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Patients forget 20-80% of information provided during medical consultations. The emotional stress often experienced by patients during consultations could be one of the mechanisms that lead to limited recall. The current experimental study therefore investigated the associations between (analog) patients' psychophysiological arousal, self-reported emotional stress and their (long term) memory of information provided by the physician. One hundred and eighty one cancer-naïve individuals acted as so-called analog patients (APs), i.e. they were instructed to watch a scripted video-recoding of an oncological bad news consultation while imagining themselves being in the patient's situation. Electrodermal and cardiovascular activity (e.g. skin conductance level and heart rate) were recorded during watching. Self-reported emotional stress was assessed before and after watching, using the STAI-State and seven Visual Analog Scales. Memory, both free recall and recognition, was assessed after 24-28 h. Watching the consultation evoked significant psychophysiological and self-reported stress responses. However, investigating the associations between 24 psychophysiological arousal measures, eight self-reported stress measures and free recall and recognition of information resulted in one significant, small (partial) correlation (r = 0.19). Considering multiple testing, this significant result was probably due to chance. Alternative analytical methods yielded identical results, strengthening our conclusion that no evidence was found for relationships between variables of interest. These null-findings are highly relevant, as they may be considered to refute the long-standing, but yet untested assumption that a relationship between stress and memory exists within this context. Moreover, these findings suggest that lowering patients' stress levels during the consultation would probably not be sufficient to raise memory of information to an optimal level. Alternative explanations for these findings are discussed.

Introduction: Experimental animal studies provided evidence for a synergistic effect of immunological and psychological stressors on subsequent sickness behaviours. Up to now, little corroborating evidence for such synergy exists for humans, in whom it may provide a mechanism leading to the expression of functional somatic symptoms. The aim of the present study was to determine an interaction between stress(-vulnerability) and an immunological activation on experimental pain sensitivity, i.e., pressure pain threshold and tolerance in healthy humans., Methods: In healthy female participants (n=25, mean age 22.3 years), negative affectivity (NA) and experienced stress were assessed by questionnaire before receiving a Salmonella typhi vaccine or saline control in a randomized blinded cross-over design. Pressure pain threshold was assessed at the lower back and calves and pain tolerance was assessed at the thumbnail, before and six hours after each injection., Results: Vaccination induced leukocytosis (+100%) and increased serum IL-6 (+670%). NA predicted decreased pain tolerance after vaccination (β=-.57, p=.007), but not after placebo (β=.25, p=.26). Post-hoc analyses also demonstrated an association with administration order., Discussion: NA moderated the effects of inflammation on pain tolerance. This finding is consistent with a synergistic model whereby inflammation may lower the threshold for pain reporting in individuals with increased vulnerability for somatic symptom reporting., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Somatoform disorders (SDs) are characterized by chronic multiple functional somatic (FS) symptoms. It has been suggested that infections may be triggers for FS symptoms to occur, pointing to the immune system as a pathogenic factor in their development. The current study aimed to compare the prevalence of infections (i.e., infection load) in the history of patients with SDs with that of matched controls., Methods: Samples (n = 185) were identified in the Psychiatric Case Register Middle Netherlands and the Julius General Practitioners Network. Patients with an SD diagnosis in the Psychiatric Case Register Middle Netherlands were compared with matched persons without somatoform complaints (controls) on their infection load in two periods before the date of the psychiatric diagnosis or a matched date for the controls (i.e., the total period for which data were available and a 3-year period). Infection load was defined as the total number of infections documented in the Julius General Practitioners Network., Results: Patients with SD had significantly more infections than did controls in both periods (total period: mean [standard error] = 0.87 [0.10] versus 0.51 [0.06], z = -3.08, p = .002; 3-year period: 3.44 [0.47] versus 2.15 [0.50], z = -2.91, p = .004)., Conclusions: Results show that patients with SD have a higher infection load preceding their diagnosis as compared with matched controls, implicating that infection load may indeed predispose for developing FS symptoms. These findings emphasize the importance of further research on immunological mechanisms in FS symptoms. Limitations of the study are discussed.

Overtraining (OT) as a sports phenomenon can be caused by stressors on various levels (physical, emotional, psychological, and social) and evokes responses on these levels. This study evaluated research and new opportunities in the field of OT by introducing an integrated multidisciplinary approach, based on the single and multistressors approach. The single stressor approach focuses on the training load-recovery imbalance, which results in a stagnating performance, excluding the etiology by nonsport-related factors. The multistressors approach includes all factors as relevant in the etiology of a stagnating performance. In future studies on OT an integrative approach should not only highlight changes in training regimes and specific responses to training stressors but also focus on the role of training-related recovery, the impact of stressors, and personality factors influencing stress appraisal. This will provide a better insight into the etiology and consequences of OT necessary for prevention and treatment in sport practice, and enhance the focus on adequate recovery (good sleep, sufficient rest periods) and athletes' stress-related responses.

