The effect of perceived appearance judgements on psychological and biological stress processes across adulthood

Social self‐preservation theory posits that stress is experienced when an aspect of an individual's identity has the potential to be negatively evaluated. Appearance is a central part of identity; however, little research has examined whether perceived appearance judgements are a source of social‐evaluative stress. In addition, stress may be an explanatory link in the association between appearance perceptions and depressive symptoms. This study examined whether perceived appearance judgements were associated with increased stress and greater depressive symptoms among adults. Study 1 examined the associations between self‐reported appearance judgements and cortisol stress responses in response to a laboratory stressor (Trier Social Stress Test) among 71 individuals aged 18–65. Study 2 assessed self‐reported appearance judgements and depressive symptoms among 498 adults ages 18–65 via an online survey data collection. Appearance judgement was associated with a stronger cortisol response, higher self‐reported stress, and greater depressive symptoms. Stress mediated all associations between appearance judgements and depressive symptoms and neither age nor gender moderated these associations. The findings suggest that appearance judgements contribute to psychological and biological stress processes and demonstrated that stress mediated the association between appearance judgements and depressive symptoms.     

Stress,symptoms of depression and anxiety,and cortisol patterns in working parents

Whether stress or psychological distress is associated with alterations in diurnal cortisol secretion patterns in healthy adults is still uncertain. In this study, the authors tested for associations between stress or symptoms of depression or anxiety and changes in diurnal cortisol patterns in 91 working parents (57 women and 34 men) across the United States. Saliva samples were collected for cortisol analysis at six timepoints over 2 days. The diurnal cortisol slope and time‐weighted average cortisol levels were analysed in relation to (1) two survey measures of stress, (2) diary reports of stress during cortisol sampling, and (3) self‐reported depression and anxiety. Cortisol slopes and average cortisol levels varied widely across individuals and within individuals across days. Only two of the 24 associations between stress or psychological symptoms and cortisol were significant at the p < 0.05 level; men with more severe symptoms of anxiety had significantly higher average cortisol levels and women who reported that work was more frequently stressful had significantly lower average cortisol levels. These results highlight the variability of diurnal cortisol secretion patterns in healthy adults and suggest that neither stress nor psychological symptomatology is a strong determinant of differences in diurnal cortisol patterns in healthy individuals. Copyright © 2004 John Wiley & Sons, Ltd.     

Depression,social support,and clinical outcomes following lung transplantation: a single‐center cohort study

Depressive symptoms are common among lung transplant candidates and have been associated with poorer clinical outcomes in some studies. Previous studies have been plagued by methodologic problems, including small sample sizes, few clinical events, and uncontrolled confounders, particularly perioperative complications. In addition, few studies have examined social support as a potential protective factor. We therefore examined the association between pretransplant depressive symptoms, social support, and mortality in a large sample of lung transplant recipients. As a secondary aim, we also examined the associations between psychosocial factors, perioperative outcomes [indexed by hospital length of stay (LOS)], and mortality. We hypothesized that depression would be associated with longer LOS and that the association between depression, social support, and mortality would be moderated by LOS. Participants included lung transplant recipients, transplanted at Duke University Medical Center from January 2009 to December 2014. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI‐II) and social support using the Perceived Social Support Scale (PSSS). Medical risk factors included forced vital capacity (FVC), partial pressure of carbon dioxide (PCO₂), donor age, acute rejection, and transplant type. Functional status was assessed using six‐minute walk distance (6MWD). We also controlled for demographic factors, including age, gender, and native disease. Transplant hospitalization LOS was examined as a marker of perioperative clinical outcomes. Participants included 273 lung recipients (174 restrictive, 67 obstructive, 26 cystic fibrosis, and six “other”). Pretransplant depressive symptoms were common, with 56 participants (21%) exhibiting clinically elevated levels (BDI‐II ≥ 14). Greater depressive symptoms were associated with longer LOS [adjusted b = 0.20 (2 days per 7‐point higher BDI‐II score), P < 0.01]. LOS moderated the associations between depressive symptoms (P = 0.019), social support (P < 0.001), and mortality, such that greater depressive symptoms and lower social support were associated with greater mortality only among individuals with longer LOS. For individuals with LOS ≥ 1 month, clinically elevated depressive symptoms (BDI‐II ≥ 14) were associated with a threefold increased risk of mortality (HR = 2.97). Greater pretransplant depressive symptoms and lower social support may be associated with greater mortality among a subset of individuals with worse perioperative outcomes.     

