Search

Objective: Previous studies implied detrimental effects of adverse childhood experiences (ACE) on cardiovascular disease and mental health. Still, data on the influence of ACE on psychological distress in patients with an implantable cardioverter-defibrillator (ICD) are lacking., Methods: We prospectively recruited 423 patients with an ICD. To determine associations between ACE (ACE questionnaire, cut-off ≥4), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), we conducted a binary logistic regression analysis. Regression models were adjusted for conventional risk factors of psychological distress in ICD patients. To identify indirect mediating effects of resilience (Resilience Scale) on ACE and psychological distress, we applied the PROCESS regression path analysis modeling tool., Results: 49.1 % of all patients reported at least one ACE, and 9.7 % experienced even four or more ACE. A high-risk ACE profile (≥ 4) was associated with higher levels of anxiety (OR 3.68, 95 % CI 1.37-9.84, p = 0.009), depression (OR 4.08, 95 % CI 1.67-9.97, p = 0.002), and PTSD symptoms (OR 2.20, 95 % CI 1.03-5.21, p = 0.041). Greater resilience partially mediated the relationship between ACE and depression (indirect effect 0.11, 95 % CI 0.01-0.26) as well as anxiety (indirect effect 0.08, 95 % CI 0.008-0.19)., Conclusions: The current study suggests an association between ACE and psychological distress in patients with an ICD. However, resilience could mitigate the adverse effects of ACE. Future studies should strive to unravel the complex mechanisms of ACE and its effects on cardiovascular and mental health in ICD patients., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Objective: The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapies, such as mindfulness-based interventions (MBI), for improving biopsychosocial outcomes. Therefore, the aim is to examine the feasibility, acceptability, and preliminary efficacy of an online-delivered, self-directed MBI, adapted to individuals with IBD and psychological distress, in comparison to wait-list control (WLC)., Methods: 50 adults with IBD were randomized to WLC (N = 25) or intervention (N = 25) groups. The intervention (MIND4IBD program) consisted of six, weekly, 15-min videos (with guided meditations). Feasibility was examined through recruitment and retention rates, while acceptability was examined through intervention satisfaction ratings and qualitative feedback. Preliminary efficacy was examined using linear mixed models for group differences in outcomes between baseline and post-intervention., Results: Primary Outcomes. The retention rate for the WLC group was 92 %, while the retention rate for the intervention group was 48 %. However, 16 % of participants allocated to the intervention group never began the intervention, therefore this resulted in a retention rate of 71 % of participants who began the intervention. Acceptability was high with an average intervention satisfaction rating of 83/100., Secondary Outcomes: When compared with the WLC, the MIND4IBD program improved total mindfulness levels (b = 0.29, 95 %CI [0.11,0.47], p = 0.004) with a large effect size (β = 0.54, b = 0.19, 95 %CI [0.04,0.34], p = 0.014). Themes based on participants' intervention feedback included: 1) beginning of journey with mindfulness, 2) the beneficial impact of mindfulness, 3) why adapting the intervention to IBD is important, 4) views on program delivery, and 5) mixed reactions to AI generated presenters., Conclusion: MIND4IBD is feasible and acceptable for individuals with IBD and psychological distress. Participants' total mindfulness levels increased significantly in the intervention group compared to WLC. Most participants provided positive intervention feedback. These findings warrant a full-scale RCT to determine MIND4IBD's efficacy for IBD., Competing Interests: Declaration of competing interest We declare no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Objective: While previous studies have examined the relationship between stressful life events (SLEs) and subjective age (SA), the results were inconclusive and the mechanisms linking the association were unclear. This study investigated whether the experience of SLEs was associated with an older SA and the potential mediating role of depression linking this association in a cross-sectional study of older adults in China., Methods: Data were drawn from the 2018 China Longitudinal Aging Social Survey (CLASS), comprising 7643 participants aged 60 and older. The association between SLEs and SA was examined using multivariate linear regression, and the mediation effect of depression was evaluated., Results: Experiencing SLEs over the past year was associated with a 0.018 increase in proportional felt age (95 % CI: 0.012, 0.024) and a 0.011 increase in proportional look age (95 % CI: 0.005, 0.016), respectively. Depression appeared to be a significant mediator, accounting for 22.2 % and 27.3 % of the association of SLEs with proportional felt age and proportional look age, respectively., Conclusion: Findings revealed that having SLEs was associated with an older SA, partially through the pathway of depression. More attention and appropriate intervention should be given to the older adults incurring SLEs to prevent the adverse effect of older SA., Competing Interests: Declaration of competing interest The authors have no competing interests to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Despite high prevalence of irritable bowel syndrome (IBS) and its significant negative impact on individuals' quality of life, its etiology remains poorly understood. This prospective study explored whether early life factors (adverse childhood experiences; ACEs) and alexithymia intensity, could explain IBS symptom severity and its effects on psychological functioning over time. We also compared the studied variables between an IBS sample and a healthy control group., Method: Based on the Rome III Diagnostic Criteria for IBS, 245 individuals with a diagnosis of IBS were recruited from a national sample of Poles. The IBS sample completed the following psychometric questionaries in three waves, one month apart: Adverse Childhood Experiences Questionnaire, Toronto Alexithymia Scale, IBS Symptom Severity Score, Short Form Perceived Stress Scale, and Ultra-Brief Patient Health Questionnaire for Anxiety and Depression. Latent transition analysis was used to identify distinct profiles of IBS symptom dynamics., Results: The IBS group reported a significantly higher number of ACEs, greater alexithymia severity, and more intense levels of stress, anxiety, and depressive symptoms compared to the healthy controls. Four profiles of IBS individuals with distinct dynamics of IBS symptoms, stress, anxiety, and depressive symptoms were extracted, which correlated with the baseline number of ACEs and alexithymia intensity among participants., Conclusion: Childhood adversity and associated problems in emotional processing affect IBS symptom severity. ACEs should be included in IBS screening and considered in the design of individualized multidisciplinary treatment approaches for IBS patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Although psychological distress is a prevalent issue among patients with amyotrophic lateral sclerosis (ALS) and can impact survival, the risk factors contributing to this distress remain insufficiently understood., Methods: Patients with ALS who completed the Profile of Mood States (POMS) between June 2017 and March 2022 were included. Participants with moderate to severe cognitive decline were excluded, resulting in the recruitment of 121 patients. The associations between POMS profiles and clinical characteristics were analyzed. Physical motor symptoms were evaluated using the Revised ALS Functional Rating Scale (ALSFRS-R) for objective measurement and the 40-item ALS Assessment Questionnaire (ALSAQ-40) for subjective assessment., Results: Our model, employing the ALSFRS-R, revealed significant factors associated with overall psychological distress, as assessed by the POMS, including upper limb symptoms, the presence of sleep apnea syndrome, older age at onset, and male sex, with an inverse association with tracheostomy. The POMS subscale scores revealed that anger and depression were significantly associated with upper limb symptoms. The second model, which employed subjective scales, yielded similar results, reinforcing the robustness of our findings. Moreover, subjective bulbar symptoms on the ALSAQ-40 were significantly associated with psychological distress, particularly in female patients., Conclusion: This study identified the main clinical characteristics significantly associated with psychological distress in patients with ALS. Our findings may be useful in developing individualized psychological management strategies for these patients., Competing Interests: Declaration of competing interest The authors have no competing interests to report., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Allergic rhinitis (AR), a prevalent global health concern, is increasingly recognized for its impact beyond physical symptoms, affecting mental health. This research examined the extent of AR's psychological burden and sleep disturbances., Methods: A systematic search of four databases yielded 49 studies reporting mental health problems in 18,269,265 individuals (15,151,322 AR patients and 3,117,943 controls). The primary outcomes included all mental health problems in AR patients. Subgroup analyses based on outcome and AR severity, country, AR diagnosis, recruitment setting, and age were performed. Secondary outcomes included the risk of these problems compared to controls (healthy or without AR)., Results: In AR, depression (25%), anxiety (25%), stress (65%), distress (57%), suicidal thoughts (14%) and attempts (4%), poor sleep quality (48%), insomnia (36%), sleep impairment (33%), and insufficient sleep duration <7 h (59%) were prevalent. The severity of these outcomes differed significantly. Patients' country, AR diagnostic method, recruitment method/setting, and age group were significant effect modifiers. Compared to controls, AR resulted in significantly higher risk of depression, anxiety, stress, suicidal attempts and thoughts, insomnia, and sleep impairment., Conclusion: AR patients had significantly lower sleep duration. Mental health problems are very common among AR patients, further exacerbating their sleep quality and duration and intention to suicide., Competing Interests: Declaration of competing interest All authors, including Alaa Safia, Uday Abd Elhadi, Marwan Karam, Shlomo Merchavy, and Ashraf Khater, declare no competing interests associated with the conduct of this work., (Copyright © 2023. Published by Elsevier Inc.)

