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.     

Psychological distress in chronic obstructive pulmonary disease patients

Stress is defined as the exposure of an individual to a threatening stimulus or overwhelming event. Increased rates of psychological distress have been established in patients with chronic diseases compared to healthy individuals. The objective of the present study is to assess the indicators and correlates of psychological distress in chronic obstructive pulmonary disease (COPD) patients. We evaluated the stress exposure (stressful events that COPD patients and control subjects had been exposed) by a life events checklist and psychological distress by General Health Questionnaire in 74 COPD patients and 30 control subjects. Serum adrenocorticotropic hormone (ACTH) and cortisol levels were measured as biochemical indicators of stress. Distress score was higher in COPD group compared to age‐matched controls, although the stress exposure score were not statistically different; indicating that COPD itself is a source of distress. 92% of COPD patients and 87% of control subjects had varying degrees of distress. Severe distress was more frequent in COPD group. Distress score was further increased in patients with severe COPD and severe hypoxemia.There was no significant difference in serum ACTH and cortisol levels of COPD patients and control subjects and distress scores were not correlated to serum ACTH and cortisol levels. However, serum cortisol was higher in patients with severe hypoxemia. These findings support the importance of screening for psychological distress symptoms in COPD outpatients. Since high degree of distress contributes to impaired quality of life and added morbidity, patients with COPD need a comprehensive care including a psychological evaluation. Copyright © 2008 John Wiley & Sons, Ltd.     

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.     

Cortisol outcomes among caucasian and latina/hispanic women caring for a family member with dementia: a preliminary examination of psychosocial predictors and effects of a psychoeducational intervention

A host of interventions are now known to be helpful to alleviate subjective distress and improve well‐being in dementia caregivers. However, few intervention studies have focused on measures of physical health, and none have examined cortisol as an outcome—despite the fact that cortisol is regarded as a crucial biological intermediary by which chronic stress leads to disease. In this study, we examined demographic and psychosocial factors as predictors of salivary cortisol at a baseline assessment, among a sample of 175 Latino/Hispanic and Caucasian women caring for a family member with dementia. We also examined the influence of a cognitive–behaviour‐based psychoeducational intervention (Coping with Caregiving) on cortisol at a post‐treatment assessment, compared with a minimal support condition. Results revealed that caregivers with high intensity caregiving situations, characterized by long hours of care and co‐residence with the care recipient, tended to have less adaptive cortisol patterns. However, these ‘at‐risk’ caregivers benefited most from the Coping with Caregiving intervention and had more normal cortisol patterns at post‐treatment, compared with caregivers in the control condition. Copyright © 2011 John Wiley & Sons, Ltd.     

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.     

Basic psychological need experiences,fatigue, and sleep in individuals with unexplained chronic fatigue

Grounded in self‐determination theory, this study tested the hypothesis that the satisfaction and frustration of the psychological needs for autonomy, competence, and relatedness would relate to fatigue and subjective and objective sleep parameters, with stress and negative sleep cognitions playing an explanatory role in these associations. During a stay at a sleep laboratory in Belgium, individuals with unexplained chronic fatigue (N = 160; 78% female) underwent polysomnography and completed a questionnaire at 3 different points in time (i.e., after arrival in the sleep lab, before bedtime, and the following morning) that assessed their need‐based experiences and stress during the previous week, fatigue during the preceding day, and sleep‐related cognitions and sleep during the previous night. Results indicated that need frustration related to higher stress, which in turn, related to higher evening fatigue. Need frustration also related to poorer subjective sleep quality and shorter sleep duration, as indicated by both subjective and objective shorter total sleep time and subjective (but not objective) longer sleep latency. These associations were accounted for by stress and negative sleep cognitions. These findings suggest that health care professionals working with individuals with unexplained chronic fatigue may consider focusing on basic psychological needs within their therapeutic approach.     

