Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression

Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus–pituitary–adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n = 26) with comorbid depression and a healthy comparison group (n = 26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA‐axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in‐patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.     

Correlates of hair cortisol concentrations in disadvantaged young children

Children from highly disadvantaged families tend to experience worse health, educational, and job outcomes than less disadvantaged peers. However, the mechanisms underlying these relationships remain to be explicated. In particular, few studies have investigated the relationships between the psychosocial influences that children are exposed to early in life and longer term cortisol output. This study aims to contribute to the literature by exploring how disadvantaged young children's experiences of family adversity, and parenting and family functioning, are related to their long‐term cortisol levels. A sample of 60 children (26 males, mean = 4.25 years, SD = 1.68) and their mothers (mean = 34.18 years, SD = 7.11) from a low‐income population took part in a single assessment. Mothers completed questionnaires on the family environment, parenting practices, and child behaviour. Children provided a hair sample for cortisol assay and anthropometric measures. A parsimonious multivariate regression model (including potential predictors identified by a selection algorithm) was used to investigate the correlates of hair cortisol concentration (HCC) in children. Higher levels of social exclusion, being male, and younger age were each associated with higher HCC. Maternal nurturing and emotion coaching were associated with lower HCC. Findings suggest that chronic stress may underlie relationships between adversity and its long‐term effects and that HCC offers a promising method for examining chronic stress in children and evaluating interventions by which it can be ameliorated.     

Unconscious Fearful Priming Followed by a Psychosocial Stress Test Results in Higher Cortisol Levels

Human perception of stress includes an automatic pathway that processes subliminal presented stimuli below the threshold of conscious awareness. Subliminal stimuli can therefore activate the physiologic stress system. Unconscious emotional signals were shown to significantly moderate reactions and responses to subsequent stimuli, an effect called ‘priming’. We hypothesized that subliminal presentation of a fearful signal during the Stroop task compared with an emotionally neutral one will prime stress reactivity in a subsequently applied psychosocial stress task, thereby yielding a significant increase in salivary cortisol. Half of 36 participants were repeatedly presented either a fearful face or a neutral one. After this, all underwent a psychosocial stress task. The fearful group showed a significant increase in cortisol levels (p = 0.022). This change was not affected by sex, age and body mass index, and it also did not change when taking resting cortisol levels into account. Post‐hoc analyses showed that the increase in cortisol in the fearful group started immediately after the psychosocial stress test. Hence, subliminal exposure to a fearful signal in combination with the Stroop and followed by a psychosocial stress test leads to an increase in stress reactivity. Copyright © 2012 John Wiley & Sons, Ltd.     

Cortisol levels and psychosocial factors in preadolescent children

Regarding the relationship between psychosocial factors and health, one model of explanation states that psychosocial stress constitutes a principal mediator connecting psychosocial factors to health outcome, affecting the body through psychobiological mechanisms. This relationship has scarcely been studied in children. In the present study the relation between diurnal cortisol secretion and psychosocial factors [socio‐economic status (SES), immigrant status and impact of psychiatric symptoms] was investigated in a normal population of 6–12 year old children (n = 273). Salivary cortisol levels were measured in the early morning, late morning and in the evening during three consecutive days. Parents answered demographic questionnaires and teachers answered psychiatric questionnaires concerning the children. Children exposed to one or more of the factors of psychosocial load (n = 117) had significantly higher morning (p < 0.001) and evening (p = 0.029) cortisol levels as well as total daily cortisol secretion [measured by the area under the curve (AUC), p = 0.003] compared to the group of children with none of the factors (n = 156). Different psychosocial stressors seemed to influence different parts of the diurnal cortisol curve. In conclusion, this study indicates that even children exposed to a moderate degree of psychosocial load differ in their cortisol levels compared to non‐exposed children. Copyright © 2006 John Wiley & Sons, Ltd.     

The influence of mindfulness and social support on stress reactivity during pregnancy

Exaggerated stress reactivity can lead to negative health outcomes, which can be especially harmful during important periods of development such as pregnancy. Therefore, studies are needed to examine potential protective factors associated with lower perceived stress reactivity and lower cortisol awakening response (CAR) during pregnancy. The current cross‐sectional study examined whether low‐income women (n = 152) with higher mindfulness (attentiveness and awareness of the present moment) and more perceived social support had lower levels of perceived stress reactivity and a lower CAR during pregnancy. Women completed self‐report measures of mindfulness (Mindful Attention Awareness Scale), social support (Medical Outcomes Study‐Social Support Scale), and perceived stress reactivity (Perceived Stress Reactivity Scale) during their first trimester of pregnancy and collected saliva using the passive drool procedure at home (at awakening and at 30 min after awakening). Results showed that women with greater mindfulness and greater perceived social support had significantly lower perceived stress reactivity, but not a lower CAR. These results provide preliminary support for mindfulness and social support as potential protective factors of perceived stress reactivity and have implications for experimental studies aimed at improving pregnant women's mindfulness and social support for reducing their stress reactivity and potentially improving health outcomes.     

Combining walking and relaxation for stress reduction—A randomized cross‐over trial in healthy adults

Both physical activity and relaxation have stress‐relieving potential. This study investigates their combined impact on the relaxation response while considering participants' initial stress level. In a randomized cross‐over trial, 81 healthy adults completed 4 types of short‐term interventions for stress reduction, each lasting for 1 hr: (1) physical activity (walking) combined with resting, (2) walking combined with balneotherapy, (3) combined resting and balneotherapy, and (4) resting only. Saliva cortisol, blood pressure, state of mood, and relaxation were measured preintervention and postintervention. Stress levels were determined by validated questionnaires. All interventions were associated with relaxation responses in the variables saliva cortisol, blood pressure, state of mood, and subjective relaxation. No significant differences were found regarding the reduction of salivary cortisol (F = 1.30; p = .281). The systolic blood pressure was reduced best when walking was combined with balneotherapy or resting (F = 7.34; p < .001). Participants with high stress levels (n = 25) felt more alert after interventions including balneotherapy, whereas they reported an increase of tiredness when walking was combined with resting (F = 3.20; p = .044). Results suggest that combining physical activity and relaxation (resting or balneotherapy) is an advantageous short‐term strategy for stress reduction as systolic blood pressure is reduced best while similar levels of relaxation can be obtained.     

Educators' emotion regulation strategies and their physiological indicators of chronic stress over 1 year

Studies show teaching is a highly stressful profession and that chronic work stress is associated with adverse health outcomes. This study analysed physiological markers of stress and self‐reported emotion regulation strategies in a group of middle school teachers over 1 year. Chronic physiological stress was assessed with diurnal cortisol measures at three time points over 1 year (fall, spring, fall). The aim of this longitudinal study was to investigate the changes in educators' physiological level of stress. Results indicate that compared to those in the fall, cortisol awakening responses were blunted in the spring. Further, this effect was ameliorated by the summer break. Additionally, self‐reported use of the emotion regulation strategy reappraisal buffered the observed blunting that occurred in the spring.     

Predictors of Acute and Posttraumatic Stress Symptoms in Parents Following Their Child's Cancer Diagnosis

This longitudinal study aimed to examine acute and posttraumatic stress symptoms and predictors of traumatic stress symptoms in parents of children recently diagnosed with cancer. The sample comprised 220 parents of 143 children who completed questionnaires at diagnosis (T1) focused on acute stress disorder (ASD); of these, 145 parents of 97 children completed questionnaires 6–8 months later (T2) focused on posttraumatic stress disorder (PTSD). Demographic, psychosocial, and treatment and illness variables were predictors. Results were that 63% of mothers and 60% of fathers met criteria for ASD at T1. At T2, 21% of mothers and 16% of fathers met criteria for PTSD, with 40% of parents reporting significant subthreshold symptoms. Predictors of ASD symptoms were female gender, presence of psychosocial risk factors, trait anxiety, family functioning, and central nervous system tumor diagnosis. Risk factors for PTSD symptoms were younger maternal age, severity of ASD symptoms, and trait anxiety at T1, and parent‐reported quality of life of the child at T2. The results suggest that screening for ASD may help identify parents at increased risk of persistent traumatic stress symptoms who could benefit from preventative, evidence‐based psychosocial interventions.     

