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A growing body of research has highlighted the adverse impact of COVID-19 stressors on health and social care workers' (HSCWs) mental health. Complementing this work, we report on the psychosocial factors that have had both a positive and negative impact on the mental well-being of HSCWs during the third lockdown period in Scotland. Using a cross-sectional design, participants (n = 1364) completed an online survey providing quantitative data and free open-text responses. A multi-method approach to analysis was used. The majority of HSCWs were found to have low well-being scores, high levels of COVID-19 stress, worry, burnout and risk perception scores and almost half of HSCWs met the clinical cut-off for acute stress (indicative of PTSD). HSCWs with higher scores on adaptive coping strategies and team resilience reported higher scores on mental well-being. HSCWs were significantly more likely to seek informal support for dealing with personal or emotional problems compared to formal supports. Barriers to formal help-seeking were identified including stigma and fear of the consequences of disclosure. HSCWs mostly valued peer support, workplace supports, visible leadership and teamwork in maintaining their mental well-being. Our findings illuminate the complexity of the effects of the COVID-19 pandemic on HSCWs' well-being and will inform future intervention development seeking to increase positive adaptation and improve staff well-being. Addressing barriers to mental health help-seeking among HSCWs is essential. The implications emphasise the importance of lessons learned across health and social care contexts, planning and preparedness for future pandemics.

Maltreatment adversely impacts the development of children across a host of domains. One way in which maltreatment may exert its deleterious effects is by becoming embedded in the activity of neurophysiological systems that regulate metabolic function. This paper reviews the literature regarding the association between childhood maltreatment and the activity of three systems: the parasympathetic nervous system, the sympathetic nervous system, and the hypothalamic–pituitary–adrenal axis. A particular emphasis is placed on the extent to which the literature supports a common account of activity across these systems under conditions of homeostasis and stress. The paper concludes with an outline of directions for future research and the implications of the literature for policy and practice.

Caregiver voices may provide cues to mobilize or calm infants. This study examined whether maternal prosody predicted changes in infants' biobehavioral state after the still face, a stressor in which the mother withdraws and reinstates social engagement. Ninety-four dyads participated in the study (infant age 4-8 months). Infants' heart rate and respiratory sinus arrhythmia (measuring cardiac vagal tone) were derived from an electrocardiogram (ECG). Infants' behavioral distress was measured by negative vocalizations, facial expressions, and gaze aversion. Mothers' vocalizations were measured via a composite of spectral analysis and spectro-temporal modulation using a two-dimensional fast Fourier transformation of the audio spectrogram. High values on the maternal prosody composite were associated with decreases in infants' heart rate (β = -.26, 95% CI: [-0.46, -0.05]) and behavioral distress (β = -.23, 95% CI: [-0.42, -0.03]), and increases in cardiac vagal tone in infants whose vagal tone was low during the stressor (1 SD below mean β = .39, 95% CI: [0.06, 0.73]). High infant heart rate predicted increases in the maternal prosody composite (β = .18, 95% CI: [0.03, 0.33]). These results suggest specific vocal acoustic features of speech that are relevant for regulating infants' biobehavioral state and demonstrate mother-infant bi-directional dynamics.

Background Joint hypermobility (JH) is associated with autonomic nervous system dysregulation and functional abdominal pain disorders (FAPDs). Understanding the neurophysiological processes linking these conditions can inform clinical interventions. Autonomic activity regulates gastrointestinal (GI) sensorimotor function and may be a key mechanism. The aims of this study were to examine the relation of JH with dynamic autonomic activity and parasympathetic regulation in adolescents with FAPDs and identify optimal JH cutoff scores that best index autonomic regulation in FAPDs. Methods A total of 92 adolescents with FAPDs and 27 healthy controls (age 8-18 years; 80% female) were prospectively enrolled. JH was assessed by Beighton scores. ECG recordings were conducted during supine, sitting, and standing posture challenges. ECG-derived variables-heart period (HP), respiratory sinus arrhythmia (RSA), and vagal efficiency (VE)-were analyzed using linear regression and mixed effects modeling. Key results Beighton scores of ≥4 optimally distinguished autonomic function. Adolescents with FAPD and JH had reduced VE compared to adolescents with FAPDs without JH (B = 18.88, SE = 6.25, p = 0.003) and healthy controls (B = 17.56, SE = 8.63, p = 0.044). These subjects also had lower and less dynamic RSA and HP values during posture shifts, with strongest differences in supine position and using the VE metric. Conclusions & inferences Suboptimal autonomic regulation indexed by reduced vagal efficiency may be a mechanism of symptoms in hypermobile FAPD patients with Beighton score ≥ 4. Autonomic disturbance may serve as potential intervention target for patients with JH and functional GI disorders.

