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Life stress following trauma exposure is a consistent predictor of the development of posttraumatic stress disorder (PTSD). However, there is a dearth of research on the effect of life stress on PTSD treatment outcomes. The current study examined the effects of pretreatment levels of perceived life stress on treatment outcome in a sample of 200 individuals with PTSD who were randomized to receive either prolonged exposure (PE) therapy or sertraline as part of a clinical trial. Life stress over the year prior to treatment significantly interacted with treatment type to predict higher residual PTSD symptom severity, as assessed using the PTSD Symptom Scale-Interview, among participants who received sertraline but not those who received PE, β = .24, p = .017, ∆R2 = .03. These findings were similar for self-reported depression severity, β = .27, p = .008, ∆R2 = .04. Adherence to either PE homework or sertraline compliance did not mediate this association nor did life stress predict treatment retention for either treatment arm. Higher levels of perceived life stress may serve as a prescriptive predictor of PTSD treatment outcome, with PE remaining efficacious regardless of heightened pretreatment life stress. These findings encourage clinician confidence when providing PE to individuals with higher levels of life stress. Future researchers should examine the impact of PTSD treatment on perceived and objective measures of life stress to improve treatment for individuals who experience chronic stress.

To understand and curb intergenerational transmission of stress-related disorder, it is important to identify how trauma-related psychopathology in mothers impacts their psychophysiological stress regulation, particularly in the context of parenting their infants. In this study we investigated associations between mothers’ trauma-related psychopathology and life stress and HPA axis response to a personally relevant stressor (infant separation stress) in a non-clinical sample followed longitudinally postpartum. A community sample of low-income mothers (n = 73) and their infants completed laboratory sessions at 3, 6, 12, and 18 months postnatal, and salivary cortisol samples collected before and after dyadic stress tasks at the latter three sessions. These tasks were used to assess HPA function. A three-level hierarchical linear model of repeated cortisol measures nested within sessions within mother-infant dyads did not reveal significant main effects of trauma-related psychopathology on maternal cortisol response, but there was evidence that both a clinical interviewer-rated diagnosis of PTSD and ongoing self-reported trauma symptoms blunted effects of life events on cortisol reactivity. Region of significance analyses indicated that current life stress predicted more pronounced cortisol reactivity only among mothers without trauma-related psychopathology; for those with trauma-related psychopathology, life stress did not relate to cortisol response. Effects held when controlling for childhood trauma and previous (prenatal) maternal distress symptoms, suggesting they did not reflect ongoing impacts of past trauma exposure and/or psychopathology. Blunting effects of trauma-related psychopathology on maternal life stress responsiveness may help clarify how stress sensitivities and mental health are transmitted from parent to child.

Background: The etiology of sudden cardiac arrest (SCA) in individuals without known cardiovascular heart disease remains elusive in nearly half of all patients after systematic testing. We investigated the relationship between stressful life events and SCA risk in cases of explained and unexplained SCA (USCA) events. Methods: Individuals who previously experienced SCA were enrolled prospectively and divided into a USCA or explained SCA (ESCA) subgroup dependent on whether a diagnosis was ascribed after SCA. Participants completed either the 1997 Recent Life Changes Questionnaire, Student Stress Scale, or Social Re-adjustment Rating Scale for Non-Adults recalling events during the year preceding their SCA, depending on age at SCA presentation; all measure stress in life change units (LCUs). SCA group scores were compared with an age- and sex-matched control group. Results: We compared 36 SCA group participants (22 USCA, 14 ESCA, age 47 ± 15 years, age at SCA 40 ± 14 years, 50% male) with 36 control participants (age 47 ± 15 years, 50% male). There was no significant difference in LCU score between the control group and the SCA group (248 ± 181 LCU vs 252 ± 227 LCU; P > .05). The ESCA subgroup had significantly lower mean LCU scores than the USCA subgroup (163 ± 183 LCU vs 308 ± 237 LCU; P = .030). Conclusions: Stressful life events, especially those producing chronic stress, might predispose otherwise healthy individuals to lethal arrhythmias. Further investigation into the role of stress in SCA precipitation is warranted. Résumé: Contexte: La cause de l’arrêt cardiaque subit (ACS) chez les personnes n’ayant pas de maladie cardiovasculaire connue demeure nébuleuse dans près de la moitié des cas, même après des examens systématiques. Nous avons étudié la relation entre les événements stressants de la vie et le risque d’ACS chez des patients présentant un ACS expliqué (ACSe) ou inexpliqué (ACSi). Méthodologie: Des sujets ayant déjà subi un ACS ont été recrutés de manière prospective et répartis en deux sous-groupes (ACSe et ACSi), selon qu’un diagnostic a pu ou non être posé après l’ACS. On a demandé aux participants de répondre au questionnaire RLCQ (Recent Life Changes Questionnaire, questionnaire sur les changements de vie récents, version de 1997), au questionnaire SSS (Student Stress Scale, échelle d’évaluation du stress vécu par les étudiants) ou au questionnaire SRRS (Social Readjustment Rating Scale, échelle d’évaluation du réajustement social) pour les non-adultes en repensant aux événements survenus dans l’année précédant l’ACS, selon leur âge au moment de l’ACS; tous ces questionnaires mesurent le stress en unités de changement de vie (UCV). Les scores des patients ayant subi un ACS ont été comparés à ceux de sujets témoins appariés selon l’âge et le sexe. Résultats: Nous avons comparé 36 sujets ayant subi un ACS (22 ACSi et 14 ACSe; âge : 47 ± 15 ans; âge au moment de l’ACS : 40 ± 14 ans; proportion d’hommes : 50 %) à 36 sujets témoins (âge : 47 ± 15 ans; proportion d’hommes : 50 %). Il n’y avait pas de différence significative quant au score UCV entre le groupe témoin et le groupe ACS (248 ± 181 UCV vs 252 ± 227 UCV; p > 0,05). Les sujets du sous-groupe ACSe avaient un score UCV moyen significativement plus faible que ceux du sous-groupe ACSi (163 ± 183 UCV vs 308 ± 237 UCV; p = 0,030). Conclusions: Les événements stressants, plus particulièrement ceux qui entraînent un stress chronique, peuvent prédisposer des personnes autrement en bonne santé aux arythmies mortelles. Une étude plus poussée du rôle du stress dans la survenue précipitée d’un ACS s’impose.

Drinking alcohol is cited as a way for men to cope with stress, with most of the research emanating from western countries. However, in the East, limited scientific research has been conducted on the relationship between stress and alcohol consumption. Thus, this study aimed to explore the influence of life stress on alcohol use among Chinese men. Our data were drawn from the 2012 China Family Panel Studies that comprised representative samples of the Chinese population. In total, 15,373 Chinese men participated in this study, and their weekly alcohol intake and life stress were evaluated using computer-assisted personal interviews. It was found that the greater the overall life pressure experienced by the Chinese men, the less likely they were to engage in both general (OR = 0.977) and heavy drinking (OR = 0.975). Although severe life stress that interfered with daily life did not affect general drinking, it had a negative effect on heavy drinking. As for less severe life stresses, feeling down and sad had an inhibitory effect on male general and heavy drinking, and experiencing loneliness had a similar effect on general drinking but no effect on heavy drinking. Further, perceiving unfriendliness from others had no influence on male drinking behavior. Although feeling disliked by others had no effect on male drinking behavior, it had a significant, positive effect on male heavy drinking. This study found that in China, stress did not increase male alcohol consumption, but rather, inhibited it. