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Objective: Medically unexplained fatigue is a burdensome, widespread symptom, and a frequent complaint in depressive disorders (DDs) as well as somatic symptom disorder (SSD). Heightened stress levels are a likely cause of fatigue, although the temporal associations, as well as the role of the stress-reactive hypothalamic-pituitary-adrenal (HPA) axis, are not yet completely understood. We were interested in the differences between DD and SSD regarding general, mental, and physical fatigue, as well as associations between psychobiological stress measures (representing different time frames) and fatigue in these groups., Methods: Fifty-eight women (29 with DD, 29 with SSD) reported subjective recent fatigue and chronic stress levels, as well as levels of depression and somatic complaints using baseline questionnaires. Furthermore, they completed an ambulatory assessment period comprising measurements of fatigue, subjective stress, and salivary cortisol five times a day for 14 consecutive days. Salivary cortisol was obtained as a measure of within-day HPA axis activity, and hair cortisol concentration was obtained as a measure of accumulated HPA axis activity of the preceding three months., Results: Women with DD reported higher levels of general and mental fatigue than did women with SSD, which was explained by their higher level of depression. Physical fatigue levels did not differ between groups. In both groups, momentary general, mental, and physical fatigue levels were associated with momentary subjective stress but not with chronic stress. Momentary salivary cortisol levels were positively associated with mental fatigue, while hair cortisol concentration was not., Conclusions: There are differences in fatigue profiles between DD and SSD, which should be accounted for in future research and practice (e.g., individualized treatment strategies focusing on mental or physical fatigue, depending on which fatigue dimension is prominent)., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The individual set point of the hypothalamic-pituitary-thyroid (HPT) axis is largely genetically determined. Apart from this genetic predisposition, the HPT axis may also be malleable to environmental demands such as psychosocial stress. Indeed, previous research has indicated that critical life events often precede the onset of autoimmune thyroid diseases, and subtle abnormalities in HPT functioning are present in some patients with stress-related disorders such as depression. However, no studies have investigated whether exposure to psychosocial stress leads to an immediate activation of the HPT axis., Methods: A total of N = 30 healthy women attended two laboratory appointments in a randomized order. An intravenous catheter was inserted at the beginning of each appointment. In the stress session, this was followed by the Trier Social Stress Test (TSST). Plasma samples to determine thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were taken at baseline and 20, 50, and 110 min after the TSST started. In the control session, participants rested and were instructed to read magazines, while the sampling schedule was maintained., Results: There was a significant rise in TSH concentrations in response to the TSST, with a peak observed 20 min after stressor onset, and a steady decline thereafter. No such response was observed in the control session. The TSST did not increase T3 or T4., Conclusion: The finding that acute psychosocial stress is able to elicit a significant increase in TSH is relevant to our understanding of a number of stress-related illnesses presenting with abnormalities of the HPT axis., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Although sleep is linked to physiological stress systems like the autonomic nervous system (ANS), research is still limited regarding night-and-day interactions between nocturnal sleep characteristics, stress, and diurnal parameters of salivary alpha-amylase (sAA) as a surrogate marker of ANS activity. Fifty healthy university students rated their chronic stress burden and completed two five-day periods of ecological momentary assessment - under everyday conditions of both low stress (beginning of semester) and high stress (final examination preparation). Participants collected saliva six times daily and reported on the previous night's sleep (quality, latency, duration, disturbances) immediately after awakening. Additionally, a sub-sample wore actigraphs recording 'time in bed'. In contrast to previous assumptions, poor sleep predicted lower sAA awakening values, more decreased awakening responses, and steeper diurnal slopes the following day only under high stress, but not under low stress. Diurnal sAA parameters did not predict the following night's sleep characteristics. The sAA profile does not seem to be sensitive to everyday occurring sleep variations, but rather seems to be an indicator of more prolonged stress induced ANS dysregulation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: There is limited knowledge about how fatigue develops and worsens and what influences fluctuations in daily fatigue. Stress was found to influence fatigue, and being in a relationship seems to either increase or decrease stress depending on the couple interaction. In this study, co-variation of fatigue, self-reported stress, and biological stress markers in couples' everyday lives was investigated. Specifically, we examined a) whether momentary couple interactions moderated dyadic outcomes and b) whether and how stress and relationship measures influenced individual momentary fatigue., Methods: Forty heterosexual couples (age: 28 ± 5 years) reported subjective fatigue and stress levels 4 times a day for 5 consecutive days (1600 measures). Furthermore, participants reported whether they had interacted with their partner since the last data entry and, if so, they rated the valence of this interaction. Salivary cortisol (a measure of HPA axis activity) and alpha amylase (a measure of ANS activity) were analyzed as biological stress markers from saliva samples obtained at the same time points. Moment-to-moment data were analyzed using dyadic multilevel models to account for the nested