Body awareness disorders and reactivity are mentioned across a range of clinical problems. Constitutional differences in the control of the bodily state are thought to generate a vulnerability to psychological symptoms. Autonomic nervous system dysfunctions have been associated with anxiety, depression, and post-traumatic stress. Though interoception may be a transdiagnostic mechanism promoting the improvement of clinical symptomatology, few psychometrically sound, symptom-independent, self-report measures, informed by brain–body circuits, are available for research and clinical use. We validated the Italian version of the body perception questionnaire (BPQ)—short form and found that response categories could be collapsed from five to three and that the questionnaire retained a three-factor structure with items reduced from 46 to 22 (BPQ-22). The first factor was loaded by body awareness items, the second factor comprised some items from the body awareness scale and some from the subdiaphragmatic reactivity scale (but all related to bloating and digestive issues), and the third factor by supradiaphragmatic reactivity items. The BPQ-22 had sound psychometric properties, good convergent and discriminant validity and test–retest reliability and could be used in clinical and research settings in which the body perception assessment is of interest. Psychometric findings in light of the polyvagal theory are discussed.

Introduction To determine whether pretreatment vagal efficiency (VE), respiratory sinus arrhythmia, and heart period can predict pain improvement with auricular neurostimulation in pediatric functional abdominal pain disorders. Methods A total of 92 adolescents with functional abdominal pain disorders underwent a 4-week randomized, double-blinded, sham-controlled auricular neurostimulation trial. Electrocardiogram-derived variables at baseline were used to predict pain using mixed effects modeling. Results A 3-way interaction (95% confidence intervals: 0.004-0.494) showed that the treatment group subjects with low baseline VE had lower pain scores at week 3. There was no substantial change in the placebo or high VE treatment group subjects. This effect was supported by a significant correlation between baseline VE and degree of pain reduction only in the treatment group. Discussion Impaired cardiac vagal regulation measured by VE predicts pain improvement with auricular neurostimulation.

BackgroundMaturation of multiple neurobehavioral systems, including autonomic regulation, is altered by preterm birth. The purpose of this study was to determine the long-term effects of Family Nurture Intervention (FNI) in the NICU on autonomic regulation of preterm infants and their mothers.MethodA subset of infants and mothers (48% of infants, 51% of mothers) randomly assigned to either standard are (SC), or SC plus the FNI in the NICU in a prior RCT (ClincalTrials.gov; NCT01439269) returned for follow-up assessments when the children were 4 to 5 years corrected age (CA). ECGs were collected for 10 minutes in mothers and their children while children were in their mothers' laps. Heart rate, standard deviation for heart rate, respiratory sinus arrhythmia (RSA)-an index of parasympathetic regulation, and a measure of vagal efficiency were quantified.ResultsBoth children and mothers in the FNI group had significantly greater levels of RSA compared to the SC group (child: mean difference = 0.60, 95% CI 0.17 to 1.03, p = 0.008; mother: mean difference = 0.64, 95% CI 0.07 to 1.21, p = 0.031). In addition, RSA increased more rapidly in FNI children between infancy and the 4 to 5-year follow-up time point (SC = +3.11±0.16 loge msec2, +3.67±0.19 loge msec2 for FNI, pConclusionAlthough these preliminary follow-up results are based on approximately half of subjects originally enrolled in the RCT, they suggest that FNI-NICU led to healthier autonomic regulation in both mother and child, when measured during a brief face-to-face socioemotional interaction. A Pavlovian autonomic co-conditioning mechanism may underly these findings that can be exploited therapeutically.

Individuals with fragile X syndrome (FXS), especially those co-diagnosed with autism spectrum disorder (ASD), face many sensory processing challenges. However, sensory processing measures informed by neurophysiology are lacking. This paper describes the development and psychometric properties of a parent/caregiver report, the Brain-Body Center Sensory Scales (BBCSS), based on Polyvagal Theory. Parents/guardians reported on 333 individuals with FXS, 41% with ASD features. Factor structure using a split-sample exploratory-confirmatory design conformed to neurophysiological predictions. Internal consistency, test-retest, and inter-rater reliability were good to excellent. BBCSS subscales converged with the Sensory Profile and Sensory Experiences Questionnaire. However, data also suggest that BBCSS subscales reflect unique features related to sensory processing. Individuals with FXS and ASD features displayed more sensory challenges on most subscales.