Objective: Physicians face documented challenges to their mental and physical well-being, particularly in the forms of occupational burnout and cardiovascular disease. This study examined the previously under-researched intersection of early life stressors, prolonged occupational stress, and cardiovascular health in physicians., Methods: Participants were 60 practicing male physicians, 30 with clinical burnout, defined by the Maslach Burnout Inventory, and 30 non-burnout controls. They completed the Adverse Childhood Experiences (ACE) Questionnaire asking about abuse, neglect and household dysfunctions before the age of 18, and the Perceived Stress Scale to rate thoughts and feelings about stress in the past month. Endothelium-independent (adenosine challenge) coronary flow reserve (CFR) and endothelium-dependent CFR (cold pressor test) were assessed by positron emission tomography-computed tomography. The segment stenosis score was determined by coronary computed tomography angiography., Results: Twenty-six (43%) participants reported at least one ACE and five (8%) reported ≥4 ACEs. A higher ACEs sum score was associated with lower endothelium-independent CFR (r partial (r p ) = -0.347, p = .01) and endothelium-dependent CFR (r p  = -0.278, p = .04), adjusting for age, body mass index, perceived stress and segment stenosis score. In exploratory analyses, participants with ≥4 ACEs had lower endothelium-independent CFR (r p  = -0.419, p = .001) and endothelium-dependent CFR (r p  = -0.278, p = .04), than those with <4 ACEs. Endothelium-dependent CFR was higher in physicians with burnout than in controls (r p  = 0.277, p = .04). No significant interaction emerged between burnout and ACEs for CFR., Conclusion: The findings suggest an independent association between ACEs and CFR in male physicians and emphasize the nuanced relationship between early life stressors, professional stress, and cardiovascular health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: In this study, we examined the extent to which parents and their children with a chronic condition communicate their stress to one another and whether stress communication is associated with different forms of dyadic coping., Methods: In a sample of 239 parent-child dyads, self-reported stress communication and different forms of perceived dyadic coping (i.e., emotion-oriented, problem-oriented, and negative dyadic coping) were assessed using a cross-sectional design., Results: We first found that children's stress communication was positively associated with more positive (r = 0.28, p < .001) and less negative dyadic coping responses by children (r = -0.22, p < .001). Children's stress communication was also associated with more positive (r = 0.52, r = 0.45, p's < 0.001), and less negative dyadic coping responses by parents (r = -0.19, p < .001). Using dyadic data of children with a chronic condition and their parents, we found that more stress communication of children was associated with healthier coping responses of both children (perceived emotion-oriented dyadic coping: β = 0.23, p < .001) and parents (perceived emotion-oriented dyadic coping: β = 0.33, p < .001; perceived problem-oriented dyadic coping: β = 0.22, p < .001)., Conclusion: This underscores the importance of communication and adaptive coping strategies of parents and children in the context of a child's chronic condition. These findings may help us find ways to support children and their parents to optimally communicate about and deal with their stress., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Long COVID has been associated with psychological symptoms, yet it is unknown if the symptom burden of individuals with current and previous long COVID differ. This pre-registered cross-sectional study assessed stress, anxiety, and depression severity among individuals with no history, previous history, or current long COVID symptoms., Methods: Adults (N = 2872) in the United States participated in an online survey detailing experiences related to the COVID-19 pandemic. Included participants reported ≥1 COVID-19 infection, and self-reported long COVID symptoms (past and present) were assessed. A multivariable linear regression evaluated the association of long COVID status and stress, anxiety, and depression severity. Post-hoc contrasts were performed to probe significant differences among no, previous, and current long COVID symptom groups., Results: Of 2872 participants with history of COVID-19 infection, 2310 reported no history of, 183 reported previous history of, and 379 reported current long COVID symptoms. Participants were an average 41.3 years of age, with most identifying as female (51.7%), White (87.7%), and non-Hispanic or Latino (84.1%). Individuals with current and previous history of long COVID reported greater stress, anxiety, and depression compared to the no history group (all ps < 0.05; current vs. no history Cohen's ds = 0.71-0.93; previous vs. no history ds = 0.30-0.66) after adjusting for demographic and lifestyle factors., Conclusions: Both current and previous long COVID may be associated with psychological symptoms., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Although tools exist to assess psychological distress during pregnancy, a scarcity of instruments are designed to measure maternal perceptions of the more positive, uplifting features of pregnancy in addition to the more negative, hassling aspects. To address this shortcoming, DiPietro et al. developed the Pregnancy Experience Scale-Brief (PES-Brief). We aimed to assess the reliability and psychometric performance of an Arabic translation of the PES-Brief among Lebanese pregnant women., Methods: The PES-Brief, the Patient Health Questionnaire, the Lebanese Anxiety Scale, and the Multidimensional Scale of Perceived Social Support were administered to 433 participants. PES-Brief scores were computed as frequency and intensity, with Hassles to Uplifts frequency and intensity ratios., Results: The PES-Brief was internally consistent, with McDonald's ω = 0.87 for Uplifts and 0.81 for Hassles. Higher PES-Uplifts scores were significantly associated with lower depression and anxiety scores, and higher perceived social support; whereas higher PES-Hassles scores showed inverse correlations. The Hassles to Uplifts frequency and intensity ratios were 0.864 and 0.836, respectively, indicating that pregnant women were more uplifted than hassled. The CFA results confirmed the two-factor structure of the scale., Conclusion: Our findings suggest that the Arabic PES-Brief is a psychometrically valid and reliable scale that may be employed as a legitimate indicator of pregnancy-specific uplifts and hassles among Arabic-speaking populations. Our study prompts clinicians and researchers to benefit from this tool for capturing the integral psychological/emotional experience of women during pregnancy, which may facilitate pregnant women's support when needed., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The present study aims to analyse the bidirectional hypothesis between stress and multiple sclerosis with several measures of stress, impairment and functionality, considering also the interaction role of stress-related psychosocial factors such as anxiety, coping and social support., Methods: A one-year follow-up was conducted with 26 people with multiple sclerosis. Participants reported i) at baseline, anxiety (State-Trait Anxiety Inventory), and social support (Multidimensional Scale of Perceived Social Support); ii) daily, Ecological Momentary Assessment through self-reported diaries of stressful events and coping strategies; iii) monthly, the perceived stress (Perceived Stress Scale), iv) trimonthly, the self-reported functionality (Functionality Assessment in multiple sclerosis) and v) at baseline and at the end, neurologist rated impairment (Expanded Disability Status Scale). Mixed-effect regression models were conducted., Results: The bidirectional hypothesis was confirmed with perceived stress and self-reported functionality, which were negatively related in both directions. Coping and anxiety showed an interaction effect: active coping increased functionality only with high levels of stress, and high-trait anxiety showed lower functionality whereas low-trait anxiety showed higher functionality but only with low stress levels., Conclusion: People with multiple sclerosis may benefit from different types of psychological therapies, from gold-standard therapies like Cognitive Behavioural Therapy to third-waves therapies like Dialectical Behaviour Therapy or mindfulness, that focus on dealing with stress and affective symptoms, adjusting to the disease, and to improving their overall quality of life. More research is needed in this field under the biopsychosocial model., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Relationship status predicts numerous outcomes among medical populations. Few interventions evaluate the role of marital status on response to psychosocial treatment, and no such studies exist within advanced prostate cancer (APC). This study examined whether marital status modified the effect of a cognitive behavioral stress management (CBSM) intervention on perceived stress., Methods: Men with APC (N = 190) were randomized to 10-week CBSM or a health promotion (HP) intervention (#NCT03149185). The Perceived Stress Scale assessed perceived stress at baseline and 12-month follow-up. Medical status and sociodemographics were captured at enrollment., Results: Participants were mostly White (59.5%), non-Hispanic (97.4%), heterosexual (97.4%) men, 66.8% of whom were partnered. Neither condition nor marital status predicted perceived stress change at follow-up. However, a significant interaction was found between condition and marital status (p = 0.014; Cohen's f = 0.07), such that partnered men who received CBSM and unpartnered men who received HP reported greater reductions in perceived stress., Conclusion: This is the first study to assess the impact of marital status on psychosocial intervention effects among men with APC. Partnered men derived greater benefit from a cognitive-behavioral intervention and unpartnered men equally benefitted from a HP intervention. Further research is necessary to understand the mechanisms underlying these relationships., Competing Interests: Declaration of Competing Interest F. Penedo & B. Yanez: Blue Note Therapeutics consulting. E. Walsh, C. Boland, P. Popok, P. Pedreira, R. Fox, and P. Moreno: None. Data Availability. Deidentified data is available upon reasonable request to the authors. Authorship Contributions. E.A. Walsh: Conceptualization, formal analysis, writing – original draft, writing – review & editing. C. Boland: Project administration, writing – original draft, writing – review & editing. P.J. Popok: Writing – review & editing. P.B. Pedreira: Writing – review & editing. R.S. Fox: Project administration, writing – review & editing. P. I. Moreno: Project administration, writing – review & editing. B. Yanez: Project administration, writing – review & editing. F. J. Penedo: Conceptualization, funding, project administration, writing – review & editing., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Psychological distress, as defined by elevations in symptoms of depression, anxiety, and/or perceived stress, is frequent in patients with chronic diseases, such as coronary artery disease (CAD). While psychological distress is known to impact disease outcomes, less is known about its influence on health care utilization, or on the factors that may modify these relationships. This prospective study examined whether 1) psychological distress predicts greater use of outpatient care services over a period of up to eight years in middle-aged to older individuals with CAD or other non-cardiovascular chronic diseases; 2) this relationship differs according to sex, presence of CAD, and/or social support., Methods: Men and women (N = 1236; aged 60.85 ± 6.95 years) with and without CAD completed validated questionnaires on symptoms of depression, anxiety, perceived stress, and social support. Number of medical outpatient visits was obtained from the Régie de l'assurance maladie du Québec. Analyses included bivariate correlations, hierarchical regressions, and moderation analyses, controlling for sociodemographic and lifestyle variables., Results: Psychological distress, social support, and yearly outpatient visits were significantly correlated (ps < 0.05). In regression analyses, only depressive symptoms were associated with significantly greater use of outpatient care (b = 0.048, p = .004), particularly among CAD patients (b = 0.085, p < .001). Neither sex nor social support moderated this relation., Conclusion: Depression predicted greater outpatient visits in patients with chronic disease, especially CAD patients. More research is needed to determine whether psychosocial interventions may have an impact on health care utilization., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: COVID-19 causes psychological distress for patients and their relatives at short term. However, little research addressed the longer-term psychological outcomes in this population. Therefore, we aimed to prospectively assess clinically relevant psychological distress in hospitalized patients with COVID-19 and their relatives 90 days after hospital discharge., Methods: This exploratory, prospective, observational cohort study included consecutive adult patients hospitalized in two Swiss tertiary-care hospitals between March and June 2020 for confirmed COVID-19 and their relatives. The primary outcome was psychological distress defined as clinically relevant symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS) 90 days after discharge., Results: Clinically relevant psychological distress 90 days after hospital discharge was present in 23/108 patients (21.3%) and 22/120 relatives (18.3%). For patients, risk and protective factors associated with clinically relevant psychological distress included sociodemographic, illness-related, psychosocial, and hospital-related factors. A model including these factors showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.84. For relatives, relevant risk factors were illness-related, psychosocial, and hospital-related factors. Resilience was negatively associated with anxiety and depression in both patients and relatives and regarding PTSD in relatives only., Conclusion: COVID-19 is linked to clinically relevant psychological distress in a subgroup of patients and their relatives 90 days after hospitalization. If confirmed in an independent and larger patient cohort, knowledge about these potential risk and protective factors might help to develop preventive strategies., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Gendered inequalities in workplace stress are linked to sex-specific health trajectories that are poorly understood. Measuring gendered inequalities is challenging but necessary to better explain individual differences in occupational health. The aim of this exploratory, retrospective study was to create a measure of occupational gender-roles and use structural equation models to investigate pathways linking layers of gendered factors to workplace stress, allostatic load, and mental health in a sample of psychiatric hospital workers (N = 192)., Methods: Individual-level gender-roles were measured with the Bem Sex-Role Inventory Short-Form. Occupational gender-roles were measured using a novel web-based survey approach. Sex-specific allostatic load indices were constructed using 23 biomarkers (e.g., neuroendocrine, immune, cardiovascular, and metabolic). Workplace stress was assessed using the Job Content Questionnaire and the Effort-Reward at Work Questionnaire. Depressive symptoms were assessed with the Beck Depression Inventory-II, burnout symptoms with the Maslach Burnout Inventory - General Survey, and trauma symptoms with the PTSD Civilian Checklist., Results: Individual-level masculine gender-roles were positively associated with psychological demands (R 2  = 0.103) and social support (R 2  = 0.078). Masculine and feminine occupational gender-roles were positively associated with decisional latitude (R 2  = 0.157) and effort-reward ratio (R 2  = 0.058). Both individual masculine and feminine gender-roles had protective effects on depressive symptoms (R 2  = 0.289) and burnout symptoms (R 2  = 0.306) but only individual masculine gender-roles had protective effects on trauma symptoms (R 2  = 0.198). We found no association between occupational gender-roles and mental health and allostatic load., Conclusion: Beyond individual gender-roles, our study shows the utility of measuring occupational gender-roles to delineate associations between workplace stressors and mental health that should be applied in future studies of sex differences in occupational health., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The development of depressive symptoms in youth with IBD is a concerning disease complication, as higher levels of depressive symptoms have been associated with poorer quality of life and lower medication adherence. Previous research has examined the association between disease activity and depression, but few studies have examined individual differences in experience of stressful life events in relation to depressive symptoms. The purpose of the current study is to examine the relation between stressful life events and depression within pediatric IBD and to determine whether individual differences in stress response moderates this association., Methods: 56 youth ages 8-17 years old diagnosed with IBD completed questionnaires about their depressive symptoms and history of stressful life events. We assessed skin conductance reactivity (SCR) to a stressful task as an index of psychophysiological reactivity., Results: Stressful life events (r = 0.36, p = .007) were positively related to depressive symptoms. Youth who demonstrated a greater maximum SC level during the IBD-specific stress trial compared to baseline (n = 32) reported greater depressive symptoms. For these same participants, the relationship between stressful life events and depressive symptoms depended on SCR F(3, 28) = 4.23, p = .01, such that at moderate and high levels of SCR, a positive relationship between stressful life events and depressive symptoms was observed., Conclusions: The relationship between stressful life events and depressive symptoms in youth with IBD may depend on individual differences in processing stress, such that risk may increase with greater psychophysiological reactivity., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To understand if presence of mental stress-induced myocardial ischemia (MSIMI) is associated with higher prevalence of cognitive impairment at baseline and its decline over time., Methods: A cohort of participants with stable coronary atherosclerosis underwent acute mental stress testing using a series of standardized speech/arithmetic stressors. The stress/rest digital vasomotor response to mental stress (sPAT) was assessed to measure microvascular constriction during mental stress. Patients received 99mTc-sestamibi myocardial perfusion imaging at rest, with mental stress and with conventional (exercise/pharmacological) stress. Cognitive function was assessed both at baseline and at a 2 year follow-up using the Trail Making Test parts A and B and the verbal and visual memory subtests of the Wechsler Memory Scale., Results: We studied 486 individuals (72% male, 32.1% Black, 62 ± 9 (mean ± SD) years old). After multivariable adjustment for baseline demographics, risk factors, and medication use, presence of MSIMI was associated with 21% and 20% slower completion of Trail-A and Trail-B, respectively (p for all <0.01). After a 2-year follow-up period, presence of MSIMI was associated with a 33% slower completion of Trail-B, denoting cognitive decline (B = 0.33, 95% CI, 0.04, 0.62). A lower sPAT, indicating greater vasoconstriction, mediated the association between MSIMI and worsening Trail-B performance by 18.2%. Ischemia with a conventional stress test was not associated with any of the cognitive tests over time., Conclusion: MSIMI is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Job strain (high psychological demands and low decision control) is associated with cardiovascular diseases, however it remains unclear if the associations are explained by depressive symptoms, and whether there are sex differences. The objective of the present study was to evaluate the association between job strain and heart diseases in a middle-aged population-based cohort., Methods: Baseline data were from CARTaGENE, a community survey of adults aged 40-60 years in Quebec, Canada. Incidence of heart diseases was examined in 8073 individuals by linking survey data with administrative data. Cox regression models were used to examine the association between job strain and heart disease, adjusting for sociodemographic characteristics, behavioral and clinical factors, and depressive symptoms., Results: In total, 557 (6.9%) participants developed heart diseases over an average follow-up of 6.6 years. Job strain was associated with an increased risk of heart diseases in women (adjusted HR = 1.63, 95% CI 1.02-2.64) after controlling for depressive symptoms, behavioral and clinical factors. There was no overall association between job strain and heart diseases in men (adjusted HR = 0.96, 95% CI 0.62-1.49); an association was observed only in men aged 50 years and