Psychosocial factors and gender as predictors of symptoms associated with sick building syndrome

Sick building syndrome (SBS) refers to a cluster of symptoms that typically worsen when employees are at work and diminish when they leave. A higher prevalence of symptoms is frequently observed among female employees. Although its aetiology is debated, evidence suggests that psychosocial factors might be at least as important as features of the working environment in predicting SBS symptoms. Utilizing a sample of 346 office‐based employees (55 per cent female) located in five buildings with no known environmental problems, this study examined job control, job satisfaction, work‐related mood and negative affectivity as predictors of self‐reported symptoms typical of SBS. The role played by gender in symptom‐reporting was also investigated. Findings revealed that employees who experienced more symptoms reported significantly less job control and job satisfaction and more work‐related depression and anxiety. A positive relationship was also observed between symptom‐reporting and negative affectivity. In contrast to previous research, no gender differences were observed in the prevalence of self‐reported symptoms, but men and women differed in the predictors of symptoms and the proportion of variance explained. The findings suggest that demographic and psychosocial factors, as well as features of the objective physical environment, should be considered in future investigations of SBS. Copyright © 2008 John Wiley & Sons, Ltd.     

Associations among stress,gender, sources of social support,and health in emerging adults

This study aimed to examine how sources of social support intersect with stress and health by testing two theoretical models. Three relationship‐specific sources of social support (family, friends, and romantic partners) and two health indicators (self‐rated physical health and depressive symptoms) were investigated. The sample consisted of 636 emerging adults attending college (age range: 18–25). Results suggest that only support from family was a stress‐buffer, in that it buffered the adverse association between stress and depressive symptoms. Holding stress constant, only support from family was related to self‐rated physical health and only support from friends or romantic partners was associated with depressive symptoms. There were no gender differences in the mean levels of self‐rated physical health and depressive symptoms. However, gender moderations were found, in that the positive relationship between friends support and physical health was observed only in women, that the association between friends support and depressive symptoms was greater in men than in women, and that family support buffered the negative relationship between stress and physical health only in men. Findings of this study suggest that the associations among stress, social support, and health vary by the sources of support, the health outcome, and gender.     

Is low cortisol release an indicator of positive health?

Compared to the knowledge of physiological processes associated with stress, ill‐health, and disease, the understanding of physiological processes associated with positive psychological functioning is lagging behind. The present study aimed to examine the relationships between psychological well‐being and physiological indicators, including blood pressure, catecholamines, and cortisol. Initial questionnaires concerning demographic information, work characteristics (decision authority, job demands, and skill discretion), physical symptoms, nicotine use, and Ryff's Psychological Well‐Being scales (RPWB) which cover self‐acceptance, environmental mastery, positive relations with others, personal growth, purpose in life and autonomy, were completed by a group of highly educated white‐collar workers. Subsequent assessments of blood pressure, urinary catecholamines, and salivary cortisol were performed during two separate workdays. Analyses of data from 12 women and 11 men revealed that individuals with high psychological well‐being had significantly lower total cortisol output than individuals with low psychological well‐being (p < 0.01), while no significant differences emerged for blood pressure and catecholamines. Further, individuals with high psychological well‐being had significantly lower levels of general (p < 0.01) as well as musculoskeletal symptoms (p < 0.01). In conclusion, the findings suggest a link between positive psychological functioning and lowered cortisol release. Copyright © 2002 John Wiley & Sons, Ltd.     

