELS was measured prospectively from birth to 10 years of age in 2,004 children from the Generation R Study. We studied overall ELS, as well as unique effects of five different ELS domains, including life events, contextual risk, parental risk, interpersonal risk, and direct victimization. Stool microbiome was assessed using 16S rRNA sequencing at age 10 years and data were analyzed at multiple levels (i.e. α- and β-diversity indices, individual genera and predicted functional pathways). In addition, we explored potential mediators of ELS-microbiome associations, including diet at age 8 and body mass index at 10 years.While no associations were observed between overall ELS (composite score of five domains) and the microbiome after multiple testing correction, contextual risk – a specific ELS domain related to socio-economic stress, including risk factors such as financial difficulties and low maternal education – was significantly associated with microbiome variability. This ELS domain was associated with lower α-diversity, with β-diversity, and with predicted functional pathways involved, amongst others, in tryptophan biosynthesis. These associations were in part mediated by overall diet quality, a pro-inflammatory diet, fiber intake, and body mass index (BMI).These results suggest that stress related to socio-economic adversity – but not overall early life stress – is associated with a less diverse microbiome in the general population, and that this association may in part be explained by poorer diet and higher BMI. Future research is needed to test causality and to establish whether modifiable factors such as diet could be used to mitigate the negative effects of socio-economic adversity on the microbiome and related health consequences.

Psychologists’ involvement in and experiences of treating patients with stress-related exhaustion in primary care

BackgroundPrimary health care is the setting for most patients with stress-related mental health problems. Good care processes are important for patients with stress-related mental health problems and the complex needs of these patients has become a challenge for primary care settings which is traditionally designed to manage acute episodes of one illness. The care process of these patients is thus interesting to investigate. The aim of this study was to explore psychologists´ involvement and experiences regarding the organisation of the care process and treatment of patients seeking care for stress-related exhaustion.MethodFifteen psychologists (14 women and 1 man, age range 27–72 years)c from fifteen different primary health care centres in the western part of Sweden, located in both rural and urban areas were included. Qualitative content analysis of individual semi-structured interviews was conducted.ResultsThe analysis resulted in eight subcategories within the two main categories studied illuminating psychologists’ involvement and experiences regarding the organisation of the care process and challenges regarding treatment of patients seeking care for stress-related exhaustion.ConclusionThe care process of patients with stress-related exhaustion is perceived to be ineffective and not congruent with the needs of the patients. A lack of holistic overview of the care process, a lack of collaboration and poor utilization of the health care professionals’ competence leads to an unstructured process forcing the patients to be the carriers and coordinators of their own care.

From trauma to resilience: The effect of stress on the labor market outcome of refugees

Millions of refugees struggle to survive in foreign countries. They have a high prevalence of stress-related mental health problems which lead to a growing concern about their labor market outcome. This study develops a stress and coping model of refugees that includes two stressors. The stress triggered by traumatic events may be eased gradually over time by coping, while the one triggered by workplace discrimination persists throughout their working life. Since coping takes time, refugees must carefully manage their time among coping, leisure, and working. We find that refugees choose to ease more stress but earn less in the early stage of their working life. After refugees reduce stress gradually over time, they transform their working life from barely surviving to striving. We also find that emotional outbursts release stress and increase income in the short term but not necessarily in the long term. Refugees prefer avoiding intentional outbursts that would do more harm than good.

Self-Compassion and Mental Health in Sexual and Gender Minority People: A Systematic Review and Meta-Analysis.

Purpose: Literature shows that sexual and gender minority (SGM) individuals are at higher risk of developing minority stress-related mental health problems. Recently, it has been suggested that promoting self-compassion through affirmative mental health care for SGM people can be beneficial. However, no systematic analysis has been published exploring the relationship between self-compassion and mental health indicators in SGM individuals. We aim to fill this gap by synthesizing and meta-analyzing studies that focus on the relationship between self-compassion and mental health in SGM people. Methods: After registering in PROSPERO (CRD42021254774), PubMed, PsycINFO, CENTRAL, and Web of Knowledge were systematically searched to identify studies assessing the association between self-compassion and mental health and/or minority stress indicators in SGM individuals. All screening steps and data extraction were performed independently by the two researchers. The quality of each study was assessed with the National Heart, Lung and Blood Institute tool, and meta-analysis was performed on R software. Results: Twenty-one studies were included in the meta-analysis, corresponding to a total of 6573 nonheterosexual and/or noncisgender participants. All meta-analytic models were significant: higher levels of self-compassion were associated with less depression, anxiety, psychological distress, suicidal ideation, internalized homophobia/transphobia, and stigma, and with more well-being, outness, and social support. Conclusion: This meta-analysis suggests that self-compassion is significantly associated with mental health indicators in SGM people, and this relationship is especially strong with internalized homophobia/transphobia in older SGM adults, and with suicidal ideation in younger SGM individuals. Results suggest that affirmative mental health care may benefit from promoting self-compassion.

The Impact of Perceived Social Support on the University 'Educators' Flourishing and the Moderating Effect of Challenge Appraisal

This study provides insights into what makes teachers flourish in public sector universities of Sindh, Pakistan. Flourishing represents a balanced life where a person is happy with their status and is functioning effectively. The well-being of teachers has reportedly been lower than the general population (Education Support Partnership, 2019). Depressive symptoms were reported by 49% of 1189 academic staff members at 12 universities in Sindh, according to research on stress-related mental health problems in the Pakistani Scenario. Yet, research on evaluating teachers' mental health is lacking, notably among Pakistani university professors (Akram, 2019). Therefore, this study sheds light on the impact of perceived social support on educators' flourishing. Also, it discusses the boundary condition of challenge appraisals in this relationship. Statistical analysis was performed on data collected from 229 educators in Sindh, Pakistan's public sector universities. The result found a positive and statistically significant link between educators' perceptions of supervisors and co-worker support with educators' flourishing. However, challenge appraisal was found insignificant between exogenous and endogenous latent components. Overall, the study's findings suggest that perceived social support might help educators flourish at Sindh's public higher education institutions. The results' implications are discussed.

Cortisol changes in healthy children and adolescents during the COVID-19 pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic has caused massive disruptions to daily life in the United States, closing schools and businesses and increasing physical and social isolation, leading to deteriorations in mental health and well-being in people of all ages. Many studies have linked chronic stress with long-term changes in cortisol secretion, which has been implicated in many stress-related physical and mental health problems that commonly emerge in adolescence. However, the physiological consequences of the pandemic in youth remain understudied. Using hair cortisol concentrations (HCC), we quantified average longitudinal changes in cortisol secretion across a four-month period capturing before, during, and after the transition to pandemic-lockdown conditions in a sample of healthy youth (n = 49). Longitudinal changes in HCC were analyzed using linear mixed-effects models. Perceived levels of pandemic-related stress were measured and compared to the physiological changes in HCC. In children and adolescents, cortisol levels significantly increased across the course of the pandemic. These youth reported a multitude of stressors during this time, although changes in HCC were not associated with self-reported levels of COVID-19-related distress. We provide evidence that youth are experiencing significant physiological changes in cortisol activity across the COVID-19 pandemic, yet these biological responses are not associated with perceived stress levels. Youth may be especially vulnerable to the deleterious impacts of chronic cortisol exposure due to their current status in the sensitive periods for development, and the incongruency between biological and psychological stress responses may further complicate these developmental problems.

"Who I Am Now, Is More Me." An Interview Study of Patients' Reflections 10 Years After Exhaustion Disorder.

Aim: To achieve a deeper understanding of the patient’s perception regarding individual aspects related to the development of exhaustion, hindering and supporting factors in the recovery process, and potential remaining consequences, 7–12 years after receiving an exhaustion disorder diagnosis.Participants and Methods: Twenty patients previously diagnosed with and treated for exhaustion disorder were interviewed 7–12 years after onset of the disease. The semi-structured interviews were transcribed verbatim and analyzed with inductive content analysis.Results: Three main themes with patterns of shared meaning resulted from the analysis: “it’s about who I am,” “becoming a more authentic me,” and “the struggle never ends.” The interviewees described rehabilitation from exhaustion disorder as the start of an important personal development toward a truer and more authentic self-image. They perceived this as an ongoing long-lasting process where learned behavior and thought patterns related to overcommitment and overcompliance needed to be re-evaluated. The results also convey long-term consequences such as cognitive difficulties and reduces energy, uncertainty about one’s own health, and the need to prioritize among one’s relationships.Conclusion: Patients with exhaustion disorder are still struggling with dysfunctional strategies and functional impairments such as cognitive problems which limit their lives, 10 years after receiving their exhaustion disorder diagnosis. While informants describe some positive consequences of ED, the results also emphasize the importance of acknowledging that the patients are embedded in systems of relationships, in working life as well as in family life. This needs to be considered, together with other aspects, when working toward prevention of stress-related mental health problems.