older. Incidence of heart diseases and high job strain was highest in those with labour jobs, and lowest in those with professional jobs., Conclusion: Job strain was associated with an increased risk of heart diseases in middle-aged women and in men aged 50 years and older. This association was not accounted for by depressive symptoms or sociodemographic, clinical, and behavioral factors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: American Indians (AIs) live with historical trauma, or the cumulative emotional and psychological wounding that is passed from one generation to the next in response to the loss of lives and culture. Psychological consequences of historical trauma may contribute to health disparities., Purpose: Here, we investigate whether historical trauma predicts changes in psychological stress associated with the onset of the COVID-19 pandemic in AI adults. Based on the stress-sensitization theory, we hypothesize that greater historical trauma will predict greater increases in levels of psychological stress from before the onset of the pandemic to after., Method: Our analytic sample consisted of 205 AI adults. We measured historical trauma and levels of psychological stress before and after the onset of the pandemic., Results: Using hierarchical regression models controlling for age, biological sex, income, symptoms of depression and anxiety, psychological stress at Time 1, COVID-19 specific stress, and childhood trauma, we found that greater historical trauma preceding the pandemic predicted greater increases in psychological stress (β = 0.38, t = 5.17 p < .01, ΔR 2  = 0.12), and levels of social support interacted with historical trauma to predict changes in psychological stress (β = -0.19, t = -3.34, p = .001, ΔR 2  = 0.04). The relationship between historical trauma and changes in stress was significant for individuals with low levels of social support., Conclusions: Historical trauma may contribute to AI mental health disparities, through heightened psychological stress responses to life stressors and social support appears to moderate this relationship., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To demonstrate the effectiveness of a cognitive behavioural therapy for stress management in pregnant women in the reduction of psychological stress and hair cortisol levels., Methods: The trial was controlled and randomised, with a total of 78 pregnant women: control group (n-39) and Cognitive Behavioural Therapy group (n-39). To test the therapy's efficacy, an evaluation of the primary outcome (hair cortisol levels) and secondary outcomes (psychological stress, psychopathological symptomatology and resilience) was conducted before and after the treatment. The therapy was conducted during 8 sessions (one per week) in a group setting. The study was registered as a Randomised Controlled Trial with the code NCT03404141., Results: The results showed a group time interaction between hair cortisol levels, psychological stress (perceived and pregnancy-specific), and in the exacerbation and severity of psychopathological symptoms. These variables presented reductions after treatment only in the Cognitive Behavioural Therapy group., Conclusions: Using a novel way of assessing chronic stress (psychological and objective measures as hair cortisol levels), this is the first study that has shown a decrease in both the levels of cortisol in hair and in psychological stress. This decline could have implications for maternal and fetal health., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: This explorative study aimed to determine the extent of psychological burden in social workers working with traumatized refugees. In addition, distressing and helpful factors determining the psychosocial burden were to be identified and described., Methods: Cross-sectional, mixed method design using quantitative and qualitative methods. The quantitative part included the Perceived Stress Questionnaire (PSQ) and items to assess specific factors of the working-context. The qualitative part is based on 5 focus groupdiscussions and 16 individual interviews. Evaluation was carried out using qualitative content analysis (QCA) including cross-analysis along the subscales of the PSQ to organise the qualitative material., Results: N = 54 social workers completed the questionnaire. High scores were found for all subscales of the PSQ. The distressing factor rated the highest was need of interpreters to communicate (M = 5.1, SD = 1.71), the helpful factor rated the highest was communication skills (M = 6.35, SD = 0.73). In the QCA, aspects of distressing and helpful factors were identified and further detailed., Conclusion: According to the here presented study results, the psychological burdens of social workers working with refugees seem to be high. The impact of distressing factors such as working with interpreters and exposure to trauma content or PTSD symptoms might be reduced by offering specific education and supervision. The individual extent of psychological burden should be considered and (re-)evaluated on a regular basis as secondary prevention. Helpful factors like self-care, teamwork, networking and cooperation are evident and should be supported by implementing professional and psychological support., Competing Interests: Declaration of Competing Interest All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Yoga positively affects health-related quality of life and disease activity in ulcerative colitis. The underlying modes of action remain unclear. Within the present study we hypothesized that patients´ perceived stress mediates the effects of yoga on health-related quality of life and disease activity., Methods: This is a secondary analysis of a randomized controlled trial comparing the effects of yoga to written self-care advice in patients with inactive ulcerative colitis and impaired quality of life. Perceived stress was assessed using the Perceived Stress Questionnaire, health-related quality of life using the Inflammatory Bowel Disease Questionnaire and disease activity using the Clinical Activity Index. Outcomes were assessed at weeks 0, 12 and 24., Results: Seventy-seven patients participated. Thirty-nine patients attended the 12 supervised weekly yoga sessions (71.8% women; 45.0 ± 13.3 years) and 38 patients written self-care advice (78.9% women; 46.1 ± 10.4 years). Perceived stress correlated significantly with health-related quality of life and disease activity at week 24. Perceived stress at week 12 fully mediated the effects of yoga on health-related quality of life (B = 16.23; 95% Confidence interval [6.73; 28.40]) and disease activity (B = -0.28; 95% Confidence interval [-0.56; -0.06]) at week 24., Conclusion: Our findings confirm the importance of perceived stress in reducing disease activity and increasing health-related quality of life in patients with ulcerative colitis and impaired quality of life. Practitioners should keep psychosocial risk in mind as a risk factor for disease exacerbation, and consider yoga as an adjunct intervention for highly stressed patients with ulcerative colitis. CLINICALTRIALS., Gov Registration Number: The trial was registered at clinicaltrials.gov prior to patient recruitment (registration number NCT02043600)., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: While flight experiences of refugees and asylum-seekers might differ profoundly, previous research has, to a large degree, not differentiated between these forcibly displaced groups. Furthermore, research has mainly focused on post-migratory stress measured after resettlement. The aim of this study was therefore to chart mental health disorders and the associations between mental health and early post-migratory stress among asylum-seekers., Method: Using a cross sectional survey design, data collection was conducted from 2016 to 2018, in three large asylum-seekers' housing facilities located in Sweden., Results: In total 455 asylum-seekers from Afghanistan, Eritrea, Iraq, Somalia and Syria responded to the questionnaire. The most prevalent type of mental health disorder was depression (67.9%) followed by posttraumatic stress disorder (PTSD) (60.7%), and anxiety (59.3%). More men than women reported mental health disorders particularly with regard to anxiety and PTSD, and respondents with the lowest level of education (≤9 years) reported the highest levels of mental health problems. Associations between mental health disorders and post-migratory stress revealed that three post-migratory stressors were consistently the strongest indicators of mental health disorders., Conclusions: Compared to previous research within populations of refugees who have received formal refugee status or resident permits, the prevalences of mental health disorders reported in the present study were substantially larger and the associations between post-migratory stressors and mental health disorders appears to be substantially stronger for asylum-seekers. This might suggest that the asylum-seekers' psychosocial situation becomes a diathesis or predisposition that interacts with early post-migratory stressors, in turn having detrimental effects on mental health., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Around 700,000 Syrian refugees live in Germany, most of them having come alone since 2015 as asylum seekers and waiting in Germany for family reunification. This study focused on separation from marital partner and its impact on quality of life among Syrian refugees with a residence permit., Methods: For the present investigation, we included only married participants of a larger registry-based study. Therefore, we analyzed 119 participants; 93 of them were married, and their partner accompanied them in Germany at the time of the investigation (partner+), while a further 26 were married but separated from their partner (partner-). The respondents were investigated for mental stress, quality of life and protective factors., Results: The partner- group reported significantly lower quality of life in the domains of psychological and social health in comparison to the partner+ group. Higher general quality of life was associated with higher social support, higher sense of coherence and fewer symptoms of depression. Predictors for a higher quality of life were male gender, fewer symptoms of depression, a higher sense of coherence, higher perceived social support and living together with the marital partner., Conclusion: Family separation of Syrian refugees with a residence permit in Germany can have an impact on their quality of life. Longitudinal studies are needed to confirm our results and determine the long-term effects of family separation., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2020. Published by Elsevier Inc.)