OBJECTIVE A growing body of literature documents sexual problems following maltreatment and traumatic experience, but the mechanisms of these effects are poorly understood. The autonomic nervous system coordinates typical and threat-reactive functions throughout the body, including those of reproductive organs. We examined whether relations between adult sexual function problems and childhood maltreatment history could be mediated by an autonomic nervous system retuning with a bias toward maintaining a physiological state that supports defensive strategies. METHOD Self-reported data on childhood physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, autonomic reactivity, and adult sexual function were collected from an online sample of U.S. residents 18 years and older (189 males and 333 females). Mediation was tested using indirect effects in structural equation modeling with age as a covariate. RESULTS Mediation via subjective reports of autonomic reactivity was supported in males and females (standardized indirect effect in males = -.35 [95% CI: -.53, -.20]; females = -.09 [95% CI: -.17, -.03]). The direct effect of childhood maltreatment was not significant with the addition of the mediator, supporting full mediation. Follow-up analyses indicated that the mediation effect remained even after those with sexual abuse were excluded from the male model (standardized indirect effect = -.30 [95% CI: -.61, -.10]) but not the female model. CONCLUSIONS A chronic autonomic state that supports biobehavioral defense following abuse and trauma may contribute to adult sexual function problems, particularly in males and may point toward new treatment opportunities that target the autonomic nervous system. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A range of psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder frequently co-occur with functional gastrointestinal (GI) disorders. Risk of these pathologies is particularly high in those with a history of trauma, abuse, and chronic stress. These scientific findings and rising awareness within the healthcare profession give rise to a need for an integrative framework to understand the developmental mechanisms that give rise to these observations. In this paper, we introduce a plausible explanatory framework, based on the Polyvagal Theory (Porges, Psychophysiology, 32, 301-318, 1995; Porges, International Journal of Psychophysiology, 42, 123-146, 2001; Porges, Biological Psychology, 74, 116-143, 2007), which describes how evolution impacted the structure and function of the autonomic nervous system (ANS). The Polyvagal Theory provides organizing principles for understanding the development of adaptive diversity in homeostatic, threat-response, and psychosocial functions that contribute to pathology. Using these principles, we outline possible mechanisms that promote and maintain socioemotional and GI dysfunction and review their implications for therapeutic targets.

Preterm infants have maturational delays in several neurobehavioral systems. This study assesses the impact of the Family Nurture Intervention (FNI) in the neonatal intensive care unit (NICU) on the maturation of autonomic regulation of preterm infants. Preterm infants born at 26-34 weeks postmenstrual age (PMA) were assigned to groups receiving either standard care (SC) or SC plus FNI, using a randomized controlled trial design. At two collection time points, approximately 35 weeks and 41 weeks PMA, electrocardiograms (ECG) were monitored for approximately 1 hour during sleep. Heart rate and respiratory sinus arrhythmia (RSA) were quantified from the ECG. Across the two time points, the FNI group exhibited greater increases in RSA (Cohen's d = 0.35) and slope between RSA and heart rate, as a measure of vagal efficiency (Cohen's d = 0.62). These results document that FNI resulted in enhanced autonomic regulation consistent with greater maturation of cardiac function. These and previous findings strongly suggest that facilitating early nurturing interactions and emotional connection between preterm infants and their mothers is a practicable and effective means of optimizing postnatal development in preterm infants. Interpretation of these autonomic function results also enriches our understanding of the potential long-term beneficial outcomes of FNI by drawing upon polyvagal theory, which explains how autonomic state provides a neurophysiological platform for optimal co-regulation between infant and caregiver, and by drawing upon calming cycle theory, which provides a model for understanding how repeated mother/infant calming interactions positively condition autonomic state and reinforce approach, prosocial behaviors.

Objective Poor behavioral self-regulation in the first 2 decades of life has been identified as an important precursor of disease risk in adulthood. However, physiological regulation has not been well studied as a disease risk factor before adulthood. We tested whether physiological regulation at the age of 2 years, in the form of vagal regulation of cardiac function (indexed by respiratory sinus arrhythmia [RSA] change), would predict three indicators of cardiovascular risk at the age of 16 years (diastolic and systolic blood pressure and body mass index). Methods Data came from 229 children who participated in a community-based longitudinal study. At the age of 2 years, children were assessed for RSA baseline and RSA change (ln(ms)) in response to a series of challenge tasks. These same children were assessed again at the age of 16 years for diastolic and systolic blood pressure (millimeters of mercury), height (meters), and weight (kilogram). Results Regression analyses revealed that less RSA withdrawal at the age of 2 years predicted higher diastolic blood pressure at the age of 16 years, adjusting for demographic characteristics (B = -3.07, M [S E] = 1.12, p = .006). Follow-up analyses demonstrated that these predictions extended to clinically significant levels of diastolic prehypertension (odds ratio = 0.43, 95% confidence interval = 0.22-0.89). RSA withdrawal did not significantly predict adolescent body mass index or systolic blood pressure. Conclusions Vagal regulation of cardiac function in early childhood predicts select indicators of cardiovascular risk 14 years later. Early signs of attenuated vagal regulation could indicate an increased risk for elevated blood pressure before adulthood. Future research should test biological, behavioral, and psychological mechanisms underlying these long-term predictions.