The prefrontal cortex in a pandemic: Restoring functions with system-, family-, and individual-focused interventions.

The COVID-19 pandemic is an unanticipated and uncontrollable chronic stressor that is detrimental to the mental and behavioral health of children and families, particularly those from disadvantaged and marginalized backgrounds. Chronic stress impairs a myriad of prefrontal cortical functions, important for coping with the COVID-19 pandemic, and has consequences on dyadic parent-child functioning. Informed by neuroscience and clinical evidence, sensitive parenting is a vital avenue of intervention that buffers against the toxic effects of COVID-19 on parent-child mental health. In the context of the COVID-19 pandemic, we first discuss the neurobiological, psychological, and behavioral mechanisms behind exacerbated mental health risks in families. We then highlight the role of sensitive parenting as a buffer against stress-related mental health problems, and conclude with recommendations for systemic-, family-, and individual-interventions to most effectively address stress-related mental health problems and their impact on children and families during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The use of coping strategies \u201cshift-persist\u201d mediates associations between physical activity and mental health problems in adolescents: a cross-sectional study

BackgroundSelf-perceived mental health problems among adolescents has had an upward trend. Concurrently, adolescents’ physical activity (PA) has been falling whilst sedentary time (SED) has increased. There is a lack of research using accelerometer measured PA and SED to study their relationships to perceived stress and psychosomatic symptoms, both frequently observed mental health problems among adolescents. Whether coping strategies is one of the mechanisms underlying such relationship is less clear.MethodsA total of 2283 13-year olds were enrolled in the baseline examination of the STARS (STudy of Adolescence Resilience and Stress) study in Western Sweden. Light-, moderate-, vigorous-intensity PA (LPA, MPA and VPA) and SED were measured using hip-worn ActiGraph GT3X+ accelerometer. A total of 1284 adolescents provided valid accelerometer data (at least 4 days with ≥10 h per day). PA and SED during school-time and leisure-time were analysed separately. Surveys were utilized to monitor perceived stress, psychosomatic symptoms and the use of coping strategies “shift-persist”. Logistic regression and mediation analyses were performed adjusting for gender, ethnicity, socioeconomic status and puberty development.ResultsWe observed that more time spent in PA was associated with less stress in adolescents. The associations were observed for LPA (Odds ratio for LPA per 60 min: 0.557 (95% CI 0.399–0.776), VPA (Odds ratio for VPA per 15 min: 0.688 (95% CI 0.588–0.806) and MVPA (Odds ratio for MVPA per 15 min: 0.795 (95%CI 0.718–0.879) during leisure time, but not during school time. Similar associations were observed between leisure time PA and psychosomatic symptoms. The associations remained statistically significant even after adjusting for the confounders. Further, our data showed that adolescents who engaged more time in PA during leisure time were more likely to adopt the coping strategies of “shift-persist”. Mediation analysis showed that the use of “shift-persist” mediated the associations between leisure time PA and stress/psychosomatic symptoms.ConclusionsLeisure time physical activity, irrespective of intensity, may facilitate successful coping with stress and stress-related mental health problems in adolescents.