Physiological measurements of stress are believed to help with the 'objectivation' of the rather subjective phenomenon called 'stress'. Because there are only moderate interpersonal correlations between the subjective experience of work-stress and physiological stress measurements, the latter are useful mainly for comparing groups with high stress and groups with low stress and not as a diagnostic tool at individual level. Physiological measurements have added value because they quantify the strain that stress exerts on the body, which ultimately determines what effect stress has on health. In addition, physiological measurements on persons with stress-related symptoms such as burn-out can help us understand the nature of the dysregulation of the stress-regulatory system which occurs in the persons with these types of symptoms. The comparison of high-stress groups and low-stress groups on the basis of various cortisol parameters has produced rather inconsistent results. This seems to be due not only to the unreliability of the measurements but also to the fact that cortisol is apparently a rather inaccurate reflection of the stress-regulatory system in the brain. Research into the changes that occur over time in the cortisol-regulatory system resulting from chronic work-stress and into the health-relevance of various cortisol parameters is essential if progress is to be achieved in this area.

Background: Burnout has a negative impact on physical health, but the mechanisms underlying this relation remain unclear. To elucidate these mechanisms, possible mediating physiological systems or risk factors for adverse health in burned-out employees should be investigated., Goal: The aim of the present study among 290 Dutch managers was to explore whether allostatic load mediates the relationship between burnout and physical health., Method: Burned-out managers, as identified with the Maslach Burnout Inventory General Survey (MBI-GS), were compared with a healthy control group with regard to their allostatic load. The allostatic load index included eight parameters: Body-mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), C-reactive protein (CRP), high-density lipoprotein (HDL), cholesterol, glycosylated hemoglobin (HbA1C) and glucose., Results: Contrary to expectations, burned-out managers did not differ from healthy managers with regard to their scores on the allostatic load index. An additional analysis, using groups of managers in the extreme deciles of exhaustion (the core symptom of burnout), did also not reveal differences in allostatic load., Conclusion: Burnout seems not to be associated with this proxy measure of allostatic load. The mediating physiological mechanisms between burnout and objective physical health remain to be elucidated.

Objective: Our aim with this study was to assess the relation between chronic fatigue syndrome in adolescents and fatigue and associated symptoms in their fathers and mothers, more specifically the presence of chronic fatigue syndrome-like symptoms and psychologic distress., Method: In this cross-sectional study, 40 adolescents with chronic fatigue syndrome according to the Centers for Disease Control and Prevention criteria were compared with 36 healthy control subjects and their respective parents. Questionnaires regarding fatigue (Checklist Individual Strength), fatigue-associated symptoms, and psychopathology (Symptom Checklist-90) were applied to the children and their parents., Results: Psychologic distress in the mother corresponds with an adjusted odds ratio of 5.6 for the presence of CFS in the child. The presence of fatigue in the mother and dimensional assessment of fatigue with the Checklist Individual Strength revealed odds ratios of, respectively, 5.29 and 2.86 for the presence of chronic fatigue syndrome in the child. An increase of 1 SD of the hours spent by the working mother outside the home reduced the risk for chronic fatigue syndrome in their child with 61%. The fathers did not show any risk indicator for chronic fatigue syndrome in their child., Conclusions: Mothers of adolescents with chronic fatigue syndrome exhibit fatigue and psychologic symptoms similar to their child in contrast with the fathers. The striking difference between the absent association in fathers and the evident association in mothers suggests that the shared symptom complex of mother and child is the result of an interplay between genetic vulnerability and environmental factors.

Objective: This study examined the effects of exposure to job strain on independent predictors of cardiovascular disease (ambulatory blood pressure, heart rate, and heart rate variability)., Methods: The participants comprised a homogeneous group of 159 healthy female nurses [mean age 35.9 (SD 8.5) years]. The choice of this population minimized variance attributable to gender, socioeconomic status, and work characteristics. Job demands, decision latitude, and social support were measured with the Karasek job content questionnaire, which was administered twice with an average interval of 12.2 months. The nurses' scores for job demands and decision latitude on both occasions were used to define their job-strain category. Ambulatory blood pressure, heart rate, and heart rate variability were assessed on a workday and a day of leisure., Results: No effect on the ambulatory levels of blood pressure, heart rate, or heart rate variability was found for job strain by itself or in interaction with social support. In addition, job strain was not associated with differences in short-term or long-term physiological recovery during sleep after a workday or a day of leisure. High job demand was associated with higher systolic blood pressure at work and with higher diastolic blood pressure at work, but the latter association was found only when decision latitude was concurrently high, rather than low., Conclusions: High job strain among young female nurses is not associated with an unfavorable ambulatory cardiovascular profile. The robust effect of job strain on male health appears to be less apparent for women.

