Chronic Stress最新文献

Background: Cardiovascular diseases (CVD) and depression are growing global health concerns as heart attack and stroke solely account for around 85% of total CVD deaths and 280 million ie, while 3.4% of the world's population have depression. A bi-directional relationship exists between depression and heart disease: about one-fourth of heart disease patients experience depression, and those with depression have a higher risk of developing heart disease compared to the general population. This study aims to examine the association between depression and heart attack as a dependent variable, focusing on demographic and behavioral correlates of individuals in Tennessee.

Methods: We performed a cross-sectional analysis using the 2022 Behavior Risk Factor Surveillance System (BRFSS) data for Tennessee (N = 5266). Our analytical approaches involved descriptive and multivariate analysis (logistic regression analysis) to assess the association between depression and heart attack in Tennessee. The primary dependent variable of interest was a self-reported lifetime heart attack and independent variables included self-reported lifetime depression, no exercise in the past 30 days, smoking status, race/ethnicity, gender, and age category.

Results: A total of 7.5% (N = 731) of participants reported lifetime heart attack and 27.8% (N = 828) of participants reported depression. Depression was found to be significantly associated with higher odds of a heart attack (AOR = 1.36; 95% CI, 1.06, 1.73), p < 0.001). Similarly, no exercise in the past 30 days (AOR = 1.74; 95% CI, 1.39, 2.20, p < 0.001) was also associated with higher odds of a heart attack. Furthermore, low income, current smoking status, and race/ethnicity were not found to be significantly associated with heart attack in our study.

Conclusion: This study reinforces the significant link between depression and heart attack while highlighting the complex interplay of demographic and behavioral factors influencing onset of cardiovascular diseases. The findings underscore the necessity for a comprehensive approach to cardiovascular health that integrates mental health considerations and addresses broader social determinants of health.

Generalized anxiety has significantly increased in the general population during and after the COVID-19 pandemic, highlighting the need for rapid screening tools. In this context, the present study analyzed the psychometric properties and internal consistency of the Generalized Anxiety Disorder Scale (GAD-7) in healthcare workers and the general population in Latin America. A cross-sectional e-health study was conducted, surveying 11,279 Latin Americans online using snowball sampling. The sample included healthcare professionals, hospital populations, community members from various occupations, and university students from six countries (Argentina, Bolivia, Ecuador, Chile, Colombia, and Peru). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed separately for each country. Additionally, the instrument's internal consistency was evaluated by calculating McDonald's W index and item-total correlations based on the final items. The EFA revealed a unidimensional structure comprising the seven items of the instrument, which explained between 62.8% and 66.1% of the variance (KMO = between .900 and .910; p < .000). The CFA confirmed adequate fit indices for each country. The omega index ranged from 0.85 (Peru: CI = 0.800-0.884) to 0.95 (Argentina-Bolivia: CI = 0.901-0.985), and item-total correlations were high, ranging from .642 to .869, demonstrating the instrument's reliability. In conclusion, the findings of this study indicate that the GAD-7 is a valid and reliable instrument for assessing generalized anxiety symptoms in the Latin American population.

Background: Mass conflict and related displacement in South Sudan has created a significant mental health need, however extant research on the impact of conflict is limited among South Sudanese people and has predominantly relied on Western-developed self report measures.

Method: A total of 195 South Sudanese adults who work in both civil society and government leadership positions participated in a psychophysiological assessment of heart rate variability (HRV) and self-reported PTSD and emotion dysregulation symptoms to participation in the Trauma-Informed Community Empowerment (TICE) Framework, developed and implemented by the Global Trauma Project (GTP). We utilized measures of heart rate variability to determine parasympathetic activity, which may be associated with difficulties responding to stressors as well as long-term physical health morbidity and mortality.

Results: Findings suggest pervasive difficulties in emotion regulation abilities among all participants and, consistent with the existing literature on PTSD in South Sudan, over a third of participants meet the clinical cut-off for PTSD. The majority of participants' physiological profiles indicate unexpected levels of parasympathetic nervous system activity given age and gender norms, demonstrating a sample with serious health risk. HRV did not correspond to self-reported PTSD symptoms, but did correlate with emotion dysregulation variables.

Conclusions: These results demonstrate the feasibility and utility of using a multimethod approach to assessment in a community-based environment and highlight the psychophysiological burden of chronic socio-political strife.

Background: Trauma-focused psychotherapy is treatment of choice for post-traumatic stress disorder (PTSD). However, about half of patients do not respond. Recently, there is increased interest in brain criticality, which assesses the phase transition between order and disorder in brain activity. Operating close to this borderline is theorized to facilitate optimal information processing. We studied if brain criticality is related to future response to treatment, hypothesizing that treatment responders' brains function closer to criticality.

Methods: Functional magnetic resonance imaging resting-state scans were acquired from 46 male veterans with PTSD around the start of treatment. Psychotherapy consisted of trauma-focused cognitive behavioral therapy, eye movement desensitization and reprocessing, or a combination thereof. Treatment response was assessed using the Clinician-Administered PTSD Scale, and criticality was assessed using an Ising temperature approach for seven canonical brain networks (ie, the visual, somatomotor, dorsal attention, ventral attention, limbic, frontoparietal and default mode networks) to measure distance to criticality.

Results: The brains of prospective treatment responders were closer to criticality than nonresponders (P = 0.017), while no significant interaction effect between group and brain network was observed (P = 0.486). In addition, average criticality across networks correlated with future treatment response (P = 0.028).

Conclusion: These results show that the brains of prospective PTSD psychotherapy treatment responders operate closer to criticality than nonresponders, and this occurs across the entire brain instead of in separate canonical brain networks. These results suggest that effective psychotherapy is mediated by brains operating closer to criticality.

Background: Greater unhelpful thinking is associated with greater musculoskeletal discomfort and incapability. Cognitive-behavioral therapy (CBT) fosters healthy thinking to help alleviate symptoms.

Questions: In a meta-analysis of randomized control trials (RCT) of CBT for unhelpful thinking among people with musculoskeletal symptoms, we asked: 1) Does CBT reduce unhelpful thinking and feelings of distress, and improve capability, in individuals with musculoskeletal symptoms? 2) Are outcomes affected by CBT delivery methods?

Methods: Following QUOROM guidelines, we searched databases using keywords of pain catastrophizing, kinesiophobia, cognitive-behavioral therapy, musculoskeletal and variations. Inclusion criteria were RCT's testing CBT among people with musculoskeletal symptoms. Study quality was assessed with Cochrane Review of Bias 2. Meta-analysis of means and standard deviations was performed.

Results: CBT led to modest reductions in catastrophic thinking (-0.44 CI: -0.76 to -0.12; P = .01, kinesiophobia (-0.60 CI: -1.07 to -0.14; P = .01) and anxiety symptoms (-0.23 CI: -0.36 to -0.09; P < .01) over six months compared to usual care. There were no improvements in levels capability (-0.28 CI: -0.56 to 0.01; P = .05). CBT led by mental health professionals reduced catastrophic thinking more than CBT led by other clinicians (QB Test = 4.73 P = .03). There were no differences between online and in-person sessions, group versus individual therapy, or surgical versus non-surgical interventions.

Conclusion: The evidence that CBT delivered by various clinicians in various settings fosters healthier thinking in people presenting for care of musculoskeletal symptoms, supports comprehensive care of musculoskeletal illness. More research is needed to develop indications and interventions that also improve levels of capability. Level-I, meta-analysis of RCT's.

Police officers are frequently faced with chronic and acute stressors, such as excessive workload, organizational stressors and emotionally charged reports. This study aims to examine the relationship between a form of chronic strain (ie, burnout symptoms) and a resource (ie, coping self-efficacy) in a sample of Dutch police officers. Specifically, we aim to investigate the existence of a loss cycle of resources. We use Latent Change Score modeling to investigate the potential depletion or loss cycle of coping self-efficacy as a result of burnout symptoms in a sample of 95 police officers who completed a survey on three consecutive timepoints. The lag between the measurements was approximately one year. We found that, during both one-year intervals, within-person increases in burnout symptoms were related to within-person decreases in coping self-efficacy. Also, the results emphasize the buffering role of coping self-efficacy for burnout symptoms, as within-person decreases in coping self-efficacy during the first year were associated with within-person increases in burnout symptoms during the following year. Together, the results imply that a loss cycle of coping self-efficacy and burnout symptoms may occur. For this we used Latent Change Score modeling, which is a relatively new approach which provides researchers with the opportunity to analyse multi-wave longitudinal data while focusing on within-person changes over time. Practically, police organizations are advised to monitor personnel wellbeing and resources, to maintain and promote sustainable employability of police officers and to be able to timely provide individuals with interventions. Limitations discussed are the use of self-report measures and large intervals between the measurements. Finally, future directions of research are discussed that would circumvent the reported limitations, such as multiple wave with shorter lags and incorporating confounding factors that could affect coping self-efficacy.

Background: During military deployment, stress regulation is vital to protect against the development of anxiety and trauma-related symptoms. Brain endocannabinoids play an important role in stress regulation and previous research has shown that genetic variations in the FAAH rs324420 polymorphism demonstrate protective effects during stress. In addition, this polymorphism shows interactions with the CRHR1 and CNR1 polymorphisms on anxiety. The present study examines whether genetic variations of the FAAH, CRHR1 and CNR1 polymorphisms interact with the development of anxiety and trauma related symptoms in military veterans.

Methods: Veterans (N = 949) who went on military deployment and experienced a stressful event were genotyped for FAAH rs324420, CRHR1 rs110402 and CNR1 rs2180619. Anxiety and trauma symptoms were measured pre-deployment and 6 months after deployment. Anxiety was measured with the anxiety subscale of the Symptom Checklist-90 (SCL-90) and trauma with the Self-Rating Inventory for PTSD (SRIP).

Results: Covariance Pattern Models demonstrated no significant relation of genetic variations in FAAH rs324420 on anxiety and PTSD symptoms from pre-deployment to 6 months after military deployment. Additionally, we investigated interactions between the FAAH s324420, CRHR1 rs110402 and CNR1 rs2180619 polymorphisms. This also demonstrated no significant effects on anxiety and PTSD symptoms pre- to post deployment. However, the covariate of childhood trauma that was included in the models was significant in all these models.

Conclusion: Genetic variations in FAAH rs324420 and its interactions with CRHR1 rs110402 and CNR1 rs2180619 are not related to the development of anxiety and trauma-related symptoms. The study however, indicates the importance of considering childhood trauma in the investigation of the effects of polymorphisms that are related to the endocannabinoid system on the development of anxiety and PTSD symptoms.

Interpersonal violence is a common type of trauma experienced by people with opioid use disorder (OUD), especially for people with co-occurring OUD and mental illness (COD). However, little is known about demographic and clinical characteristics of individuals with COD who have experienced an interpersonal violence traumatic event compared to those who have experienced a non-violent trauma, and how experiences of interpersonal violence are associated with treatment utilization. Data presented are from a randomized clinical trial testing collaborative care for COD in primary care. Of the 797 patients enrolled in the larger study, 733 (92%) were included in this analysis because they reported a traumatic event. In this sample, 301 (41%) participants experienced a traumatic event involving interpersonal violence. Participants who experienced interpersonal violence were more likely to be younger and female. Among the 301 people who experienced interpersonal violence, 30% experienced child sexual abuse, 23% experienced physical violence, 19% experienced domestic violence, and 28% experienced sexual assault. Those who experienced physical violence were significantly less likely to be female (28.6% vs 74.2% to 88.2% in other groups). Those who reported domestic violence had significantly fewer days of drug use (4.1 days vs 9.0 to 11.5 in the other groups) and lower opioid use severity scores (mean = 13.0 vs 16.6 to 19.5 in the other groups). Multivariable regression results examining the associations between interpersonal violence experiences on treatment utilization revealed no statistically significant differences. Rates of receipt were high for medication for opioid use disorder (∼80%) in this sample while rates of mental health counseling were around 35% and rates of receiving mental health medication around 48%. These findings make an important contribution to understanding the associations between patient characteristics and traumatic experiences, and receipt of treatment for OUD and mental health problems among a sample of patients with COD.

Clinical trial registration: clinicalTrials.gov ID: NCT04559893.

Objective: Binge drinking and heavy alcohol use are highly prevalent among college students. During the COVID-19 pandemic, due to lockdown restrictions and other challenges, many college students were burdened with loneliness, which can contribute to chronic stress, and substance use. The current study explores the association between loneliness and various levels of alcohol use among college students in the rural, underserved region of Central Appalachia, USA.

Methods: Data were collected from a regional sample (n = 320) of college age adults, age 18-25 in the Central Appalachian region. The UCLA-3 item Loneliness Scale (UCLA-3) was used in the study to evaluate loneliness. Logistic regression analysis was conducted to assess the association between levels of loneliness and three separate outcomes, including past year binge drinking, past year heavy alcohol use, and past year weekly alcohol use.

Results: Overall, 25.5% of the participants reported severe loneliness, 33.6% reported moderate, and 40.9% reported low levels of loneliness. Results of the adjusted models revealed that severe loneliness was associated with higher odds of heavy alcohol use (AOR = 1.89, 95% CI [1.02, 3.50]) and binge drinking (AOR = 2.96, 95% CI [1.16, 7.51]), and not associated with weekly alcohol use.

Conclusion: The study found that higher levels of loneliness were linked to both binged drinking and heavy alcohol use. Further efforts for counseling and treatment among college students who are burdened with severe loneliness should be considered. The chronic stress associated with severe loneliness needs to be further addressed, particularly among emerging adults.

Background: Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms.

Methods: Individuals with PTSD (n = 27), trauma-exposed individuals without PTSD (n = 27), and individuals without trauma exposure (n = 26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed.

Results: We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity.

Conclusion: In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.