Background Physical inactivity is a leading cause of mortality worldwide. Many patterns of physical activity involvement are established early in life. To date, the role of easily identifiable early-life individual predictors of PA, such as childhood temperament, remains relatively unexplored. Here, we tested whether childhood temperamental activity level, high intensity pleasure, low intensity pleasure, and surgency predicted engagement in physical activity (PA) patterns 11 years later in adolescence. Methods Data came from a longitudinal community study (N = 206 participants, 53% females, 70% Caucasian). Parents reported their children’s temperamental characteristics using the Child Behavior Questionnaire (CBQ) when children were 4 & 5 years old. Approximately 11 years later, adolescents completed self-reports of PA using the Godin Leisure Time Exercise Questionnaire and the Youth Risk Behavior Survey. Ordered logistic regression, ordinary least squares linear regression, and Zero-inflated Poisson regression models were used to predict adolescent PA from childhood temperament. Race, socioeconomic status, and adolescent body mass index were used as covariates. Results Males with greater childhood temperamental activity level engaged in greater adolescent PA volume (B = .42, SE = .13) and a 1 SD difference in childhood temperamental activity level predicted 29.7% more strenuous adolescent PA per week. Males’ high intensity pleasure predicted higher adolescent PA volume (B = .28, SE = .12). Males’ surgency positively predicted more frequent PA activity (B = .47, SE = .23, OR = 1.61, 95% CI: 1.02, 2.54) and PA volume (B = .31, SE = .12). No predictions from females’ childhood temperament to later PA engagement were identified. Conclusions Childhood temperament may influence the formation of later PA habits, particularly in males. Boys with high temperamental activity level, high intensity pleasure, and surgency may directly seek out pastimes that involve PA. Indirectly, temperament may also influence caregivers’ perceptions of optimal activity choices for children. Understanding how temperament influences the development of PA patterns has the potential to inform efforts aimed at promoting long-term PA engagement and physical health.

This study examined individual differences in the function of the hypothalamic-pituitary-adrenal (HPA) axis with regard to age and cumulative risk during challenging laboratory tasks administered at 6, 12, 24, and 36 months. Saliva samples were collected from a majority-minority sample of N=185 children (57% African American, 50% female) prior to and following these tasks and later assayed for cortisol. Cumulative distal risk was indexed via a composite of maternal marital status, maternal education, income-to-needs ratio, the number of children in the household, and maternal age at childbirth. Probing of hierarchical models in which cortisol levels and age were nested within child revealed significant differences in cortisol as a function of both age and cumulative risk, such that children exposed to high levels of risk exhibited higher levels of cortisol both within and across age. These results highlight the sensitivity of the HPA axis to environmental context at the level of the individual, even as that sensitivity is manifest against the background of species-typical biological development.

Evidence has accrued to show that autonomic and adrenocortical systems act in coordination to facilitate responses to environmental opportunities and threats. In the current study, we used cluster analysis to examine whether individual differences in patterns of joint baseline activity among the parasympathetic and sympathetic branches of the autonomic nervous system with the hypothalamic-pituitary-adrenal axis are associated with parent-reported temperamental positive and negative affectivity in 36-month old children. The resulting clusters corresponded to the sensitive, buffered, and vigilant patterns as predicted by the adaptive calibration model of stress responsivity (Del Giudice et al., 2011) and included a novel pattern. Cluster memberships predicted differences in overall negative affectivity and its subscales, but no associations were found with positive affectivity. These results provide evidence that the joint activity of physiological systems at rest may underlie temperamental differences in negative affect.

Body awareness and reactivity dysfunction are characteristic of a range of psychiatric disorders. Although the neural pathways communicating between the body and brain that contribute to these experiences involve the autonomic nervous system, few research tools for studying subjective bodily experiences have been informed by these neural circuits. This paper describes the factor structure, reliability, and convergent validity of the Body Awareness and Autonomic Reactivity subscales of the Body Perception Questionnaire‐Short Form (BPQ‐SF). Exploratory and confirmatory factor analyses were applied to data from three samples collected via the internet in Spain and the US and a college population in the US (combined n = 1320). Body awareness was described by a single factor. Autonomic reactivity reflected unique factors for organs above and below the diaphragm. Subscales showed strong reliability; converged with validation measures; and differed by age, sex, medication use, and self‐reported psychiatric disorder. Post hoc analyses were used to create the 12‐item Body Awareness Very Short Form. Results are discussed in relation to the distinct functions of supra‐ and sub‐diaphragmatic autonomic pathways as proposed by the Polyvagal Theory and their potential dysfunction in psychiatric disorders.