Objective: Demoralization has been mostly investigated in oncology but is also relevant for patients with other physical illnesses. Our aims were to investigate the psychometric properties of the 24-item Italian version of the Demoralization Scale (DS-24) among medically ill inpatients, and to develop shorter versions for screening., Methods: Four-hundred and seventy-three participants were recruited from medical wards of the University Hospital of Ferrara. Patients were assessed using the Diagnostic Criteria for Psychosomatic Research-Demoralization module (DCPR/D), Demoralization Scale (DS-24), Patient Health Questionnaire-9 (PHQ-9), Brief-Symptom Inventory-18, Anxiety subscale (BSI-Anx) and EuroQol Group (EQ-5D). Confirmatory factor analyses of previous structures and exploratory factor analyses were conducted using an Item Response Theory approach, including a bifactor model., Results: According to DCPR/D criteria, the prevalence of demoralization was 40%. Confirmatory analyses revealed that none out of seven factor structures from oncology studies adequately fitted data from hospital inpatients. Exploratory Item Factor Analysis uncovered a four-factor model comprising Disheartenment, Dysphoria, Sense of Failure, Loss of Meaning and Purpose, or a bifactor model, comprising similar factors with the addition of a general factor accounting for 45% of the variance. Moreover, we developed 13 and 6-item versions of the DS, both retaining high correlation with DS-24 scores (r = 0.98 and r = 0.95, respectively) and concordance with DCPR/D criteria (AUC-ROC 0.82 and 0.81)., Conclusion: The DS factor structure differs between general hospital and cancer patients. Differences may depend on intrinsic disease features and cultural-geographic factors. The short versions of the DS-24 may aid clinicians in identifying demoralized patients in hospital settings., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Knowledge of objective psychophysiological stress parameters and its relationship to health-related quality of life (HRQoL) is limited in patients with coronary artery disease (CAD). The aim was to investigate the association of cardiovascular reaction to psychosocial stress with HRQoL in patients with CAD., Methods: One-hundred and thirty-six patients (84.6% men, age 52 ± 8) within 2-3 weeks after acute coronary syndromes (ACS) during cardiac rehabilitation were recruited in this cross-sectional study. Patients were evaluated for HRQoL (SF-36 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression scale) and Type D personality (DS14 scale). Trier Social Stress Test (TSST) was employed to evaluate cardiovascular reactivity (systolic and diastolic blood pressure [BP], and heart rate [HR]) to psychosocial stress. Multiple linear regression analyses were performed to test for the associations between cardiovascular reactivity and HRQoL, while controlling for possible confounders., Results: After controlling for baseline levels of HR, gender, age, NYHA functional class, AH, Type D personality, symptoms of anxiety and depression, use of beta-blockers, and history of smoking, the SF-36 Social functioning scale (β = -0.182; p = .03) and SF-36 Vitality scale (β = -0.203; p = .03) was associated with prolonged HR recovery following stress evoking tasks. No associations were found between HRQoL and BP measures during the TSST., Conclusion: In CAD patients who have experienced ACS, HRQoL was associated with prolonged HR recovery after mental stress, even after controlling for potential confounder. Future studies should investigate the possible role of mediating factors involved in the mechanisms relating cardiovascular stress response and HRQoL., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Healthcare professionals (HCPs) experience a wide range of physical and psychological symptoms that can affect quality of patient care. Previous meta-analyses exploring mindfulness-based interventions (MBIs) for HCPs have been limited by their narrow scope regarding intervention type, target population, and/or measures, and reliance on uncontrolled studies; therefore, a more comprehensive and methodologically rigorous examination is warranted. This meta-analysis quantified the effectiveness of MBIs on distress, well-being, physical health, and performance in HCPs and HCPs-in-training., Method: RCTs examining the effect of meditation and MBIs on HCPs and HCPs-in-training were identified and reviewed. Two independent reviewers extracted data and assessed risk of bias., Results: Thirty-eight studies were included in the analyses (n = 2505; 75.88% female). Intervention had a significant moderate effect on anxiety (Hedge's g = 0.47), depression (Hedge's g = 0.41), psychological distress (Hedge's g = 0.46), and stress (Hedge's g = 0.52). Small to moderate effects were also found for burnout (Hedge's g = 0.26) and well-being at post-intervention (Hedge's g = 0.32). Effects were not significant for physical health and performance. Larger intervention effects on overall outcomes were found with HCPs (Hedge's g = 0.52), with Mindfulness-based Stress Reduction intervention (Hedge's g = 0.47), and inactive controls (Hedge's g = 0.36)., Conclusions: Results suggest mindfulness-based interventions are effective in reducing distress and improving well-being in HCPs and HCP-ITs. Subgroup analyses suggest the importance of exploring potential participants' needs prior to selecting the type of mindfulness intervention. Future studies should assess changes in mindfulness and include active controls., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Diminished cardiac reactions to acute psychological stress are associated with adverse behavioral and health-relevant outcomes. It has been proposed that diminished cardiac reactivity may be a marker for deficits in motivational functioning both at the biological and behavioral levels. Social participation reflects the frequency with which individuals participate in social events and has motivational components. As such, it is a distinct construct from other constructs such as social integration, which measures the number of social roles an individual has. Additionally, lower levels of social participation and diminished reactivity have been associated with similar adverse health outcomes. Therefore, it is possible that diminished cardiac reactivity is associated with lower levels of social participation. We aimed to examine whether diminished cardiovascular reactivity in response to an acute lab stressor was associated with reported social participation. The analyses were conducted using publicly available data from the Pittsburgh Cold Study 3 (PCS3). The PCS3 was a prospective viral-challenge study, which included participants completing an in-lab social evaluative stressor (N = 202, Age = M = 29.71, SD = 10.66) and measuring cardiovascular responses at baseline and in response to the stressor. Separate regression analyses for each cardiovascular variable (SBP, DBP, MAP, and HR) demonstrated that lower cardiovascular reactivity was associated with less social participation. These associations were still evident following adjustment for respective baseline cardiovascular levels, age, sex, race, depressive symptomology, body mass index, socioeconomic status, smoking status, and levels of social integration (R 2 changes: ≥ 0.017; ps ≤ 0.02) The findings provide initial evidence that blunted cardiac reactivity may be a precursor to low levels of social participation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Felt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer., Method: A mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance., Results: The prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = -0.54, 95%CI: -0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization., Conclusion: Attachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: The objective of the present study was to test the moderating impact of an unknown pain etiology on the relationship between psychological factors and chronic pain intensity and disability., Methods: N = 471 chronic pain sufferers presented to an online Cognitive Behavioral Therapy randomized control trial, known as the Pain Course. Participants' etiology was classified as medically unexplained or medically explained via interview and self-reported data. Standardized psychological measures at baseline were used in a non-hierarchical cluster analysis, which allocated chronic pain participants into mutually exclusive groups., Results: Four distinct clusters were identified: Psychologically healthy, mild psychological distress, high psychological distress, and average. The profile with high psychological distress experienced the greatest pain intensity (mean: 6.44 (SD = 1.66)) and disability (mean: 17.53 (SD: 3.65)). This relationship was not moderated by preceding pain etiology being medically explained or unexplained (χ 2 (3) = 0.45, p = 0.93 and χ 2 (3) = 7.07, p = 0.07 respectively)., Conclusion: These findings indicate that an unknown pain etiology has little role in altering the relationship between psychological factors and pain disability in individuals experiencing chronic pain. This suggests that the psychological association with pain disability and intensity experienced by people with medically unexplained symptoms is similar to people with medically explained symptoms., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: In psoriasis, taking steps to improve emotional health is important to bring lasting benefits to patients' physical health and overall well-being. We aimed to identify factors that relate to anxiety in psoriasis and are potentially modifiable and that thus qualify as targets for future planned interventions for improving mental health. In this study, the importance of coping strategies and self-esteem as potential targets were tested., Methods: A total of 102 patients diagnosed with psoriasis, aged 26-65 years (M = 43.39 years, SD = 10.56) and 98 healthy controls (with an overall age, gender, educational attainment distribution similar to that of the cases) completed the Rosenberg's Self-Esteem Scale, the Coping Inventory for Stressful Situations, and the State-Trait Anxiety Inventory., Results: Patients with psoriasis compared to healthy controls reported significantly higher rates of anxiety and emotion- and avoidance-oriented coping strategies, presented lower rates of task-oriented coping strategies, and significantly lower levels of self-esteem. Importantly, our results revealed that self-esteem in psoriasis patients was strongly related to anxiety. Moreover, the increased rates of anxiety in psoriasis were not significantly associated with the coping strategies, suggesting that in patients with psoriasis coping strategies are secondary to other factors such as self-image and self-esteem., Conclusions: The results identify self-esteem as a target to adopt in further interventions for psoriasis patients. Recommendations for future