design., Results: Stress (women and men: p ≤ 0.001) and fatigue (women: p = .003, men: p = .020) showed patterns of co-variation within couples, especially if partners had interacted with each other since the previous data entry. Cortisol was also found to co-vary between partners (women: unstandardized coefficient (UC) = 0.12, p ≤ .001, men: UC = 0.18, p ≤ .001), whereas the regulation of alpha-amylase levels depending on the partner's levels was only present in women (UC = 0.11, p = .002). Valence of couple interaction was negatively associated with fatigue (women: UC = -0.13, p ≤ .001, men: UC = -0.06, p = .011). There was no momentary association of fatigue with an individual's own or the partner's subjective or biological stress markers., Conclusions: Fatigue and stress levels during the day seem to co-vary within couples. These associations were particularly strong when the partners had interacted with each other since the last measurement. These data underline the importance of social factors in fatigue and stress in everyday life., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: Fatigue is a defining characteristic and one of the most debilitating features of fibromyalgia syndrome (FMS). The mechanisms underlying different dimensions of fatigue in FMS remain unclear. The aim of the current study was to test whether stress-related biological processes and physical activity modulate fatigue experience., Methods: Using an ambulatory assessment design, 26 female FMS patients reported general, mental, and physical fatigue levels at six time points per day for 14 consecutive days. Salivary cortisol and alpha-amylase were analyzed as markers of neuroendocrine functioning. Participants wore wrist actigraphs for the assessment of physical activity., Results: Lower increases in cortisol after awakening predicted higher mean daily general and physical fatigue levels. Additionally, mean daily physical activity positively predicted next-day mean general fatigue. Levels of physical fatigue at a specific time point were positively associated with momentary cortisol levels. The increase in cortisol after awakening did not mediate the physical activity - fatigue relationship. There were no associations between alpha-amylase and fatigue., Conclusion: Our findings imply that both changes in hypothalamic-pituitary-adrenal axis activity and physical activity contribute to variance in fatigue in the daily lives of patients with FMS. This study helps to paint a clearer picture of the biological and behavioral underpinnings of fatigue in FMS and highlight the necessity of interdisciplinary treatment approaches targeting biological, behavioral and psychological aspects of FMS., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Although fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain is known to fluctuate over the day. Stress has often been claimed to exacerbate pain; however, there is barely any evidence on whether or not this is true on a day-to-day basis (and, alternatively, on whether pain leads to increased stress levels). Using an ecologically valid measurement design, we tested whether and how stress and pain are intertwined in participants with FMS. We additionally examined the role of the two major stress-responsive systems, the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as potential mediators of this relationship., Methods: An ambulatory assessment study was conducted over the course of 14 days. On each day, 32 females with FMS provided six diary entries on momentary stress and pain levels. Saliva samples were collected at the same time points to determine cortisol and alpha-amylase as indicators of stress-responsive systems., Results: Higher stress at a given measurement time point was associated with higher reported pain levels at the subsequent time point (UC=1.47, p<0.001), but not vice versa (UC<0.01, p=0.179). The stress-pain relationship was neither mediated by momentary cortisol nor by alpha-amylase; however, momentary cortisol was independently associated with momentary pain (UC=0.27, p=0.009)., Conclusion: Stress seems to be a powerful exacerbating factor for pain as experienced by patients with FMS in their everyday lives. Cortisol may be involved in the diurnal fluctuation of pain levels in patients with FMS. Future studies should identify relevant daily stressors in persons with FMS and scrutinize the mechanisms underlying the cortisol-pain relationship., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The relation between music listening and stress is inconsistently reported across studies, with the major part of studies being set in experimental settings. Furthermore, the psychobiological mechanisms for a potential stress-reducing effect remain unclear. We examined the potential stress-reducing effect of music listening in everyday life using both subjective and objective indicators of stress. Fifty-five healthy university students were examined in an ambulatory assessment study, both during a regular term week (five days) and during an examination week (five days). Participants rated their current music-listening behavior and perceived stress levels four times per day, and a sub-sample (n = 25) additionally provided saliva samples for the later analysis of cortisol and alpha-amylase on two consecutive days during both weeks. Results revealed that mere music listening was effective in reducing subjective stress levels (p = 0.010). The most profound effects were found when 'relaxation' was stated as the reason for music listening, with subsequent decreases in subjective stress levels (p ≤ 0.001) and lower cortisol concentrations (p ≤ 0.001). Alpha-amylase varied as a function of the arousal of the selected music, with energizing music increasing and relaxing music decreasing alpha-amylase activity (p = 0.025). These findings suggest that music listening can be considered a means of stress reduction in daily life, especially if it is listened to for the reason of relaxation. Furthermore, these results shed light on the physiological mechanisms underlying the stress-reducing effect of music, with music listening differentially affecting the physiological stress systems., (Copyright © 2015 Elsevier Ltd. All rights reserved.)