Effects of Threat Context,Trauma History,and Posttraumatic Stress Disorder Status on Physiological Startle Reactivity in Gulf War Veterans

In the current study, we explored exaggerated physiological startle responses in posttraumatic stress disorder (PTSD) and examined startle reactivity as a biomarker of PTSD in a large veteran sample. We assessed heart rate (HR), skin conductance (SC), and electromyographic (EMG) startle responses to acoustic stimuli under low‐, ambiguous‐, and high‐threat conditions in Gulf War veterans with current (n = 48), past (n = 42), and no history of PTSD (control group; n = 152). We evaluated PTSD status using the Clinician‐Administered PTSD Scale and trauma exposure using the Trauma History Questionnaire. Participants with current PTSD had higher HR, ds = 0.28–0.53; SC, d = 0.37; and startle responses than those with past or no history of PTSD. The HR startle response under ambiguous threat best differentiated current PTSD; however, sensitivity and specificity analyses revealed it to be an imprecise indicator of PTSD status, ROC AUC = .66. Participants with high levels of trauma exposure only showed elevated HR and SC startle reactivity if they had current PTSD. Results indicate that startle is particularly elevated in PTSD when safety signals are available but a possibility of danger remains and when trauma exposure is high. However, startle reactivity alone is unlikely to be a sufficient biomarker of PTSD.     

Psychosocial,Demographic, and Illness‐Related Factors Associated With Acute Traumatic Stress Responses in Parents of Children With a Serious Illness or Injury

This study investigated factors associated with acute stress symptoms in parents of seriously ill children across a range of illnesses and treatment settings within a pediatric hospital setting. It was hypothesized that psychosocial variables would be more strongly associated with acute stress responses than demographic and child illness variables. Participants were 115 mothers and 56 fathers of children treated within the oncology, cardiology, and intensive care departments of a pediatric hospital. Acute stress, psychosocial, demographic, and medical data were collected within the first 4 weeks of the child's hospital admission. A robust hierarchical regression model revealed that psychosocial factors significantly explained 36.8% of the variance in parent acute stress responses (p < .001); demographic variables significantly added a further 4.5% (p = .022), but illness‐related factors did not contribute to the model. Findings support the implementation of a general psychosocial screening approach for parents across the wider hospital system, and that psychosocial risk factors may be targeted in interventions across different illnesses and treatment settings to improve parent outcomes.     

Physiological and Subjective Responses after Psychosocial Stress in Chinese Hepatitis B Patients

Compared with healthy participants, Chinese patients with hepatitis B (HB) experience more psychosocial stress. The present study provided the first examination of physiological and subjective responses to stress in Chinese HB patients. A standard psychosocial stressor, the Trier Social Stress Test (TSST), was administered to 26 Chinese HB patients and 24 healthy control participants. Cortisol concentrations were measured in blood samples collected before and after the stressor. Self‐reported emotional responses and cardiovascular measures were examined before and after the TSST. Depression and anxiety were assessed using Hospital Anxiety and Depression Scale. Chinese HB patients exhibited higher cortisol response to the stressor than healthy control participants. Compared with healthy participants, Chinese HB patients showed higher levels of anxiety, depression and nervousness, and lower levels of calmness after the TSST. HB patients reported more negative life events in the previous 6 months and obtained higher adversity scores, as compared with control participants. Significant correlations were obtained between adversity scores and change cortisol secretion after TSST in HB patients, but not in healthy participants. This study firstly demonstrates that physiological and subjective responses to psychosocial stress among Chinese HB patients were different from that in healthy control participants. Copyright © 2013 John Wiley & Sons, Ltd.     

Medically unexplained symptoms in women as related to physiological stress responses

The present, cross‐sectional study explored whether self‐reported symptoms are related to physiological stress indicators in a group of 43‐year‐old women representing the general population in Sweden. Analyses were performed both on raw scores of physiological indicators and on a multisystem summary index of allostatic load as a measure of cumulative biological burden. Participants answered a health questionnaire and underwent a medical examination including blood pressure, heart rate measurements, determination of blood lipids and stress hormones. Urinary epinephrine and norepinephrine were measured both on a working day and a work free day at home. In addition, salivary morning cortisol was measured on a non‐work day. The physiological profiles based on raw scores from 222 women showed that women with a high symptom load had significantly higher levels of cortisol (p < 0.05), and higher heart rate (p < 0.05) than did those with a low symptom load. In contrast, women with a low symptom load had significantly higher levels of epinephrine on a work free day than did women with a high symptom load (p < 0.05). No significant differences were found in norepinephrine responses. When analysing the summary measure of allostatic load in relation to symptom prevalence no significant difference between the symptom groups emerged. One possible explanation for this result could be that a majority of the study population was healthy, reporting a low level of symptoms in general. However, the results support the notion that common, medically unexplained symptoms among women are associated with certain biological parameters known to play a role in the development of ill health. Copyright © 2004 John Wiley & Sons, Ltd.     

