Loneliness Mediates the Relationship Between Early Life Stress and Perceived Stress but not Hypothalamic-Pituitary-Adrenal Axis Functioning

Many authors have proposed that early life stress (ELS) provokes a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and contributes negatively to the management of stress in adulthood. However, these associations have not always been observed, making it necessary to include new factors that could explain the different results found. In this regard, people with ELS experiences report less social support during adulthood, suggesting that loneliness could be a mediating factor. Thus, our aims were to investigate whether ELS was related to both perceived stress and diurnal HPA axis activity, and whether loneliness mediates these relationships, in a community sample (N=187, 18-55years old). Fourteen cortisol samples were collected on two non-consecutive days to obtain the overall diurnal cortisol, diurnal cortisol slope, and bedtime levels. Additionally, ELS was assessed with the Risky Families Questionnaire (RFQ) and the Recalled Childhood and Adolescence Perceived Stress (ReCAPS) measure. Results revealed that ELS was associated with perceived stress, but not HPA axis functioning, and loneliness mediated the relationship between ELS and perceived stress, but not between ELS and HPA axis functioning. Similar results were found for both ELS questionnaires, suggesting that the ReCAPS is an adequate tool. These results highlight the importance of loneliness in understanding the long-term effects of ELS, and they indicate different effects of ELS on subjective and physiological stress indicators

Resilience and Psychobiological Response to Stress in Older People: The Mediating Role of Coping Strategies

Resilience, the ability to overcome adversity and face stressful demands and experiences, has been strongly associated with successful aging, a low risk of diseases and high mental and physical functioning. This relationship could be based on adaptive coping behaviors, but more research is needed to gain knowledge about the strategies employed to confront social stress. Thus, we aimed to investigate the role of the use of active or passive coping strategies by resilient people in dealing with stressful situations. For this purpose, we measured resilience, coping strategies, and perceived stress in 66 healthy older adults (31 men and 35 women) between 56 and 75 years old who were exposed to stress (Trier Social Stress Test, TSST) or a control situation. The stress response was analyzed at endocrine (cortisol) and psychological (anxiety) levels. In the stress condition, moderated mediation analysis showed a conditional indirect effect of resilience on cortisol reactivity through active coping. However, passive coping strategies did not mediate the resilience-cortisol relationship. In addition, neither active nor passive coping mediated the relationship between resilience and the anxiety response. These results suggest that resilience is associated with active coping strategies, which in turn could explain, at least in part, individual differences in the cortisol response to a psychosocial laboratory stressor. These factors may prevent the development of stress-related pathologies associated with aging and facilitate healthy and satisfactory aging.

Loneliness and health indicators in middle-aged and older females and males

Loneliness is a complex and uncomfortable feeling that results from the perception of a lack of desired personal and social ties. Loneliness is accentuated with aging. It has been related to a wide range of objective and subjective health indicators and is a risk factor for morbidity and mortality. One of the proposed underlying mechanisms through which loneliness affects health is the dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. However, the relationship between loneliness and cortisol, the main product of the HPA axis, is unclear and requires more research. The aims of this cross-sectional study were to investigate the relationships between loneliness, subjective health, and cortisol indexes, taking the sex into account, and investigate whether the HPA axis mediates the relationship between loneliness and subjective health. For this purpose, 79 participants (between 55 and 75 years old) completed several scales on loneliness, depression, perceived stress, psychological and physical health, and social relationships. Various salivary cortisol measurements were obtained on two consecutive days. The initial results showed that loneliness was related to psychological and physical health in the mixed-sex sample. However, when covariates were introduced, loneliness was only associated with psychological health in males. In addition, the cortisol indexes employed were not related to loneliness and did not mediate the relationship between loneliness and subjective health. Hence, we did not find a relevant role of the HPA axis in the association between loneliness and subjective health. More severe perceptions of loneliness would probably be necessary to detect this role. Overall, these results also show that the expected negative outcomes of loneliness associated with aging can be countered by an active life that can compensate for the natural losses experienced with age or at least delay these negative outcomes. Finally, some sex differences were found, in line with other studies, which warrants further examination of social variables and dimensions related to gender in future research. Copyright © 2022 Crespo-Sanmiguel, Zapater-Fajarí, Garrido-Chaves, Hidalgo and Salvador

Depression and Suicide Risk in Mild Cognitive Impairment: The Role of Alzheimer’s Disease Biomarkers

Background: Patients with depression and mild cognitive impairment (MCI) are at greater risk of developing dementia. Depression involves a higher risk of suicidal ideation (SI) and suicide attempts (SA). Biomarkers of Alzheimer’s Disease (AD) could help to clarify the role of depression and SI in AD. Method: Fifty-nine participants aged > 50 with criteria of MCI positive (MCI-AD) (n=22) and negative (MCI-Non AD) (n=24) AD and healthy controls (HC) (n=13) were evaluated. We used the Geriatric Depression Scale (GDS-30) and the GDS-SI factor to measure depression and indirect risk for suicide, respectively. Additionally, AD biomarkers such as amyloid-ß (Aß), hyperphosphorilated tau (P-tau), and total tau (T-tau) in cerebrospinal fluid (CSF) were analyzed. Results: No significant differences between the groups were found in depression. However, in the MCI-AD group, lower P-tau and T-tau levels were related to higher GDS-SI scores, suggesting that MCI-AD patients with lower AD pathology are at a higher risk of suicide. Conclusions: The result highlights the importance of considering SI in the initial phases of AD, and the potential role of AD biomarkers in early detection of symptoms. Antecedentes: Los pacientes con depresión y deterioro cognitivo leve (DCL) tienen un alto riesgo de desarrollar demencia. La depresión implica un alto riesgo de ideación suicida (IS) e intentos de suicidio (AS). Los biomarcadores de la enfermedad de Alzheimer (EA) pueden clarificar el papel de la depresión e IS en la EA. Método: Cincuenta y nueve participantes >50 años con criterios de DCL-EA positivo (DCL-EA; 22) y negativo (DCL-NoEA; 24) y 13 controles sanos. La depresión fue evaluada con la Escala Geriátrica de Depresión (GDS-30) y la IS con el factor GDS-IS. Además, se midieron los siguientes biomarcadores en el líquido cefalorraquídeo: ß-amiloide (ß-A), tau hiperfosforilada (H-tau) y total (T-tau). Resultados: No se encontraron diferencias significativas entre los tres grupos de participantes en depresión o en IS. Sin embargo, en el grupo DCL-EA, niveles más bajos de H-tau y T-tau, indicadores de menor patología EA, se relacionaron significativamente con mayor riesgo de suicidio indirecto. Conclusiones: Este resultado subraya la importancia de considerar la IS en fases iniciales de EA, y el potencial papel de los biomarcadores de EA para detectar sus síntomas

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology