Daily stress reactivity and serotonin transporter gene (5-HTTLPR) variation: internalizing responses to everyday stress as a possible transdiagnostic phenotype

BACKGROUND: Recent studies examining the interaction between the 5-HTTLPR locus in the serotonin transporter gene and life stress in predicting depression have yielded equivocal results, leading some researchers to question whether 5-HTTLPR variation indeed regulates depressive responses to stress. Two possible sources of inconsistent data in this literature are imprecise stress assessment methodologies and a restricted focus on depression phenotypes as the outcome of interest, as opposed to transdiagnostic emotional symptoms such as internalizing and externalizing dimensions. The present study aimed to address these critical limitations in prior research by examining how 5-HTTLPR acts in concert with idiographically assessed daily life stress to predict transdiagnostic emotional outcomes. RESULTS: One hundred and four healthy young adults genotyped for 5-HTTLPR reported on their life stress exposure and internalizing and externalizing experiences for 14 consecutive days. As hypothesized, daily stress levels were associated with severity of internalizing symptoms, but only for 5-HTTLPR S allele carriers. Additional analyses revealed that these interactive effects of 5-HTTLPR and daily life stress on internalizing symptoms extended to both the distress and fear subdomains of internalizing symptoms. CONCLUSIONS: Considered together, these results support the validity of the 5-HTTLPR stress sensitivity hypothesis and suggest for the first time that variation at 5-HTTLPR moderates the effects of daily life stress on broadband symptom profiles

Out of Mind, Out of Sight: Unexpected Scene Elements Frequently Go Unnoticed Until Primed

Abstract The human visual system employs a sophisticated set of strategies for scanning the environment and directing attention to stimuli that can be expected given the context and a person's past experience. Although these strategies enable us to navigate a very complex physical and social environment, they can also cause highly salient, but unexpected stimuli to go completely unnoticed. To examine the generality of this phenomenon, we conducted eight studies that included 15 different experimental conditions and 1,577 participants in all. These studies revealed that a large majority of participants do not report having seen a woman in the center of an urban scene who was photographed in midair as she was committing suicide. Despite seeing the scene repeatedly, 46 % of all participants failed to report seeing a central figure and only 4.8 % reported seeing a falling person. Frequency of noticing the suicidal woman was highest for participants who read a narrative priming story that increased the extent to which she was schematically congruent with the scene. In contrast to this robust effect of inattentional blindness, a majority of participants reported seeing other peripheral objects in the visual scene that were equally difficult to detect, yet more consistent with the scene. Follow-up qualitative analyses revealed that participants reported seeing many elements that were not actually present, but which could have been expected given the overall context of the scene. Together, these findings demonstrate the robustness of inattentional blindness and highlight the specificity with which different visual primes may increase noticing behavior

More than a feeling: A unified view of stress measurement for population science.

Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes alone have been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic - and more precise language for dimensions of stress measurement

Assessing lifetime stressor exposure in sport performers:Associations with trait stress appraisals, health, well-being, and performance

Research has found that greater lifetime stressor exposure increases the risk for mental and physical health problems. Despite this, few studies have examined how stressors occurring over the entire lifespan affect sport performers’ health, well-being, and performance, partly due to the difficulty of assessing lifetime stressor exposure. To address this issue, we developed a sport-specific stress assessment module (Sport SAM) for the Stress and Adversity Inventory (STRAIN) and then analyzed the instrument’s usability, acceptability, validity, and test-retest reliability. Furthermore, we examined whether trait-like tendencies to appraise stressful situations as a challenge or threat mediated the association between lifetime stressor exposure and health, well-being, and performance. Participants were 395 sport performers (M(age) = 22.50 years, SD = 5.33) who completed an online survey. Results revealed that the Sport SAM demonstrated good usability and acceptability, good concurrent validity in relation to the Adult STRAIN (rs = 0.23 to 0.29), and very good test-retest reliability (r(icc) = 0.87 to 0.89). Furthermore, the Sport SAM was significantly associated with symptoms of depression (β = 0.21 to 0.24, ps ≤ .001) and anxiety (β = 0.13 to 0.19, ps ≤ .012), and general physical (β = 0.24 to 0.27, ps = ≤ 0.001) and mental (β = 0.23 to 0.32, p ≤ .001) health complaints. Finally, we found that associations between total lifetime non-sport and sport-specific stressor severity and health were mediated by trait stress appraisals. Consequently, these findings may help practitioners better identify sport performers who are at risk of developing stress-related health problems

Oxytocin, Cortisol, and Cognitive Control During Acute and Naturalistic Stress

Although stress is a strong risk factor for poor health, especially for women, it remains unclear how stress affects the key neurohormones cortisol and oxytocin, which influence stress-related risk and resilience. Whereas cortisol mediates energy mobilization during stress, oxytocin has anti-inflammatory, anxiolytic, and analgesic effects that support social connection and survival across the lifespan. However, how these neurohormones interrelate and are associated with cognitive control of emotional information during stress remains unclear. To address these issues, we recruited 37 college-aged women (Mage = 19.19, SD = 1.58) and randomly assigned each to a one-hour experimental session consisting of either an acute stress (emotionally stressful video) or control (non-stressful video) condition in a cross-sectional manner across the semester. Salivary cortisol and oxytocin samples were collected at baseline and after the video, at which point participants also completed measures assessing affect and an emotional Stroop task. As hypothesized, the emotional stressor induced negative emotions that were associated with significant elevations in cortisol and faster Stroop reaction times. Moreover, higher baseline oxytocin predicted greater positive affect after the stressor and also better cognitive accuracy on the Stroop. Analyses examining the naturalistic stress effects revealed that basal oxytocin levels rose steeply three weeks before the semester’s end, followed by rising cortisol levels one week later, with both neurohormones remaining elevated through the very stressful final exam period. Considered together, these data suggest that women’s collective experiences of stress may be potentially buffered by a synchronous oxytocin surge that enhances cognitive accuracy and reduces stress “when the going gets tough”

Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study

Objective: Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. Method: In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: (1) assessment of stress in primary care; (2) biobehavioral pathways linking stress and illness; (3) the value of stress measurements for improving outcomes in primary care; (4) barriers to measuring and managing stress; and (5) key research questions relevant to stress assessment and intervention in primary care. Results: Based on our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. Conclusions: Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and wellbeing

The Stress and Adversity Inventory for Adults (Adult STRAIN) in German: An overview and initial validation

Life stress is a key determinant of poor mental and physical health, but until recently no instrument existed for efficiently assessing cumulative stress exposure and severity across the entire lifespan. The Stress and Adversity Inventory (STRAIN) is an online, interview-based stress assessment system that was developed to address this need. We examined the concurrent, predictive, and discriminant validity of a German translation of the STRAIN by administering the instrument, along with several other measures of stress and health, to 298 adults (81 men, 217 women, Mage = 30.3 years). The German STRAIN demonstrated excellent concurrent validity, as evidenced by associations with other instruments assessing early adversity (|rs|≥.62, ps≤.001). It also correlated with instruments assessing recent life event exposure in adulthood (|rs|≥.48, ps≤.001), as well as recent perceived stress (|rs|≥ .25, ps≤.001) and recent chronic stress levels (|rs|≥ .19, ps≤.001). Additionally, the German STRAIN showed strong predictive validity in relation to anxiety symptoms (|rs|≥ .22, ps≤.001) and depressive symptoms (|rs|≥ .33, ps≤.001). Finally, the German STRAIN showed good discriminant validity, with lifetime stressor count being unrelated to personality features like neuroticism. These results demonstrate that the German version of the STRAIN is a valid tool for assessing lifetime stress exposure and severity. Additional research is needed to examine how the German STRAIN predicts psychological and biological stress reactivity and physical health outcomes

Using mobile sensing data to assess stress: Associations with perceived and lifetime stress, mental health, sleep, and inflammation