Development and Psychometric Evaluation of Child Acute Stress Measures in Spanish and English

Clinicians and researchers need tools for accurate early assessment of children's acute stress reactions and acute stress disorder (ASD). There is a particular need for independently validated Spanish‐language measures. The current study reports on 2 measures of child acute stress (a self‐report checklist and a semistructured interview), describing the development of the Spanish version of each measure and psychometric evaluation of both the Spanish and English versions. Children between the ages of 8 to 17 years who had experienced a recent traumatic event completed study measures in Spanish (n = 225) or in English (n = 254). Results provide support for reliability (internal consistency of the measures in both languages ranged from .83 to .89; cross‐language reliability of the checklist was .93) and for convergent validity (with later PTSD symptoms, and with concurrent anxiety symptoms). Comparing checklist and interview results revealed a strong association between severity scores within the Spanish and English samples. Differences between the checklist and interview in evaluating the presence of ASD appear to be linked to different content coverage for dissociation symptoms. Future studies should further assess the impact of differing assessment modes, content coverage, and the use of these measures in children with diverse types of acute trauma exposure in English‐ and Spanish‐speaking children.     

Association of psychosocial factors with leukocyte telomere length among African Americans in the Jackson Heart Study

Leukocyte telomere length (LTL) is a biomarker of cellular aging. African Americans report more stress than other groups; however, the association of psychosocial stressors with biological aging among African Americans remains unclear. The current study evaluated the association of psychosocial factors (negative affect and stressors) with LTL in a large sample of African American men and women (n = 2,516) from the Jackson Heart Study. Using multivariable linear regression, we examined the sex‐specific associations of psychosocial factors (cynical distrust, anger in and out, depressive symptoms, negative affect summary scores, global stress, weekly stress, major life events, and stress summary scores) with LTL. Model 1 adjusted for demographics and education. Model 2 adjusted for model 1, smoking, alcohol intake, physical activity, diabetes, hypertension, and high‐sensitivity C‐reactive protein. Among women, high (vs. low) cynical distrust was associated with shorter mean LTL in model 1 (b = ?0.12; p = 0.039). Additionally, high (vs. low) anger out and expressed negative affect summary scores were associated with shorter LTL among women after full adjustment (b = ?0.13; p = 0.011; b = ?0.12, p = 0.031, respectively). High levels of cynical distrust, anger out, and negative affect summary scores may be risk factors for shorter LTL, particularly among African‐American women.     

Acute stress and performance in police recruits

Emergency personnel consistently work under high‐stress situations, and thus, the question about whether this stress affects performance is critical to the safety of both themselves and the public. However, considerable controversy exists about the influence of stress on performance. This study investigates the association between both biological and psychological manifestations of stress and performance. The study was conducted with 84 police recruits using a high‐fidelity simulation of a policing event in order to try to determine performance in a life‐like workplace environment. Measures included both biological (heart rate and salivary cortisol levels) and psychological (subjective anxiety) indicators of stress. Performance was videotaped and was later evaluated by three expert raters. The results of this study are promising in that neither physiological nor psychological responses impaired performance in a simulated acutely stressful policing situation. On the other hand, those individuals with greater cortisol release showed higher levels of performance, supporting the notion that cortisol can enhance ability in high‐stress situations. Recruits were also asked to subjectively evaluate their performance. A small group of individuals ranked themselves as poor performers while evaluators ranked them highly. These individuals experienced significantly higher increase in subjective distress and significantly higher cortisol levels at baseline and peak. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of Caffeine and Stress on Biomarkers of Cardiovascular Disease in Healthy Men and Women with a Family History of Hypertension

The connection between caffeine and its potentially detrimental effects on blood markers of cardiovascular disease (CVD) are controversial. Most studies have focused on cholesterol as a putative mediator of the caffeine–CVD relationship. Other blood markers such as C‐reactive protein (CRP) and fibrinogen have been understudied. We examined the effects of caffeine and psychological stress on these CVD markers in healthy, young men and women with a confirmed family history of hypertension. A total of 52 normotensive, healthy adults (26 men and 26 women) aged 18–29 years (21.4 ± 0.3) participated in a laboratory session to examine stress reactivity following caffeine consumption. All participants had normal cholesterol levels. Blood pressure (BP), heart rate, serum cortisol and CRP and plasma fibrinogen were collected. Men and women administered caffeine displayed an additional increase in systolic BP and cortisol response to the stressor (p < 0.05). Stress interacted with caffeine and sex to alter cortisol, fibrinogen and systolic BP but not CRP levels. These results may shed light on sex‐specific pathways that associate caffeine with CVD. Copyright © 2013 John Wiley & Sons, Ltd.     