Maternal psychological well‐being and salivary cortisol in late pregnancy and early post‐partum

Maternal cortisol plays an important role in foetal development and is often used to measure stress. In addition to stress, prenatal and post‐partum women experience a mix of positive and negative emotions. However, few studies have examined the relationship between cortisol and maternal psychological health or how these relationships change from the prenatal to the post‐partum periods. The purpose of this study was to examine the relationships between maternal cortisol and stress, happiness, and depression components of psychological well‐being, in late pregnancy and early post‐partum. The study used a repeated measure design with 41 women; 21 women completed all data collections. As expected, maternal salivary cortisol increased from awakening to 30 minutes after awakening during pregnancy. Levels of salivary cortisol were lower at post‐partum. Stress, happiness and depression were significantly correlated at both prenatal and post‐partum measurements. Prenatal cortisol awakening response was correlated with happiness. Maternal psychological well‐being and cortisol did not differ by parity, race or employment. Maternal cortisol could potentially serve as a biochemical marker of maternal psychological well‐being. Interventions to decrease maternal stress may promote maternal psychological well‐being. Longitudinal studies with larger sample and diverse ethnicities may increase our understanding of the role of cortisol in foetal and maternal health. Copyright © 2009 John Wiley & Sons, Ltd.     

Plasma isatin is increased in maternal anxiety and obstetrical stress

Isatin (2,3‐dioxoindole) is a component of tribulin. Tribulin, an inhibitor of monoamine oxidase (MAO) and benzodiazepine (BDZ) receptor binding, has been identified as an endogenous marker of stress and anxiety. In animal experiments, isatin has been found to produce an anxiety‐like action and its level is increased during stress and anxiety. Maternal anxiety and obstetrical complications are two different stressors that can affect perinatal outcome. In this study we investigated plasma isatin levels in maternal anxiety and stress. The study was conducted in 279 pregnant and non‐pregnant women. The patients were stratified into five groups—A, B, C, D and E. Plasma cortisol was measured to assess the intensity of the stressor and plasma isatin was measured by a high‐performance liquid chromatography (HPLC) method. Perinatal outcome was measured by gestational weight and birth weight of the baby. Non‐pregnant women (group D) had a significantly lower plasma isatin level (P < 0.001) compared to women with normal pregnancies (group E), whose plasma isatin was monitored once in each trimester. Patients with anxiety and psychological stress (group B) and patients with obstetrical stress from obstetrical complications (group C) had significantly higher levels of plasma cortisol (P < 0.001) and plasma isatin (P < 0.001) compared to women with normal pregnancies (group A). Perinatal outcome data were significantly lower (P < 0.001) in both groups B and C. In conclusion, our data proved that maternal anxiety and obstetrical complications are two different stressors evidenced by higher plasma cortisol and isatin levels in patients of these two groups. The present study further validated the postulated role of isatin as a marker of anxiety and stress in a clinically relevant condition in humans. Copyright © 2002 John Wiley & Sons, Ltd.     

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.     

Inflamed by the Flames? The Impact of Terrorism and War on Immunity

The physiological impact on citizens of prolonged exposure to violence and conflict is a crucial, yet underexplored, issue within the political science and biology literature. We examined the effect of high levels of exposure to rocket and terrorist attacks on biological markers of immunity and inflammation in a sample of 92 Israelis. A stratified random sample of individuals was drawn from a pool of subjects in Israel who had previously been interviewed regarding their stress exposure and psychological distress during a period of active rocket and terrorist attacks. These individuals were reinterviewed and blood samples were collected to assess antibodies to cytomegalovirus (CMV antibodies) and C‐reactive protein (CRP). Posttraumatic stress disorder (PTSD) was significantly related to CRP, β = .33, p = .034, with body mass index, depression, and exposure to terrorism included in the model. Depression scores were not significantly associated with CRP or CMV antibody levels. In contrast to the established convention that psychological distress is the sole outcome of terrorism exposure, these findings reveal that individuals exposed to terrorism experience higher levels of both PTSD/depression, and inflammation. This study has important ramifications for how policy makers and medical health professionals should formulate public health policies and medically treat individuals living in conflict zones.     

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.     

Stress‐induced increase in morning cortisol variance

Empirical evidence for the role of the hypothalamo‐pituitary‐adrenal axis in chronic stress is contradictory. Findings of enhanced cortisol concentrations conflict with hypocortisolism in chronic stress. Both, high and low cortisol levels, have been reported to go along with psychological and somatic complaints. To integrate conflicting empirical results and theoretical assumptions it is hypothesized, that (1) the cortisol distribution becomes broader under the influence of persisting stress. Because of the association between extreme cortisol values and stress related complaints it is supposed, that (2) stress related complaints will increase in prevalence in chronic stress. A high level of chronic stress was assured by recruiting a sample of nursing staff; a waiting list controlled cognitive‐behavioral stress management intervention was implemented to vary stress systematically. As expected a high level of stress was accompanied by a broader morning cortisol distribution. After the intervention the distribution was less broad and corresponded with representative normative values. However, subjects grouped on basis of (extreme) cortisol values did not differ in the amount of stress, coping or psychophysiological complaints. The results suggest a stress‐induced variation of basal cortisol concentrations. The assumption of specific complaints depending on cortisol status could not be confirmed. Copyright © 2004 John Wiley & Sons, Ltd.     