Dyadic Associations Between Physical Activity and Depressive Symptoms in Older Adults with Musculoskeletal Conditions and Their Spouses

This study examined the association between physical activity of older individuals with musculoskeletal conditions (IMCs) and their spouses' physical activity, how physical activity related to one's own and one's partner's depressive symptoms, and whether the similarity of partners' physical activity related to each partner's depressive symptoms using the actor–partner interdependence model. Seventy‐seven dyads completed self‐report measures of physical activity, depressive symptoms and potential covariates (socio‐demographics, physical health conditions and marital satisfaction; IMCs' functional impairment and pain; and spouses' support‐related stress). As hypothesized, we found a positive association between the IMC's and the spouse's physical activity. Also, spouses had more depressive symptoms when IMCs engaged in less physical activity. However, for both partners, one's own physical activity was not significantly associated with one's own depressive symptoms. The spouse's physical activity was also not significantly associated with the IMC's depressive symptoms, and the similarity between partners' physical activity did not significantly relate to either partner's depressive symptoms. Our findings suggest that interventions that help increase the physical activity of both partners, but particularly IMCs, may benefit spouses' well‐being. Copyright © 2014 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.     

Does stress mediate the association between personal relative deprivation and gambling?

Evidence has linked subjective feelings of personal relative deprivation with general gambling involvement and problem gambling tendencies. In turn, problem gambling tendencies have been linked with a wide array of damaging physical and mental health consequences. It has been theorized that the deleterious effects of perceived inequality on mental and physical health operate at the individual level through the experience of personal relative deprivation leading to psychosocial stress. We empirically examined whether the experience of perceived stress contributes to explaining the deprivation‐gambling link using cross‐sectional, self‐reported survey data collected from a crowdsourced population of adults (n = 565). Results indicate that personal relative deprivation is associated with problem gambling tendencies (but not general gambling involvement) and that this association is mediated by perceived stress. These associations were particularly strong among participants who reported non‐zero levels of problem gambling tendencies. Together, our results further emphasize the importance of individual‐level social comparison reactions in the context of health.     

The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol Use Through Negative Cognitions in Sexual Minority Men

Self‐medication theory posits that some trauma survivors use alcohol to cope with posttraumatic stress disorder (PTSD) symptoms, but the role of negative posttraumatic cognitions in this relationship is not well defined. We examined associations among PTSD symptoms, posttraumatic cognitions, and alcohol intoxication frequency in 290 men who have sex with men (MSM), who reported a history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined the indirect effects of PTSD symptoms on alcohol intoxication frequency through posttraumatic cognitions regarding the self, world, and self‐blame. In separate regression models, higher levels of PTSD symptoms and posttraumatic cognitions were each associated with more frequent intoxication, accounting for 2.6% and 5.2% of the variance above demographics, respectively. When examined simultaneously, posttraumatic cognitions remained significantly correlated with intoxication frequency whereas PTSD symptoms did not. Men reporting elevated posttraumatic cognitions faced increased odds for current alcohol dependence, odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low posttraumatic cognitions, independent of current PTSD diagnosis. A higher level of PTSD symptom severity was indirectly associated with more frequent alcohol intoxication through cognitions about the self and world; the indirect to total effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions pertaining to individuals’ self‐perceptions and appraisals of the world as dangerous may play a role in self‐medication with alcohol among MSM with a history of CSA. Interventions targeting these cognitions may offer potential for reducing alcohol misuse in this population, with possible broader implications for HIV‐infection risk.     

Hope as a Moderator of Negative Life Events and Depressive Symptoms in a Diverse Sample

Depression is a significant public health problem for young adults of college age, and negative life events exacerbate risk. Not all individuals who experience negative life events, however, report depressive symptoms, perhaps owing to protective characteristics. We examined one such characteristic, trait hope, a goal‐oriented construct, as a potential moderator of the association between negative life events and depressive symptoms in an ethnically diverse sample of 386 college students. In support of our hypotheses, negative life events were significantly associated with greater levels of depressive symptoms, and higher levels of hope attenuated this relationship, such that those with greater hope reported fewer depressive symptoms related to potentially traumatic events. The moderating effect of hope did not differ across ethnic groups. Our findings have implications for managing the sequelae of negative life events, including depression. Cognitive–behavioural interventions tailored to help young adults identify and attain important life goals might help to overcome psychopathology associated with life stress. Copyright © 2012 John Wiley & Sons, Ltd.     

Aromatase Inhibitor Associated Musculoskeletal Symptoms are associated with Reduced Physical Activity among Breast Cancer Survivors

Physical activity (PA) has numerous health benefits for breast cancer survivors. Recent data suggest that some breast cancer survivors treated with aromatase inhibitors may experience aromatase inhibitor associated musculoskeletal symptoms. It is unknown whether aromatase inhibitor associated musculoskeletal symptoms are associated with reduced PA and what other risk factors are associated with such PA reductions. We conducted a cross‐sectional study at a large university‐based breast cancer clinic among breast cancer survivors prescribed an aromatase inhibitor. At routine follow‐up, we surveyed participants about aromatase inhibitor associated musculoskeletal symptoms, as well as pre‐aromatase inhibitor, and current, PA levels. Among 300 participants, 90 (30%) reported a reduction of PA since the initiation of aromatase inhibitor therapy. Those with aromatase inhibitor associated musculoskeletal symptoms were more likely to report decreased PA (62% versus 38%, p = 0.001) compared with those without aromatase inhibitor associated musculoskeletal symptoms. In multivariate analyses, aromatase inhibitor associated musculoskeletal symptoms (odds ratio [OR] = 2.29 [95% confidence interval [CI]: 1.36–3.86]), and body mass index (OR = 1.06 [95% CI: 1.02–1.12]) were associated with reductions in PA. In subgroup analysis among breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms, self‐reported lower extremity joint pain (OR = 1.23 [95% CI: 1.00–1.50]) and impaired lower extremity physical function (OR = 1.07 [95% CI: 1.01–1.14]) were associated with reductions in PA. Breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms were more likely to report reductions in PA since initiating aromatase inhibitor therapy compared with those without aromatase inhibitor associated musculoskeletal symptoms. Our findings suggest that tailored interventions targeting lower extremity functional limitations are needed to enable breast cancer survivors with aromatase inhibitor associated musculoskeletal symptoms to participate in PA.     

Prospective evidence for a reciprocal relationship between sense of control and depressive symptoms following a flood

The purpose of this research is to test a feedback loop between sense of control and depressive symptoms within the context of a flood. Prospective cohort data were gathered from 1735 individuals that assessed the respondent's state prior to experiencing a flood. Path analysis is used to test for a reciprocal association between change in sense of control and change in depressive symptoms. The flood was indirectly associated with sense of control through depressive symptoms. Sense of control was negatively associated with change in depressive symptoms, and depressive symptoms were negatively associated with change in sense of control. Experiencing a flood is associated with more depressive symptoms, which in turn may undermine the sense of control over one's life. Likewise, lower sense of control associated with a flood is related to higher depressive symptoms. A reciprocal model not only implies that sense of control and depressive symptoms may mutually affect one another, but also that stressors may indirectly affect sense of control through depressive symptoms, which could lead individuals to be more vulnerable to future stress. Copyright © 2006 John Wiley & Sons, Ltd.     

Cluster analysis and lower urinary tract symptoms in men: findings from the Boston Area Community Health Survey

OBJECTIVES

To classify lower urinary tract symptoms (LUTS) in a large, representative sample of men in the USA by means of cluster analysis and to investigate risk factors and comorbidities associated with the resulting cluster patterns.

SUBJECTS AND METHODS

A combination of hierarchical and non‐hierarchical cluster methods was used to assign men with LUTS in the Boston Area Community Health (BACH) study to symptom‐based categories or clusters. Of the 2301 men in the BACH study, those reporting one or more of 14 common LUTS (1592 men) were included in the analysis. The prevalence and frequency of symptoms in each cluster was assessed, in addition to the demographic, lifestyle risk factors, comorbidities, quality of life, and interference with activities of daily living associated with each cluster. We used anova methods for assessing cluster effects on continuous variables, and cross‐classification and chi‐square tests for categorical measures. Internal validity of the cluster solution was tested by means of a split‐half replication, and external validity by comparison with previously published data.

RESULTS

Five clusters were identified among symptomatic men. About half of the symptomatic men were assigned to Cluster 1, which included individuals with a low prevalence and frequency of urological symptoms and a correspondingly low level of interference with activities of daily living. There were intermediate levels of symptom frequency and prevalence in Clusters 2–4, which were characterized by mixed patterns of voiding, storage and postvoiding symptoms. Cluster 5 consisted of predominantly older men (mean age 58.9 years), with a high prevalence and frequency of urological symptoms with a mean (sd ) number of symptoms of 9.9 (2.1), and with elevated levels of comorbid cardiovascular disease (P < 0.001). These men also had higher rates of kidney and bladder infections and previous urological surgery. Men with increased waist circumference and more sedentary lifestyles were over‐represented in the more symptomatic clusters.

CONCLUSION

Cluster analysis provides an empirically based method for categorizing men with LUTS. These findings provide a new framework for examining aetiological pathways and mechanisms, the potential impact of and consequences for comorbid conditions, and for assessing prognosis and outcomes associated with common urological disorders.     

Factors affecting health-related quality of life among patients with lower urinary tract symptoms

BACKGROUND: This study aimed to evaluate the association of factors such as pain, lower urinary tract symptoms (LUTS), anxiety, depression and psychiatric morbidity on health-related quality of life (HRQoL) of patients with LUTS. METHODS: A total of 227 patients with LUTS were recruited into the study. The patients were assessed on pain, LUTS, anxiety, depression, psychiatric morbidity and health-related quality of life (HRQoL) using standardized questionnaires. RESULTS: The study showed that after adjustment, age, pain, anxiety, depression, psychiatric morbidity and LUTS contributed 31%, 13%, 45%, 16% and 48% respectively to the variability of the physical, mental, social, global and overall HRQoL. CONCLUSION: Age, pain, psychiatric morbidity, anxiety and depression are associated with HRQoL among patients with LUTS.     

Perceived Unfairness at Work,Social and Personal Resources,and Resting Blood Pressure

By drawing from theoretical perspectives suggesting that unfair conditions threaten fundamental psychological needs, perceived unfairness at work was proposed and tested as a predictor of resting blood pressure. As part of the Midlife Development in the United States Biomarkers project, participants completed questionnaires measuring perceived unfairness, self‐esteem and coworker support. Resting blood pressure readings were also recorded as part of a larger physical examination. Results indicate that perceived unfairness at work was associated with higher resting diastolic and systolic blood pressure. Perceived unfairness was most strongly related to diastolic and systolic blood pressure among women with low levels of coworker support. Contrary to predictions, self‐esteem did not moderate the association between perceived unfairness and blood pressure. These results suggest that high blood pressure may be a mechanism linking unfairness to negative health outcomes and point to coworker support as a moderator of the perceived unfairness–blood pressure relationship among women. Further research is needed exploring the mediating mechanisms linking unfair treatment at work to blood pressure and health. Copyright © 2013 John Wiley & Sons, Ltd.     

Posttraumatic stress symptoms as a mediator between sexual assault and adverse health outcomes in undergraduate women

This study investigated the links between sexual assault experiences, posttraumatic stress symptoms, and adverse physical health outcomes among undergraduate women. Existing research has demonstrated that posttraumatic stress disorder mediates the relationship between trauma exposure and physical health in general, but this has yet to be tested for sexual assault specifically. Using structural equation modeling, support was found for a model in which posttraumatic stress symptom severity partially mediates the association between sexual assault severity and self‐reported health outcomes. An alternative model using depression symptoms did not meet the criteria for mediation. Implications for the physical health of sexual assault survivors are discussed.     