Lower cortisol response in high‐resilient caregivers of people with autism: the role of anger

Caring for an offspring with an autism spectrum disorder (ASD) has been related to high stress levels and health disturbances. However, a protective effect against these negative health outcomes has been described in high‐resilient caregivers. In this context, the main aim of the present study was to assess the association between resilient coping and cortisol response to acute stress in caregivers of people with ASD. Furthermore, the study aimed to explore the mediating role of anger in this association. We exposed 40 caregivers of people with ASD to an acute psychosocial stressor in the laboratory. Salivary cortisol samples were obtained before, during, and after the stressor. Resilient coping, anger, and socio‐demographic variables were also assessed. Resilient coping was negatively correlated with cortisol response. Specifically, cortisol release was lower in high‐resilient than low‐resilient caregivers. Anger was positively correlated with cortisol response, mediating the association with resilient coping. The observed associations of resilient coping and anger with cortisol response indicate that these variables may affect health outcomes, resilience being protective and anger harmful. Psychotherapeutic interventions focused on strengthening resilience and anger management could benefit caregivers, improving their health status and quality of life.     

The Multitasking Framework: The Effects of Increasing Workload on Acute Psychobiological Stress Reactivity

A variety of techniques exist for eliciting acute psychological stress in the laboratory; however, they vary in terms of their ease of use, reliability to elicit consistent responses and the extent to which they represent the stressors encountered in everyday life. There is, therefore, a need to develop simple laboratory techniques that reliably elicit psychobiological stress reactivity that are representative of the types of stressors encountered in everyday life. The multitasking framework is a performance‐based, cognitively demanding stressor, representative of environments where individuals are required to attend and respond to several different stimuli simultaneously with varying levels of workload. Psychological (mood and perceived workload) and physiological (heart rate and blood pressure) stress reactivity was observed in response to a 15‐min period of multitasking at different levels of workload intensity in a sample of 20 healthy participants. Multitasking stress elicited increases in heart rate and blood pressure, and increased workload intensity elicited dose–response increases in levels of perceived workload and mood. As individuals rarely attend to single tasks in real life, the multitasking framework provides an alternative technique for modelling acute stress and workload in the laboratory. Copyright © 2013 John Wiley & Sons, Ltd.     

Dispositional mindfulness is associated with heart rate reactivity and recovery in response to a lab stressor

Heightened perceived stress is consistently associated with symptoms of psychopathology. Perceived stress can be reliably linked with physiological responses, such as increased heart rate. Even though dispositional mindfulness is associated with lower self‐reported stress, no studies to date have examined whether dispositional mindfulness can predict physiological responses to and recovery from stress. We recruited 142 student participants and administered a measure of dispositional mindfulness (Five Facet Mindfulness Questionnaire—Short Form/FFMQ‐SF) and a modified version of the Trier Social Stress Test (TSST). Specifically, during the TSST, we instructed participants that they were about to deliver a presentation to a panel of judges, then informed them they no longer need to deliver this presentation, all while measuring their heart rate. We found that total FFMQ‐SF and non‐reactivity subscale scores were positively and significantly correlated with heart rate reactivity to the lab stressor. Further, we found that the FFMQ‐SF facet of non‐judgment was negatively and significantly correlated with the time it took for participants' heart rates to return to and stabilize at baseline. The results of this study elucidate potential mechanisms of mindfulness in stress. Specifically, mindfulness may not necessarily make people less reactive to stressors, but may operate through top‐down processes to enhance recovery and resilience during stress.     

A Pilot Study: Short‐term Reduction in Salivary Cortisol Following Low Level Physical Exercise and Relaxation among Adolescents and Young Adults on the Autism Spectrum

Many adolescents and young adults with autism spectrum disorders (ASD) experience high levels of stress and anxiety. The purpose of this pilot study was to examine whether physical exercise and relaxation could reduce stress and anxiety among those with ASD. Salivary cortisol levels were collected before and after each of three sessions during an 8‐week exercise programme. Our findings showed a significant reduction in cortisol at the end of the sessions compared with the beginning. This was supported by a self‐report anxiety measure. Although reductions in these stress measures were not sustained over time, our results highlight the potential of exercise and relaxation for improving symptoms of stress. Future studies are needed which examine longer term reductions in stress following physical exercise interventions. Copyright © 2011 John Wiley & Sons, Ltd.