Background Although stress is a risk factor for mental and physical health problems, it can be difficult to assess, especially on a continual, non-invasive basis. Mobile sensing data, which are continuously collected from naturalistic smartphone use, may estimate exposure to acute and chronic stressors that have health-damaging effects. This initial validation study validated a mobile-sensing collection tool against assessments of perceived and lifetime stress, mental health, sleep duration, and inflammation. Methods Participants were 25 well-characterized healthy young adults (Mage = 20.64 years, SD = 2.74; 13 men, 12 women). We collected affective text language use with a custom smartphone keyboard. We assessed participants’ perceived and lifetime stress, depression and anxiety levels, sleep duration, and basal inflammatory activity (i.e. salivary C-reactive protein and interleukin-1β). Results Three measures of affective language (i.e. total positive words, total negative words, and total affective words) were strongly associated with lifetime stress exposure, and total negative words typed was related to fewer hours slept (all large effect sizes: r = 0.50 – 0.78). Total positive words, total negative words, and total affective words typed were also associated with higher perceived stress and lower salivary C-reactive protein levels (medium effect sizes; r = 0.22 – 0.32). Conclusions Data from this initial longitudinal validation study suggest that total and affective text use may be useful mobile sensing measures insofar as they are associated with several other stress, mental health, behavioral, and biological outcomes. This tool may thus help identify individuals at increased risk for stress-related health problems

Psychosocial and clinical characteristics of a patient with Takotsubo syndrome and her healthy monozygotic twin: a case report

Background: Takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by transient left ventricular dysfunction, increased myocardial biomarkers, and electrocardiographic changes. Symptoms of TTS are similar to those of acute coronary syndromes, but there is often no significant coronary stenosis. Although emotional and physical stressors are often reported as having triggered TTS, the pathogenesis is largely unknown. To address this issue, we comprehensively characterized a monozygous pair of twin sisters, one of whom experienced TTS. Case summary: The 60-year-old Caucasian monozygotic female twins with and without TTS were examined at the University Hospital Zurich in Switzerland. The twins completed questionnaires and clinical interviews assessing several sociopsychological factors. The twin sister with TTS exhibited higher levels of anxiety, vital exhaustion, social inhibition, and alexithymia, and lower levels of quality of and meaning in life. She was given the diagnoses of social phobia, adjustment disorder, specific anxiety disorder, obsessive-compulsive personality disorder, and an accentuated anxiety-avoidant personality disorder. Additionally, the twin with TTS experienced more-and also more severe-stressors involving life-threatening and dangerous situations over the life course. Discussion: These monozygous female twins with and without TTS differed in several notable aspects of their psychological functioning, psychiatric status, personality, and lifetime stressor exposure. The results thus highlight several factors, besides genetic components, that may play an important role in the pathogenesis of TTS. Looking forward, larger studies using experimental and longitudinal designs are needed to elucidate the role that psychosocial factors play in TTS. Keywords: Case report; Monozygotic twins; Psychology; Stress-induced cardiomyopathy; Takotsubo syndrom

Diurnal Cortisol and Survival in Epithelial Ovarian Cancer

IntroductionHypothalamic-pituitary-adrenal (HPA) deregulation is commonly observed in cancer patients, but its clinical significance is not well understood. We prospectively examined the association between HPA activity, tumor-associated inflammation, and survival in ovarian cancer patients prior to treatment.Materials and methodsParticipants were 113 women with ovarian cancer who provided salivary cortisol for three days prior to treatment for calculation of cortisol slope, variability, and night cortisol. Cox proportional hazard regression analyses were used to examine associations between cortisol and survival in models adjusting for disease stage, tumor grade, cytoreduction and age. On a subsample of 41 patients with advanced disease ascites fluid was assayed for levels of interleukin-6 (IL-6) and correlated with cortisol variables.ResultsEach cortisol measure was associated with decreased survival time, adjusting for covariates (all p<.041). A one standard deviation increase in night cortisol was associated with a 46% greater likelihood of death. Patients in the high night cortisol group survived an estimated average of 3.3 years compared to 7.3 years for those in the low night cortisol group. Elevated ascites IL-6 was associated with each cortisol measure (all r>36, all p<.017).DiscussionAbnormal cortisol rhythms assessed prior to treatment are associated with decreased survival in ovarian cancer and increased inflammation in the vicinity of the tumor. HPA abnormalities may reflect poor endogenous control of inflammation, dysregulation caused by tumor-associated inflammation, broad circadian disruption, or some combination of these factors. Nocturnal cortisol may have utility as a non-invasive measure of HPA function and/or disease severity