Depressive symptoms and bodily pain: the role of physical disability and social stress

This study evaluates the bi‐directional association between depressive symptoms and bodily pain, and examines the role of physical disability and perceived social stress in the depression–pain relationship. Data are employed from a two‐wave panel study of Miami‐Dade county residents (n = 1459) that includes a substantial over‐sampling of individuals who identify as physically‐disabled. Findings indicate that the bi‐directional relationship between depression and pain is similar for those with and without a physical disability. Results also demonstrate that stress exposure, specifically recent life events and daily discrimination, partially mediated the relationship between prior levels of depression and changes in pain. Directions for future research and the need for a more comprehensive model of health incorporating physical, psychological, and social factors are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychological stress,cardiac symptoms,and cardiovascular risk in women with suspected ischaemia but no obstructive coronary disease

This paper evaluated cross‐sectional relationships between psychological stress and coronary artery disease (CAD) risk among women with suspected ischaemia and no obstructive coronary artery disease (INOCA). Between 1996 and 2000, 551 women with INOCA were enrolled in the Women's Ischemia Syndrome Evaluation (WISE) cohort from four U.S. institutions. Between 2009 and 2012, 376 women with INOCA were recruited from two U.S. institutions for an independent cohort study titled WISE‐Coronary Vascular Dysfunction (WISE‐CVD). Participants underwent coronary angiography and testing for CAD symptoms and risk factors at baseline. Psychological stress was assessed in the form of home/work stress in WISE and home/work stress and financial stress in WISE‐CVD. Results showed that home/work stress predicted greater depression, functional impairment, CAD symptoms, and lower self‐rated health in WISE but was inconsistent as a predictor in WISE‐CVD. In contrast, >60% of WISE‐CVD women reported moderate or severe financial stress. Financial stress levels predicted more CAD risk factors and cardiac symptoms, poorer self‐rated health, and greater depression and functional impairment. Among women with INOCA, psychological stress was associated with CAD symptoms and CAD risk factors. The prevalence and predictive value of psychological stress in this population supports the inclusion of stress measures in future CAD research.     

Possible association of Toll-like receptor 9 polymorphisms with cytokine levels and posttraumatic symptoms in individuals with various types of orthopaedic trauma: Early findings

Background

Although TLR9 polymorphisms may be associated with cytokine dysregulation, its role in regulation of cytokines due to bodily trauma or in relation to acute stress symptoms or posttraumatic stress symptoms (ASS/PTS) has not been evaluated.

Aims

To assess serum cytokine levels and levels of ASS and PTS in relation to four common TLR9 single-nucleotide polymorphisms (SNPs) in individuals with various types of orthopaedic trauma.

Methods

Forty-eight accident-injured individuals, aged 20–60 years were studied. Serum cytokine levels and TLR9 SNPS (1486T/C, 1237T/C, 1174G/A and 2848G/A) were assessed together with intensity of ASS and PTS symptoms.

Results

Statistically significant higher serum levels of IL-12 and IL-1β (p < .05) were found in individuals heterozygous for TLR9-1237 (TC) than in individuals expressing the most common TLR9-1237 type (TT), while differences in levels of IL-6 were not significant. Also, marginally significant levels of IL-6 were found in individuals expressing the common TLR9-1174 (GG) compared with individuals homozygous (AA) or heterozygous (GA) for this SNP. They also had non-significant higher intensity of ASS symptoms. A trend of higher PTS levels in individuals expressing the most common type TLR9-1174 (GG) was found, contrary to homozygous (AA) and heterozygous individuals (GA).

Conclusions

The results of this pilot study suggest that accident-injured individuals with certain TLR9 polymorphisms express higher levels of pro-inflammatory cytokines (IL-1β, IL-6 and IL-12). The associations of TLR9 SNPSs with increased risk of ASS or PTS should be further studied in larger groups of such patients.