Self-perceived work-related stress and its relation to salivary IgA, cortisol and 3-methoxy-4-hydroxyphenyl glycol levels among neonatal intensive care nurses

This study investigated self‐perceived work‐related stress, along with salivary IgA (s‐IgA), cortisol and 3‐methoxy‐4‐hydroxyphenyl glycol (MHPG) in 38 neonatal intensive care unit (NICU) nurses and 26 general ward (GW) nurses. To adjust for sociodemographic characteristics, the two groups of nurses were strictly matched for age, gender (feminine), average work experience and marital status (unmarried). General fatigue and anxiety were significantly higher, and depressive mood tended to be higher, in NICU nurses compared to GW nurses, based on Cumulative Fatigue Symptoms Index scores (p < 0.05, p < 0.05, p = 0.079, respectively). s‐IgA concentrations were also inversely correlated with self‐perceived work‐related stress and were significantly lower in NICU nurses than in GW nurses (p < 0.01). There tended to be a positive association between high cortisol concentrations and the CFSI subscale of depressive mood in both NICU and GW nurses (p = 0.053). Cortisol and MHPG levels were not different between NICU and GW nurses. These work‐related stress markers, both self‐perceived (CFSI) and biological (s‐IgAand cortisol concentrations), highlight the importance of creating and sustaining healthy work environments for NICU and GW nurses. Copyright © 2011 John Wiley & Sons, Ltd.     

Effect of snack eating on salivary α‐amylase,a novel stress marker

The aim of this study is to investigate the effect of snack eating on salivary α‐amylase (sAA) as compared with salivary cortisol. From 15 healthy males, saliva samples were collected every 30min from 14:00 to 18:00. Immediately after the sampling at 15:00, seven subjects (snack‐eating group) ate a snack. The sAA and cortisol levels were determined with commercial kits. In the snack‐eating group, there was a significant increase in both the levels of sAA and cortisol after snack eating at 15:30. Even higher salivary cortisol levels were detected at 16:00. In the control group, no significant changes were detected. These findings suggest that both the levels of sAA and salivary cortisol are affected by snack eating and that, before saliva sampling for stress measurement, a fasting period of about 90min is appropriate. Copyright © 2007 John Wiley & Sons, Ltd.     

Cortisol Responses to Naturalistic and Laboratory Stress in Student Teachers: Comparison with a Non‐stress Control Day

Ambulatory assessments of hypothalamus–pituitary–adrenal axis responses to acute natural stressors yield evidence on stress regulation with high ecological validity. Sampling of salivary cortisol is a standard technique in this field. In 21 healthy student teachers, we assessed cortisol responses to a demonstration lesson. On a control day, sampling was repeated at analogous times. Additionally, the cortisol awakening response (CAR) was assessed on both days. Participants were also exposed to a laboratory stressor, the Trier Social Stress Test, and rated their individual levels of chronic work stress. In pre‐to‐post‐stress assessment, cortisol levels declined after the lesson. However, post‐stress cortisol levels were significantly higher compared with those on the control day. Also, the Trier Social Stress Test yielded higher cortisol responses when using the control day as reference baseline. Associations between the CAR and chronic stress measures were observed solely on the control day. There were no significant associations between cortisol responses to the natural and laboratory stressors. Our results indicate that a control day might be an important complement in laboratory but especially in ambulatory stress research. Furthermore, associations between chronic stress measures and the CAR might be obscured by acute stress exposure. Finally, responses to the laboratory stressor do not seem to mirror natural stress responses. Copyright © 2012 John Wiley & Sons, Ltd.     

Physical injury,stress, and health: Protective role of dispositional optimism

Physical injuries are common occurrences that can have substantial implications for personal, emotional, and social functioning. A recent study reported higher prevalence of common illnesses and reduced health‐related quality of life (HRQL) in injury victims. Based on these findings, the present study examined the role of the antibody immunoglobulin A (IgA) and the stress hormone cortisol in the association between injury and health. Additionally, the role of daily life stress and dispositional optimism in this association was examined. Thirty‐seven victims of injury (e.g., fractures and burns) and 41 noninjured participants were assessed for cortisol and IgA levels and completed a battery of questionnaires assessing illness prevalence, HRQL, perceived stress, and optimism. Injured participants reported higher prevalence of illness and poorer HRQL compared with noninjured participants; however, changes in cortisol or IgA levels did not explain this increase in illness. Correlations between perceived stress and HRQL were stronger in injured participants compared with noninjured controls, indicating that injured individuals are more affected by stress. Dispositional optimism was lower in injured participants, and optimism buffered the negative effect of stress on HRQL. Accordingly, it is suggested that optimism played a protective role against the negative consequences of stress in injured individuals, thus improving HRQL.     

Basal SIgA and cortisol levels predict stress‐related health outcomes

The present study investigates the relationship between stress and health in young adults. We predicted that academic stressor exposure would lead to an increase in self‐reported stress and health symptoms, as well as alterations in salivary secretory immunoglobulin A (SIgA) and salivary cortisol concentration. Thirty‐four healthy participants were administered stress and health inventories and tested to assess SIgA and cortisol levels during a baseline (low‐stress) session and during an examination (high‐stress) session. Self‐report stress and health scores increased between low‐ and high‐stress sessions in all participants. Cortisol level also increased between study sessions, but only in those participants who experienced an increase in perceived stress. No changes in SIgA were observed. Multiple linear regression revealed that baseline SIgA and cortisol level moderated the relationship between stressor exposure and health outcome. Participants with low basal SIgA levels and high basal cortisol levels had poorer health outcomes during the examination session than did participants with high basal SIgA levels and low basal cortisol levels. Neither cortisol reactivity, nor SIgA reactivity moderated the relationship between stressor exposure and health outcome. These findings suggest that individual differences in basal immune and endocrine activity predict stress‐related susceptibility to ill health. Copyright © 2006 John Wiley & Sons, Ltd.     

The effect of a one‐hour Eastern stress management session on salivary cortisol

Body‐Mind‐Spirit (BMS) model by Chan (2001) have been applied to interventions for a variety of clienteles and the effectiveness has been supported by positive psychological outcomes. This study aims to complement these studies by evaluating the efficacy of a one‐hour Eastern stress management session in reducing salivary cortisol levels in working adults in Hong Kong. Pre‐ and post‐test salivary cortisol levels were measured and a significant drop after the session when compared with local normative data was evident. The efficacy of the stress management session, limitations of this study and suggestions for further research are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Work stress and performance among financial traders

This study investigated factors associated with work stress and performance among professional decision‐makers in financial markets. Three hundred and twenty‐six financial traders completed questionnaires while supervisors provided performance ratings. Of these 32 per cent of traders reported ‘very high’ or ‘extremely high’ stress levels. Overall, traders ranked ‘profit goal’ as the highest stressor followed by ‘long working hours’. Traders' experience of occupational stress was based on four main factors: Profit Pressure, Social Pressure, Work Load, and Decision‐Processing. These factors varied systematically across different trading roles. Proprietary traders with higher performance ratings experienced less stress. Similar stress ‘profiles’ of North American and European traders indicate universal responses to job demands. Trader work stress is possibly mitigated through self‐selection and substantial latitude over trading style. Copyright © 2005 John Wiley & Sons, Ltd.     

Individual Differences in the Psychobiological Response to Psychosocial Stress (Trier Social Stress Test): The Relevance of Trait Anxiety and Coping Styles

The main objective of this study was to investigate the contribution of some personality traits to the physiological and psychological response to a standardized laboratory psychosocial stressor (trier social stress test). Cortisol and affective response (anxiety and mood) were analysed in a mixed‐sex group composed of 35 young adults who participated in a crossover design (18 men and 17 women). After verifying a statistically significant response to the trier social stress test in all parameters studied in both sex groups, exploratory cluster analyses were carried out to identify sub‐groups based on their psychophysiological responses. These analyses showed two different groups: subjects displaying lower psychological response along with higher cortisol response (cluster 1) compared with the group with high affective reactivity along with lower cortisol response (cluster 2). Interestingly, we also found significant differences in trait anxiety and coping styles when the two clusters were compared. Subjects in cluster 1 showed lower scores on trait anxiety and higher scores on active coping, whereas the subjects in the second cluster obtained higher scores on anxiety and on coping focused on emotions and mental disengagement. These findings support the importance of personality traits and coping styles in understanding the overall integrative psychobiological responsiveness to social stress. Copyright © 2014 John Wiley & Sons, Ltd.