Objective: Work stress is associated with an increased risk for cardiovascular disease (CVD). Exaggerated cardiovascular reactivity to work-related stressors or incomplete recovery after work is a proposed mechanism underlying this increase in risk. This study examined the effects of work stress on 24-hour profiles of the pre-ejection period (PEP), a measure of cardiac sympathetic activity, obtained from ambulatory measurement of the impedance cardiogram., Methods: A total of 67 male white-collar workers (age 47.1 +/- 5.2) underwent ambulatory monitoring on 2 workdays and 1 non-workday. Work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (high imbalance) or 2) an exhaustive work-related coping style (high overcommitment)., Results: High overcommitment was associated with shorter absolute PEP levels during all periods on all 3 measurement days, reduced wake-to-sleep PEP differences and reduced PEP variability, as indexed by the SD., Conclusions: Overcommitment to work was associated with an increase in basal sympathetic drive and a reduction in the dynamic range of cardiac sympathetic regulation. Both findings are compatible with the hypothesis that overcommitment induces beta-receptor down-regulation.

This study examined the possible effects of job demands, decision latitude, and job-related social support on risk indicators for cardiovascular disease (CVD) in 165 female nurses. Job strain was measured with the Job Content Questionnaire; CVD risk was measured with insulin, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fibrinogen, tissue-type plasminogen activator (tPA) antigen, tPA activity, plasminogen activator inhibitor-1 antigen, and blood pressure. Multivariate analysis of covariance and regression analyses revealed no effects of either job strain or social support on these risk indicators. All risk indicators deteriorated with age and body mass index. Oral contraceptive use improved fibrinolytic potential and increased HDL-C but had adverse effects on TG levels. Results suggest that in healthy young women job strain is not associated with an unfavorable metabolic or fibrinolytic risk profile.

Work stress has repeatedly been associated with an increased risk for cardiovascular disease. This study tested whether this relationship could be explained by exaggerated cardiovascular reactivity to work or impaired recovery in leisure time. Vagal tone was assessed as a possible determinant of these work stress effects. Participants included 109 male white-collar workers (age, 47.2+/-5. 3) who were monitored on 2 workdays and 1 nonworkday for ambulatory blood pressure, heart rate, and heart rate variability. Chronic work stress was defined according to Siegrist's model as (1) high imbalance, a combination of high effort and low reward at work, or (2) high overcommitment, an exhaustive work-related coping style indexing the inability to unwind. All findings were adjusted for possible differences in posture and physical activity between the work stress groups. High imbalance was associated with a higher heart rate during work and directly after work, a higher systolic blood pressure during work and leisure time, and a lower 24-hour vagal tone on all 3 measurement days. Overcommitment was not associated with an unfavorable ambulatory profile. Logistic regression analysis revealed that heart rate [odds ratio 1-SD increase 1.95 (95% CI, 1.02 to 3.77)] and vagal tone [odds ratio 1-SD decrease 2.67 (95% CI, 1.24 to 5.75)] were independently associated with incident mild hypertension. Surprisingly, the values during sleep were more predictive for mild hypertension than the values during work. The results from the present study suggest that the detrimental effects of work stress are partly mediated by increased heart rate reactivity to a stressful workday, an increase in systolic blood pressure level, and lower vagal tone.

Objective: A high level of work stress has been associated with cardiovascular disease. However, the pathophysiological mechanisms underlying this association remain unclear. This study examined the effect of work stress on a cluster of metabolic and hemostatic risk factors., Methods: Blood was collected three times, on the first, third, and fifth day of a work week, from 124 middle-aged, white-collar workers. Metabolic measures were insulin, glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol. Hemostatic measures were fibrinogen, tissue-type plasminogen activator activity, tissue-type plasminogen activator antigen, and type 1 plasminogen activator inhibitor antigen. Chronic work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (effort-reward imbalance) or 2) high overcommitment (an exhaustive work-related coping style)., Results: Overcommitment, but not imbalance or the imbalance-overcommitment interaction, was associated with an impaired fibrinolytic system, as reflected in decreased tissue-type plasminogen activator activity levels and increased type 1 plasminogen activator inhibitor antigen levels on all three measurement occasions. After controlling for body mass index, total cholesterol, triglycerides, high-density lipoprotein/low-density lipoprotein cholesterol ratio, glucose, and insulin, the relation between overcom-mitment and the fibrinolytic factors was attenuated but remained significant., Conclusions: The results suggest that individuals with an exhaustive coping style at work have an impaired fibrinolytic capacity that is possibly due to the effects of chronic stress on insulin resistance.

We studied the influence of mental stress on the contributions of genes and environment to individual variation in systolic (SBP) and diastolic (DBP) blood pressure by structural equation modelling in 320 adolescent male and female twins. Blood pressure data were collected during rest and during a reaction time and a mental arithmetic task. Univariate analyses of SBP and DBP showed familial aggregation for blood pressure. A genetic explanation for this resemblance was most likely, although during rest conditions a model that attributed familial resemblance to shared environmental factors, also fitted the data. There was no evidence for sex differences in heritabilities. Multivariate analyses showed significant heterogeneity between sexes for the intercorrelations of the blood pressure data measured under different rest and task conditions. Multivariate genetic analyses were therefore carried out separately in males and females. For SBP and DBP in females and for SBP in males an increase in heritabilities was seen for blood pressure measured during stress, as compared to rest measurements. The influence of shared environmental factors decreased during stress. For DBP in males no significant contributions of shared environment were found. The multivariate analyses indicated that the same genetic and environmental influences are expressed during rest and stress conditions.

Several studies have reported an association between serum lipid levels and cardiovascular reactivity to laboratory stressors. Their findings, however, are equivocal. The inconsistencies may be due to shortcomings such as the small number of subjects, the inclusion of patient groups, no control for medication, and no control for age effects. Two studies are presented investigating the relationship in large groups of adolescent and middle-aged males and females. Cholesterol, triglycerides and HDL were measured. Subjects were exposed to mental stressors, and in one study also to a cold pressor test. In addition to heart rate and blood pressure, in one study impedance cardiography was used to measure pre-ejection period, stroke volume and total peripheral resistance. Canonical correlation analysis suggested an association between triglycerides and decreased cardiac reactivity to mental stressors in middle-aged females. Trends in the same direction were found in both middle-aged males and females with respect to reactivity to the cold pressor. These associations, however, were not confirmed when the extreme deciles of the triglyceride distributions were compared with respect to stress reactivity. The fact that associations were completely absent in youngsters but sometimes showed up in older persons suggested an age dependency of the association. In post hoc analyses, indeed, some evidence was found for stronger cardiac responsivity being associated with cholesterol specifically in relatively older males. In females, in contrast to this, the association between triglycerides and cardiac responsivity was stronger in the younger group. More detailed measurement techniques, of specifically vascular processes, may be needed to explore further the effects of sex and age on the association between lipids and stress reactivity.

Objective: To compare blood pressure-regulating mechanisms during mental stress in two groups of offspring with contrasting risk for hypertension., Design: Cardiovascular reactivity to two different types of mental stressors was studied in adolescents and young adults with two hypertensive or two normotensive parents. The two tasks used were intended to evoke either a predominantly adrenergic cardiac response (a memory search task) or a predominantly vascular response (a reaction-time task with visual search and tone avoidance)., Methods: Blood pressure and heart rate were recorded at rest and during stress. To study adaptations of the cardiovascular system to mental stress, cardiac output, total peripheral resistance and indices of vagal and sympathetic influences on the heart were measured., Results: The reactivity of systolic blood pressure (SBP) to the memory search task was significantly higher in offspring of hypertensive parents, which resulted in a longer recovery after the task. In contrast, during the reaction-time task, offspring of hypertensive parents had a significantly enhanced reactivity of peripheral resistance, but no differences in heart rate or blood pressure response were observed. No differences between the two groups were found in sympathetic or vagal activity during either task measured by the ratio of pre-ejection time and left ventricular ejection time, and respiratory sinus arrhythmia, respectively., Conclusion: Apart from a higher reactivity of SBP during the memory search task, no other indications supporting the presence of hyperadrenergic activation of the heart in early primary hypertension were found. On the contrary, the results of the present study support the hypothesis that blood pressure responses in prehypertensive subjects are characterized by enhanced vasoconstriction rather than by increased cardiac output.

Background: Acute mental stress evokes responses in the cardiovascular and the immune systems. In particular, the subset of natural killer (NK) cells is found to be responsive to mental stress. The role of beta-adrenergic mechanisms in these processes in the subject of this investigation., Methods and Results: Healthy male volunteers (n = 31) were subjected to two consecutive mental tasks. Subjects were randomly assigned to a beta-blocker (propranolol 40 mg) or a placebo group. The capsules were ingested 1 hour before the tasks. The tasks evoked sympathetic responses, as indicated by an increase in heart rate and a decrease in the preejection period. These effects were abolished under beta-blockade, indicating that effective beta-blockade was achieved. In the immune system, significant increases were found for the number of NK cells and NK cell activity in the placebo group; these increases were absent in the propranolol group. In addition, an increase in all lymphocyte subsets was observed in subjects who had ingested propranolol. This increase, however, was also observed in subjects who had received propranolol but had not performed the tasks, indicating that these non-subset-specific increases in lymphocytes were a side effect of the beta-blocker., Conclusions: Mental stress induces activation of the sympathetic nervous system, with concomitant increases in the number of NK cells in the circulation. These changes were inhibited by propranolol, indicating that stress-induced increases in the number and activity of NK cells in the circulation are controlled by a beta-adrenergic mechanism.

This study assessed the association of aerobic fitness with psychological make-up and physiological stress-reactivity in a group of untrained men, as well as the effects of 4 and 8 months of exercise training on these parameters. Psychological assessment included questionnaires on personality (Neuroticism, Type A, Hostility), coping styles (Anger In, Anger Out), negative affect (Depression, Anxiety), and self-esteem. Stress reactivity was measured as the cardiovascular and urinary catecholamine response to two competitive reaction time tasks and the cold pressor test. No cross sectional relationships were found between aerobic fitness, defined as the maximal oxygen consumption during an exhaustive exercise test, and any of the psychological variables. In addition, psychological make-up did not change as a consequence of exercise training. In further contrast to our hypothesis, aerobic fitness was associated with high, rather than low, cardiovascular reactivity. Longitudinal effects of training were limited to a reduction in the overall levels of heart rate and diastolic blood pressure. This suggests that regular exercise does not increase the resistance to stress-related disease by influencing psychological make-up or acute psychophysiologic reactivity.

Studies on the predictive value of stress testing in the laboratory for the reaction to real-life stress have shown equivocal results. The variety of laboratory tasks differ for unknown reasons in their predictive power, and the results vary unsystematically among the physiological parameters measured. Most studies have focused on the prediction of ambulatory levels of blood pressure. Many other influences, besides stress, however, influence ambulatory levels. Therefore, a better operationalization of real-life stress is to measure a person in a resting position during a period of well defined real-life stress. The present study investigates whether the difference in ability of laboratory stress tasks to predict real-life stress values is due to the different type of physiological response they induce. Hence, in the present study a more detailed measurement of the stress response was performed. A second question was whether stress testing would add to the prediction of the real-life stress reactions above the prediction based on resting levels. This question was answered for both cardiovascular and catecholamine reactions to laboratory tasks. Two active coping tasks, one inducing a mainly cardiac-sympathetic reaction and the other a relatively more vascular response, and a cold pressor test were administered to 33 healthy young males. Real-life stress consisted of the anticipation of the public defence of the PhD thesis. Tasks indeed differed in predictive power, but this was not a function of the type of response they induced.(ABSTRACT TRUNCATED AT 250 WORDS)

It appears that serum-cholesterol level may serve as an important mediator between psychological variables and coronary heart disease (CHD). From a review of the literature it is concluded that (1) psychological stressors significantly elevate serum-cholesterol level and (2) psychological characteristics like the Type A-pattern and depression are positively correlated with serum-cholesterol levels. This suggests that the relationship between CHD and stress and coronary prone behavior may be partially explained by the mediating role of serum-cholesterol. A more careful consideration of psychological variables may be helpful in reducing the substantial amount of unexplained variance in cholesterol levels.

In the present study an attempt was made to assess whether male and female students differ in their cholesterol and catecholamine reaction to examination stress. An answer was also sought to the question of whether cholesterol level and reactivity could be predicted from behavioral traits and mood. In 29 male and 23 female students, cholesterol and urine-catecholamines were measured on an examination day and on a control day. Cholesterol level was found to be higher on the examination day, in both males and females. Although males showed a larger adrenaline reaction than females, their cholesterol reaction did not differ from that of the females. Specifically with regard to males, 62% of the variance in cholesterol base level and 40% of the variance of the stress induced cholesterol rise, were explained by the psychological variables measured. Achievement motivation and depression contributed to both predictions. No significant predictions could be made in the female group. This demonstrates the necessity of taking sex differences into account in psychophysiological studies. It is suggested to pay greater attention in future research to the mediating role that blood lipids play in the relationship between psychological factors and the risk of coronary heart disease.