Mindfulness-Based Trauma Recovery for Refugees (MBTR-R): Randomized Waitlist-Control Evidence of Efficacy and Safety

Refugees and asylum seekers often suffer from trauma- and stress-related mental health problems. We thus developed mindfulness-based trauma recovery for refugees (MBTR-R)—a 9-week, mindfulness-based, trauma-sensitive, and socioculturally adapted group intervention for refugees and asylum seekers. We conducted a randomized waitlist-control study to test its efficacy and safety among a community sample of 158 Eritrean asylum seekers (46.2% female) with severe trauma history and chronic postmigration stress. Relative to the waitlist-control group, MBTR-R participants demonstrated significantly reduced rates and symptom severity of posttraumatic stress disorder, depression, anxiety, and multimorbidity at postintervention and 5-week follow-up. Therapeutic effects were not dependent on key demographics, trauma history severity, or postmigration living difficulties. Finally, there was no evidence of adverse effects or lasting clinically significant deterioration in monitored outcomes. The brief intervention format, group-based delivery, and limited attrition indicate that MBTR-R may be a feasible, acceptable, readily implemented, and scalable mental health intervention for refugees and asylum seekers.

Self-reported cognitive impairment and daily life functioning 7-12 years after seeking care for stress-related exhaustion.

The overall aim of this study was to investigate self-reported cognitive difficulties, daily life activities, and health/sleep factors in former patients with exhaustion disorder (ED) who still fulfill the clinical criteria for exhaustion 7-12years after seeking care. The Sahlgrenska Self-reported Cognitive Impairment Questionnaire (SASCI-Q) was used to measure cognitive difficulties, daily life activities, and health/sleep factors. Three groups were compared: previous patients still judged to be clinically exhausted seven years or more after seeking care (n=51); previous patients considered clinically recovered (n=98); and healthy controls (n=50). Patients who still fulfilled the diagnostic criteria for ED reported widespread problems related to cognition, fatigue, and daily life functioning compared to the clinically recovered group. Furthermore, despite no longer fulfilling the clinical criteria, the recovered patients still reported more problems related to cognitive functioning and fatigue compared to healthy controls. Thus, this group appeared intermediary between the non-recovered group and healthy controls regarding self-reported cognitive functioning. To conclude, ED may have considerable negative long-term effects, and it is possible that some of these residual symptoms, particularly the cognitive problems and persistent fatigue, are permanent in some patients. Preventive measures should be the primary focus for all stakeholders, since the consequences of stress-related mental health problems seem to be extensive and long-lasting.

Mindfulness, Stress Reactivity, and Depressive Symptoms Among “Third Culture Kids” in the United Arab Emirates

So called third culture kids (TCKs), the children and adolescents who accompany their parents on long-term overseas work assignments, often have to face life changes, cultural challenges and threats to social identity. The frequency, intensity and nature of these challenges arguably places some TCKs at heightened risk of stress-related mental health problems. Trait mindfulness, an attribute that can be enhanced through intervention, has been found to buffer against stress reactivity and common mental health problems. This study aims to explore the relationship between stress reactivity, trait mindfulness and depressive symptomatology among expatriate adolescents (TCKs) attending an international school in the United Arab Emirates (UAE). Participants included 230 high school students (57% female) from 45 different nations, with a mean age of 15.5 (±1.3, 12–19). Forty one percent had lived in the UAE for 7+ years. Participants completed measures of trait mindfulness, daily life stress reactivity, and depressive symptoms (CES-D). Mean depression score was high with 68.7% of TCK participants presenting as at risk of clinical depression. Lower stress-reactivity and greater trait mindfulness were associated with lower levels of depression; furthermore, low levels of trait mindfulness partially mediated the relationship between stress reactivity and depression. Efforts that aim to reduce stress reactivity and increase mindfulness might prove especially beneficial among the TCK population.

Resilience beyond reductionism: ethical and social dimensions of an emerging concept in the neurosciences

Since a number of years, popular and scientific interest in resilience is rapidly increasing. More recently, also neuroscientific research in resilience and the associated neurobiological findings is gaining more attention. Some of these neuroscientific findings might open up new measures to foster personal resilience, ranging from magnetic stimulation to pharmaceutical interventions and awareness-based techniques. Therefore, bioethics should also take a closer look at resilience and resilience research, which are today philosophically under-theorized. In this paper, we analyze different conceptualizations of resilience and argue that especially one-sided understandings of resilience which dismiss social and cultural contexts of personal resilience do pose social and ethical problems. On a social level such unbalanced views on resilience could hide and thereby stabilize structural social injustices, and on an individual level it might even lead to an aggravation of stress-related mental health problems by overexerting the individual. Furthermore, some forms of fostering resilience could be a latent form of human enhancement and trigger similar criticisms.