research and intervention development are discussed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Cognitive-behavioral stress management (CBSM) improves adaptation to primary treatment for breast cancer (BCa), evidenced as reductions in distress and increases in positive affect. Because not all BCa patients may need psychosocial intervention, identifying those most likely to benefit is important. A secondary analysis of a previous randomized trial tested whether baseline level of cancer-specific distress moderated CBSM effects on adaptation over 12 months. We hypothesized that patients experiencing the greatest cancer-specific distress in the weeks after surgery would show the greatest CBSM-related effects on distress and affect., Methods: Stages 0-III BCa patients (N = 240) were enrolled 2-8 weeks after surgery and randomized to either a 10-week group CBSM intervention or a 1-day psychoeducational (PE) control group. They completed the Impact of Event Scale (IES) and Affect Balance Scale (ABS) at study entry, and at 6- and 12- month follow-ups., Results: Latent Growth Curve Modeling across the 12-month interval showed that CBSM interacted with initial cancer-related distress to influence distress and affect. Follow-up analyses showed that those with higher initial distress were significantly improved by CBSM compared to control treatment. No differential improvement in affect or intrusive thoughts occurred among low-distress women., Conclusion: CBSM decreased negative affect and intrusive thoughts and increases positive affect among post-surgical BCa patients presenting with elevated cancer-specific distress after surgery, but did not show similar effects in women with low levels of cancer-specific distress. Identifying patients most in need of intervention in the period after surgery may optimize cost-effective cancer care., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: Adjustment to life with an implantable cardioverter defibrillator (ICD) may be challenging for some patients and their partners, with disease and individual characteristics likely influencing the process. We examined whether perceived social support and clinical patient characteristics are associated with change in couples' symptoms of anxiety and depression in the first year after ICD implantation, and explored whether the associations differ between patients and partners., Method: A cohort of consecutively implanted patients (n = 286; 21% women) and their partners completed questionnaires on social support and symptoms of anxiety and depression prior to ICD implantation and 12 months later. Information on demographic and clinical characteristics were captured from patients' medical records or purpose-designed questions. Data were analyzed using multilevel models accounting for the interdependency of scores within couples with adjustment for possible confounders., Results: Higher ratings of perceived social support prior to ICD implantation were associated with greater reductions in couples' symptoms of anxiety and depression, whereas having received an ICD shock was associated with less improvement. Secondary prevention indication for ICD implantation and symptomatic heart failure were associated with less improvement in anxiety symptoms. These associations applied to both patients' and partners' levels of distress., Conclusion: The patient's heart disease affects both patients' and partners' psychological adjustment in the first year after ICD implantation. Interventions are warranted that address this issue not only in patients but also in partners. Targeting social support as a resource for both could be one avenue to pursue., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To examine differences in blood pressure response and recovery in a sample of bereaved and non-bereaved youths during an acute stress task conducted 5 years after time of parental death., Methods: One-hundred and ninety-two (n = 192) bereaved and non-bereaved offspring (ages 11-29) participated in an adaptation of the Trier Social Stress Task (TSST) 5-years after the time of parental death. Blood pressure measurements were collected before, during, and after the laboratory stress protocol. Mixed models for repeated measures were used to analyze the effects of bereavement status and course of psychiatric disorder in the 5-year period after parental death in both offspring and caregivers on blood pressure response; linear regression was used to examine these associations with blood pressure recovery., Results: Although there were no differences across groups in diastolic (DBP) or systolic blood pressure (SBP) response to stress, bereaved offspring demonstrated less SBP recovery to the TSST as compared to non-bereaved offspring. A significant interaction between bereavement status and race, and a marginally significant interaction between bereavement status and sex indicated poor SBP recovery for parentally bereaved racial/ethnic minority offspring as compared to parentally bereaved Caucasian offspring, and for parentally bereaved males compared to parentally bereaved females., Conclusions: Parentally bereaved youths demonstrate blood pressure response to social stress tasks similar to that of non-bereaved youths, but parentally bereaved ethnic/racial minority youths and parentally bereaved males evidence a less complete recovery from the effects of stress. The health consequences of poor blood pressure recovery in bereaved youths are discussed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To explore the effect of perceived stress and coping behaviors on quality of life and clinical outcomes in patients with ulcerative colitis., Methods: This is a prospective cohort study in a tertiary inflammatory bowel disease center in China. A total of 263 ulcerative colitis patients were enrolled consecutively between June 2013 and February 2015. The Perceived Stress Scale, the Medical Coping Modes Questionnaire, and the Inflammatory Bowel Disease Questionnaire were used to assess perceived stress, medical coping and quality of life at baseline. Patients were followed up for hospitalization due to relapse over a one-year period. Multivariate analyses were performed to identify whether perceived stress and medical coping behavior were related to quality of life and hospitalization., Results: Patients with invalid questionnaires (n = 6) and those lost to follow-up (n = 28) were excluded. A total of 229 ulcerative colitis patients (mean age 40.4 ± 12.6, 50.7% male) were included in the final analysis, and 23 patients had been hospitalized during the one-year follow-up period. After adjusting other associated variables, perceived stress (OR: 1.13; 95% CI: 1.07 to 1.19) and acceptance-resignation behavior (OR: 1.41; 95% CI: 1.21 to 1.65) were independently associated with poor quality of life. Patients scoring highly for acceptance-resignation behavior (OR: 1.23; 95% CI: 1.04 to 1.46) were more likely to be hospitalized during the one-year follow-up period., Conclusion: In patients with ulcerative colitis, identifying those who adopted more acceptance-resignation behavior and improving their medical coping behavior by psychotherapy could be helpful to achieve better quality of life and disease control., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Chronic Kidney Disease (CKD) is known to adversely affect mental health. The study was aimed at estimating the prevalence of depression and psychological distress and the associated factors among CKD patients living in Anuradhapura, a rural district in Sri Lanka., Method: A community-based, cross-sectional study included a representative sample of 1174 CKD patients, drawn proportionately from all registered patients in all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained paramedical staff visited the households and administered the locally validated Centre for Epidemiologic Studies Depression Scale and General Health Questionnaire-12 to screen for depression and psychological distress. Information related to associated factors was obtained through an interviewer-administered questionnaire., Results: A total of 1118 CKD patients participated, with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years. 62.7% of participants were males. The majority of participants was in CKD stage 4 (58.3%). The screening revealed that 75.0% (95% CI 72.5-77.5) of participants were psychologically distressed while 65.2% (95%CI 62.4-68.0) were found to be depressed. Multiple logistic regression analysis revealed advanced age, unemployment and poor health related quality of life contributed significantly to both depression and psychological distress., Conclusion: Depression and psychological distress were significant in this community. Policymakers should consider the likely high prevalence of psychological distress and depression among CKD patients as well as the need for specific mental health services to confirm diagnosis and initiate effective management. Identified associated factors should be used to identify targeted preventative interventions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To systematically review the relationship between acute posttraumatic stress symptoms (<1 month) and subsequent physical and mental health outcomes other than posttraumatic stress disorder (PTSD)., Methods: A systematic search of electronic databases (PubMed, PsycINFO, CINAHL, and Web of Science) was conducted to identify longitudinal studies examining the link between acute posttraumatic stress and physical and mental health. Inclusion criteria required assessment of acute posttraumatic stress (<1 month post-event) and at least one follow-up assessment of a physical or mental health outcome (not PTSD)., Results: 1,051 articles were screened; 22 met inclusion criteria. Fourteen studies examined physical health outcomes and 12 examined non-PTSD mental health outcomes. Early psychological responses to trauma were associated with a variety of short- (<1 year) and long- (≥1 year) term physical and mental health outcomes. Physical health outcomes included poor general physical health, increased pain and disability, lower quality of life, and higher risk of all-cause mortality. Significant psychological outcomes included more cumulative psychiatric disorders, depression, and anxiety. Significant psychosocial outcomes included increased family conflict., Conclusions: Methodologically rigorous longitudinal studies support the utility of measuring acute psychological responses to traumatic events as they may be an important marker of preventable trauma-related morbidity and mortality that warrants long-term monitoring and/or early intervention., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time., Methods: Adolescents in 18 public schools were followed from 7th to 9th grade (N = 1181) and answered self-report questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator., Results: In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys., Conclusion: Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Illness perception is significantly related to several outcome measures in different medical conditions. However, little is known about headache-related causal attributions and cognitive and emotional representations in patients with migraine., Objective: To examine perceived causes of headache and demographic, clinical, and psychological correlates and predictors of illness perception in patients with migraine attending a tertiary care headache centre., Methods: A sample of 143 patients with migraine (85.3% women, mean age 44.0 ± 12.1 years) completed the Brief Illness Perception Questionnaire (Brief IPQ), the Symptom Questionnaire (SQ), and the Migraine Disability Assessment (MIDAS) Questionnaire. A set of demographic and clinical characteristics was also collected., Results: Stress, heredity, and nervousness were the most frequent perceived causes of headache. Female gender was significantly related to higher Brief IPQ "consequences" and "emotional response" scores. Increased psychological distress and a poorer clinical course were significantly associated with more negative illness representations. In multiple regression analysis, a longer illness duration, increased depressive symptoms, and higher levels of headache-related disability and painfulness of headache attacks independently predicted a worse illness perception., Conclusions: In patients with migraine, depressive symptoms and a worse disease status, characterized by a longer history of suffering, higher disability and more painful headache attacks, may negatively affect illness perception. It could also be that dysfunctional illness representations lead to depressive symptoms and decrease patients' motivation to adhere to treatments, resulting in a worse outcome. Future studies should examine whether the improvement of illness perception through specific psychological interventions may promote a better adaptation to migraine., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The relationship between psychological stress and breast cancer risk is unclear. The present study sought to understand how stressfulness appraisal of salient Life Events (LEs) influences breast cancer risk., Methods: A case-control design was used and included 664 female cases identified through the Cancer Surveillance Program of Orange County, CA and 203 female population-based controls. A LE questionnaire determined if events occurred prior to breast cancer diagnosis and if these events were considered to be stressful or not. Multivariate unconditional logistic regression was used to calculate ORs while adjusting for known breast cancer covariates., Results: Cumulative adverse LEs perceived as stressful were associated with increased breast cancer risk in a dose response fashion (OR = 1.63, 95% CI = 1.00-2.66, P trend  = 0.045). Conversely, events perceived as non-stressful did not have a significant impact on breast cancer risk. Previous personal illness was directly related to increased breast cancer risk, whether perceived as stressful (OR = 2.84, 95% CI = 1.96-4.11) or non-stressful (OR = 3.47, 95% CI = 1.34-8.94). Abortion and relocation were observed to have a protective effect on breast cancer risk only when reported as stressful (OR = 0.54, 95% CI = 0.32-0.92; OR = 0.63, 95% CI = 0.43-0.93, respectively). Pre/Peri-menopausal women who were nulliparous or who had their first child at ≥30 years of age were especially prone to the effects of appraised stress on increased breast cancer risk., Conclusions: This study underscores the importance of stressfulness appraisal when determining the effect of major LEs on breast cancer risk. Our results support incorporating assessments of perceived stressfulness in future epidemiological investigation of this topic., (Copyright © 2018. Published by Elsevier Inc.)

Objective: To examine the relationship between psychological distress and risk of developing arthritis, cardiovascular disease, chronic obstructive pulmonary disease and diabetes across the range of distress severity, investigate the mediating roles of health behaviours and explore whether the associations vary with socioeconomic position., Methods: Participants were 16,485 adults from the UK Household Longitudinal Study We examined prospective relationships between psychological distress at baseline (measured using the 12-item General Health Questionnaire) and incidence of arthritis, cardiovascular disease, chronic obstructive pulmonary disease and diabetes (measured using self-report) over 3 years using logistic regression. We then examined the mediating effects of health behaviours and investigated whether the associations varied with socioeconomic position., Results: Distress significantly increased risk of incident arthritis, cardiovascular disease and chronic obstructive pulmonary disease in a dose-response pattern after controlling for age, sex, socioeconomic position, neighbourhood cohesion, marital status, BMI and baseline disease. High levels of distress (GHQ ≥ 7) increased risk of arthritis (OR 2.22; 1.58-2.13), cardiovascular disease (OR 3.06; 1.89-4.98) and chronic obstructive pulmonary disease (OR 3.25; 1.47-7.18). These associations were partially mediated by smoking status but remained significant after controlling for smoking status, diet and exercise. Distress significantly predicted incident diabetes in manual socioeconomic groups only. Effect sizes did not vary with socioeconomic position for arthritis, cardiovascular disease and chronic obstructive pulmonary disease., Conclusion: Psychological distress increases risk of incident arthritis, cardiovascular disease and chronic obstructive pulmonary disease in a dose-response pattern, even at low and moderate distress levels. Future research should investigate the mediating role of inflammatory biomarkers., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to examine the buffering role of time-varying received and provided support in the relationship between stress and end-of-day mood among people living with HIV. In addition, the moderating role of intimate relationships in this buffering effect was verified., Methods: The participants included 115 patients with a confirmed diagnosis of HIV infection. The data were collected using an online diary method. For five consecutive days (from Monday to Friday), participants completed an online time-stamped questionnaire in the evening to assess their end-of day-mood, stress related to a central hassle on any given day and social support that was received and provided., Results: The results of the multilevel analysis showed that daily provided, but not received, support had the following partial buffering effect: the association between negative affect and stress was weaker on days with higher support provision. However, this effect was limited to those participants who were in an intimate relationship; the opposite effect was observed in single participants., Conclusion: These findings suggest that the buffering effect of daily support may be modified by other social resources, such as being in an intimate relationship, and when they are not available, it can even become detrimental., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to assess the mediating role of dissatisfaction with friendships in adulthood in the associations between psychological abuse in childhood, substance abuse distress in childhood, and incident psychiatric problems (IPPs) in adulthood over 13 years of follow-up., Methods: We used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 9502), a representative, longitudinal, prospective cohort study. Poisson regression analysis was used to assess the associations between psychological abuse, substance abuse distress, dissatisfaction with friendships in adulthood, and IPPs in adulthood. Indirect effects and proportion mediated (%) were assessed with the difference-in-coefficients method., Results: Psychological abuse (relative risk [RR] = 1.66, 95% confidence interval [CI]: 1.45-1.89) and substance abuse distress in childhood (RR = 1.38, 95% CI: 1.18-1.62) were associated with an increased risk of dissatisfaction with friendships in adulthood. Dissatisfaction with friendships in adulthood was associated with an increased risk of IPPs in adulthood (RR = 1.71, 95% CI: 1.33-2.20). Moreover, dissatisfaction with friendships in adulthood mediated 9.31% (95% CI: 4.25-14.57) of the association between psychological abuse in childhood and IPPs in adulthood, and 9.17% (95% CI: 4.35-16.33) of the association between substance abuse distress in childhood and IPPs in adulthood., Conclusions: Dissatisfaction with friendships in adulthood mediates a minor proportion of the associations between psychological abuse, substance abuse distress, and IPPs in adulthood. Interventions aimed at decreasing dissatisfaction with friendships may dampen some of the effect of psychological abuse and substance abuse distress in childhood on IPPs in adulthood., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Meta-analyses of trials of psychological treatments for emotional distress in breast cancer (BCa) conclude that efficacious treatments exist. Subsequently, their implementation in routine care is widely promoted by health policy. However, the methodological quality of these trials has not been systematically evaluated. The present review investigates this issue., Method: A systematic search identified randomized controlled trials of psychological treatments for emotional distress in BCa. The Psychotherapy Outcome Study Methodology Rating Form was used to assess the quality of trials. Generic design elements, including representativeness of sample, control of concomitant treatments, reporting clinical significance outcomes, and design elements specific to psychotherapy trials, including manualisation, therapist training, and therapist adherence and competence were evaluated., Results: 91 trials were eligible. Overall, methodological quality was low. Generic design elements were limited in most trials: 15% specified as an inclusion criterion that participants were distressed; 10% controlled for concomitant treatments; and 11% reported the clinical significance of findings. Design elements specific to psychotherapy trials were also implemented poorly: 51% used treatment manuals; 8% used certified trained therapists; and monitoring of adherence and competence occurred in 15% and 4%, respectively., Conclusion: The methodological quality of psychological treatment trials for emotional distress in BCa is improving. However, if relevant health policies are to be adequately empirically informed, trials of greater methodological rigour are essential. Trials should include participants with clinical levels of distress, control for concomitant treatments and report the clinical significance of findings. Trialists must also consider the specific requirements of psychotherapy trials., (Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.)

Objective: Psychosocial stress is associated with substantial morbidity and mortality. Accordingly, there is a growing interest in biomarkers that indicate whether individuals show adaptive (i.e., stress-buffering and health-promoting) or maladaptive (i.e., stress-escalating and health-impairing) stress reactions in social contexts. As heart rate variability (HRV) has been suggested to be a biomarker of adaptive behavior during social encounters, it may be possible that inter-individual differences in HRV are associated with inter-individual differences regarding stress in distinct social domains., Methods: To test this hypothesis, resting state HRV and psychosocial stress was assessed in 83 healthy community-dwelling individuals (age: 18-35years). HRV was derived from heart rate recordings during spontaneous and instructed breathing to assess the robustness of possible associations between inter-individual differences in HRV and inter-individual differences in psychosocial stress. Psychosocial stress was determined with a self-report questionnaire assessing stress in distinct social domains., Results: A series of categorical and dimensional analyses revealed an association between inter-individual differences in HRV and inter-individual differences in psychosocial stress: Individuals with high HRV reported less stress in social life, but not in family life, work life or everyday life, than individuals with low HRV., Conclusions: On basis of these findings, it may be assumed that individuals with high HRV experience less psychosocial stress than individuals with low HRV. Although such an assumption needs to be corroborated by further findings, it seems to be consistent with previous findings showing that individuals with high HRV suffer less from stress and stress-related disorders than individuals with low HRV., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Studies assessing the effects of work stress on health in older adults in the U.S. labor force are scarce. We examined the longitudinal association between work stress as measured by effort-reward imbalance (ERI) and incident diabetes over a 7-year period in U.S. working adults aged 50years and older., Methods: We used longitudinal data from the 2006-2012 waves of the Health and Retirement Study (n=1932). Cox proportional hazard regression was used to examine whether ERI significantly predicted diabetes incidence in older adults who were diabetes-free at baseline., Results: High stress level at work (ERI ratio>1.0) was found in participants who worked 55h or more a week (37.3%), had no insurance coverage (35.9%), and those working in blue collar jobs (34.4%). Participants with high ERI had a significantly higher risk of diabetes (HR=1.33, 95%CI=1.04-1.69) relative to those with low ERI, after adjustment for known predictors of adult-onset diabetes., Conclusion: Effort-reward imbalance was associated with increased risk of diabetes incidence after controlling for other known predictive factors, which suggests an independent non-mediated effect of work stressors. More research is required to better understand the effects of work stress in aging populations and how psychosocial disequilibrium in the work environment may impact susceptibility to chronic conditions, and in particular how change in self-assessed reward might vary toward the end of a working lifetime., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: Multiple sclerosis (MS) is a chronic demyelinating disease that poses significant life challenges. Depression and anxiety often occur in people with MS (PwMS). An information processing model of psychopathology, the Self-Regulatory Executive Function (S-REF) model specifies that maladaptive metacognitive beliefs play a fundamental role in the development and maintenance of distress. The model also asserts that a style of thinking known as the cognitive attentional syndrome (CAS), which consists of worry and rumination, focusing on sources of threat, and unhelpful coping responses, is common across all psychological conditions. This study investigated for the first time whether metacognitive beliefs explained additional variance in distress in PwMS, after accounting for demographic, clinical, and illness appraisal variables., Method: One hundred and thirty-two participants with MS completed self-report questionnaires measuring distress, fatigue, pain, metacognitive beliefs, illness appraisals, and the CAS. Hierarchical regression modelling was used to test whether metacognitive beliefs accounted for distress. Mediational modelling examined if the CAS mediated the association between metacognitive beliefs and distress., Results: Metacognitive beliefs made a unique contribution to distress, over and above demographic and clinical variables, and illness appraisals. The CAS fully mediated the relationship between positive metacognitive beliefs and distress, and partially mediated the relationship between negative metacognitive beliefs and distress., Conclusions: Metacognitive beliefs are associated with emotional distress in PwMS, and the CAS mediates this relationship. Future studies should examine if modification of metacognitive beliefs and processes in PwMS will lead to effective alleviation of emotional distress., (Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)

Objective: Caregiving stress is associated with increased risk of cardiovascular disease (CVD). Inability to adequately regulate blood pressure is a possible underlying mechanism explaining this risk. We examined the relationship between length of caregiving and cardiovagal baroreflex sensitivity (cBRS) to better understand the link between caregiving and CVD risk., Methods: A total of 146 elderly individuals (≥55years) participated in this study, of whom 96 were providing in-home care to a spouse with dementia and 50 were healthy controls married to a non-demented spouse (i.e., non-caregivers). Among the caregivers, 56 were short-term caregivers (caring<4years) and 40 were long-term caregivers (caring≥4years). A multiple linear regression model, with contrast codes comparing short and long-term caregivers with non-caregivers was used to understand relationships between chronic caregiving and cBRS., Results: After controlling for relevant demographic and health characteristics, mean±SE log transformed cBRS for non-caregivers was 0.971±0.029. Relative to non-caregivers, the long-term caregivers had significantly impaired cBRS (0.860±0.033; p=0.013). However, mean cBRS for short-term caregivers did not significant differ from non-caregivers (0.911±0.028; p=0.144)., Conclusion: These results suggest that long-term caregiving stress is associated with an impaired cBRS. Accumulation of stress from years of caregiving could result in worse cBRS function, which could be a mechanistic explanation for the correlation between caregiving stress and the increased risk of CVD., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: Allostatic Load (AL) represents the strain on the body produced by repeated physiologic or allostatic responses activated during stressful situations. Several cross-sectional studies have found empirical substantiation for the relationship between impaired psychosocial work environment and high AL. The aim of this longitudinal study is to investigate changes in AL during workplace reorganization that has been shown to cause impaired psychosocial work environment. Moreover, we aim to investigate the association between changes in AL and changes in psychosocial work environment (job strain, effort-reward imbalance) and psychological distress (stress symptoms and perceived stress)., Methods: A major reorganization of non-state public offices was effectuated in Denmark on 1 January 2007. In 2006 and 2008, we collected clinical and questionnaire data from 359 participants, 265 women and 94 men, employed in seven municipality or county administrations. Four municipalities and one county merged with others, while one municipality and one county remained unmerged. We calculated the AL score based on 13 physiological markers reflecting stress responses of the cardiovascular, metabolic, neuroendocrine and immune systems. We analysed changes in AL from 2006 to 2008., Results: AL increased significantly during workplace reorganization in the whole study group but we observed only a tendency of significant increase in AL in the merger group compared with the control group. Moreover, we observed no association between the changes in AL and changes in psychosocial work environment and psychological distress., Conclusions: This result leaves the conclusion unclear but contributes to the limited research in this area with a longitudinal design and focus on low-risk levels and small changes in AL in healthy people as predictor of future disease., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: This randomized controlled trial aimed at evaluating the efficacy of an internet-based cognitive behavioral stress management program (IB-CBSM) for pregnant women with preterm labor (PTL) on birth outcome and stress-related psychological and biological parameters., Methods: 93 pregnant women with PTL (gestational age 18-32) were assigned to either the IB-CBSM (n=50) or a control group (CG) based on distraction (n=43). Participants in both groups worked through six weekly modules. Birth outcome measures included gestational age, neonatal weight and length at birth and the rate of preterm birth (PTB). Questionnaires assessed psychological wellbeing and the activity of the HPA-axis was measured with the cortisol awakening reaction (CAR), both before (T1) and after the intervention (T2)., Results: Birth outcome and psychological wellbeing did not differ between IB-CBSM and CG. However, psychological wellbeing was higher after both interventions (PSS: η p 2 =0.455, STAIX1: η p 2 =0.455, STAIX2: η p 2 =0.936, PRAT: η p 2 =0.465, EPDS: η p 2 =0.856). Cortisol levels were stable and did not alter differently between groups from T1 to T2. Higher cortisol levels were associated with lower gestational age at birth, whereas no significant correlations were found between weight and length at birth., Conclusions: Although there were no significant differences between the two groups and birth outcome, psychological and biological parameters, both interventions (CBSM and CG) showed equivalent effects and proved to be beneficial with regard to psychosocial distress and well-being. Further research is needed to investigate CBSM and distraction interventions for pregnant women at risk for PTB together with a non-intervention control condition., (Copyright © 2017 Elsevier Inc. All rights reserved.)