Cumulative lifetime stress exposure, depression, anxiety, and well-being in elite athletes: A mixed-method study

Research suggests that elite athletes are at increased risk of poor mental health, partly due to the intense demands associated with top-level sport. Despite growing interest in the topic, the factors that influence the mental health and well-being of elite athletes remain unclear. From a theoretical perspective, the accumulation of stress and adversity experienced over the life course may be an important factor. To investigate this possibility, we employed a mixed-method design to: (a) examine whether cumulative lifetime stress predicted depression, anxiety, and well-being in elite athletes; and (b) help explain why cumulative lifetime stress exposure might have resulted in poor mental health and well-being. Ninety-five elite athletes (Mage = 29.81, SD = 10.88) completed the Stress and Adversity Inventory, Patient Health Questionnaire, Generalized Anxiety Disorder 7-item scale, and the Scales of General Well-Being. Hierarchical regression analyses revealed that total count and severity of lifetime stressor exposure significantly predicted greater depression (β = .42, p < .001; β = .46, p < .001) and anxiety symptoms (β = .34, p = .003; β = .28, p = .018), and worse well-being (β = -.42, p < .001; β = -.30, p = .015). Semi-structured interviews were then conducted with six athletes. Thematic analysis revealed that cumulative lifetime stress exposure fostered poor mental health and well-being by promoting maladaptive long-term coping strategies, increasing susceptibility to future stress, and limiting interpersonal relationships. We believe these findings can help practitioners identify, and intervene accordingly with, elite athletes at risk of experiencing stress-related mental health problems.

Dance intervention for adolescent girls: Effects on daytime tiredness, alertness and school satisfaction. A randomized controlled trial

IntroductionDaytime tiredness is a risk factor for poor health and well-being in the short and long term and is often associated with sleep problems, stress-related mental health complaints and decreased school functioning. This study investigates the effect of an 8 month dance intervention study on daytime tiredness, alertness, sleep duration, sleep quality and school satisfaction. MethodsRandomized controlled intervention study that included a total of 112 girls aged 13–18 years old with stress-related somatic and mental health problems. Dance intervention with focus on enjoyment were performed semiweekly for 8 months. Questionnaire-based measurements regarding self-reported daytime tiredness, alertness, school satisfaction, sleep duration and quality were evaluated at baseline and at 8-, 12- and 20- month follow-ups. ResultsDaytime tiredness decreased significantly in the dance group compared to control group at all follow-ups. Alertness increased significant within the dance group, but there were no significant difference compared to the controls. Significant improvements were found in all sleep quality items within the dance group, between groups only one significant result was found. No conclusive changes in sleep duration were observed. School satisfaction increased significantly in the dance intervention group; however, its significance compared to that of the control group faded after adjustment for differences between groups at baseline. ConclusionsThis study suggests that a dance intervention focusing on enjoyment can be effective in decreasing daytime tiredness. This study also adds to the growing body of evidence for the benefits of using nonpharmacological interventions to decrease stress-related problems among adolescents.

The Happy Entrepreneur? A Meta-Analysis of Entrepreneurship and Well-Being Considering Context

Entrepreneurs’ wellbeing is receiving increasing attention in research and practice, but uncertainty remains whether entrepreneurs experience higher wellbeing than non-entrepreneurs, which contingencies drive potential differences. To date, theory and empirical evidence offer conflicting predictions and findings, using different indicators of wellbeing and largely ignoring the context in which the entrepreneurs are embedded. We introduce the component view of wellbeing to entrepreneurship research and theorize how the components of wellbeing (cognitive wellbeing, positive and negative affective wellbeing, stress-related mental health problems) are differently sensitive to dissonance and stressor-strain processes associated with entrepreneurship. The results of our meta-analysis comprising 251 independent samples from 96 studies indicate no differences in negative and positive affective wellbeing between entrepreneurs and non-entrepreneurs. We find that entrepreneurs are more satisfied with their work and life but also experience more stress-related mental health problems. The strength of the associations of cognitive wellbeing (satisfaction) and mental health problems with entrepreneurship is contingent upon country contexts that enable choice and trigger dissonance processes versus those that increase constraints and stress for entrepreneurs. We also find differences between opportunity and necessity entrepreneurs. In sum, our findings nuance the dominant narrative of entrepreneurship as a ‘happy occupation’.

Early Detection of the Risk of Developing Psychiatric Disorders: A Study of 461 Chinese University Students under Chronic Stress

Chronic stress, a characteristic of modern time, has a significant impact on general health. In the context of psychiatric disorders, insufficient coping behavior under chronic stress has been linked to higher rates of (1) depressive symptoms among subjects of the general population, (2) relapse among patients under treatment for clinical depression, and (3) negative symptoms among subjects with an elevated vulnerability to psychosis. In this normative study we assessed basic coping behavior among 461 Chinese freshman university students along with their consumption behavior and general health in terms of regular exercises, physical health, psychosomatic disturbances, and mental health. The assessments relied on two instruments that have already demonstrated their capability of (1) reliably detecting insufficient coping behavior under chronic stress and (2) reliably quantifying the interrelation between coping behavior and mental health in the Western world. Thus, we aimed to complement existing data and to develop a generally available, socioculturally independent tool that can be used for the early detection of subjects with an elevated risk of mental health problems. Structural analyses yielded essentially the same scales “activity” and “defeatism” as previous studies on 2,500 students from Switzerland, Italy, Spain, the USA, and Argentina. These scales explained 74.3% of the observed variance in coping behavior among the 461 Chinese students. We found highly significant correlations (p < 0.0001) between the “defeatism” scale on the one hand, and the scales “regular use of medicine,” “psychosomatic disturbances,” and “impaired mental health” on the other. Particularly intriguing was the finding that a neural net classifier could be constructed to identify students with the highest contributions to the interrelation between “coping behavior” and “mental health,” yielding a correlation coefficient as high as r = 0.597 for the respective subgroup. Based on the normative data, an online tool for risk assessments was developed with immediate feedback to users. This study provided another piece of evidence regarding the close link between basic coping behavior and mental health, across cultures and ethnicities. In consequence, our approach to quantifying basic coping behavior, along with other risk factors, can be expected to clear the way for an “early” detection of students with an elevated risk of stress-related mental health problems, nota bene prior to the development of clinically relevant symptoms. The socioeconomic impact of the potential prevention of depressive ­disorders, and psychiatric disorders in general, may be enormous.

Increased instruction time and stress-related health problems among school children

While several studies suggest that stress-related mental health problems among school children are related to specific elements of schooling, empirical evidence on this causal relationship is scarce. We examine a German schooling reform that increased weekly instruction time and study its effects on stress-related outpatient diagnoses from the universe of health claims data of the German Social Health Insurance. Exploiting the differential timing in the reform implementation across states, we show that the reform slightly increased stress-related health problems among school children. While increasing instruction time might increase student performance, it might have adverse effects in terms of additional stress.

Stress, mental and physical health and the costs of health care in German high school students.

Stress is a mind-body phenomenon, which affects both mental and physical health and is highly relevant to the health care system. Yet, knowledge on the costs of stress and related health problems in adolescence is missing. The present study addresses this gap by investigating direct health care costs in relation to stress, mental health problems and physical health in high school students. The sample comprised 284 pupils from four schools in Heidelberg (mean age 16.75 ± 0.64years, 59.64% female). Self-reported health care utilization and medication intake within 1 month were translated into costs. We established correlative associations of the dichotomized overall costs (no vs. any) with stress, mental health problems and physical health within generalized structural equation models. In particular, mental health problems and physical health were examined as mediators of the association between stress and costs. An increase of stress by 1 SD corresponded increased chances for costs by OR 1.39 (Odds Ratio; 95% CI 0.13-0.53, p = 0.001). When mediators were analysed separately, both mental and physical health (problems) fully mediated the association. Yet, when examined together, only mental health problems acted as a mediator. Our results indicate the health economic relevance of stress-related mental health problems in high school students. The finding is meant to set the stage for further cost-of-illness studies of stress and related health problems, as well as economic evaluations. Longitudinal research is needed to allow conclusions on directionality.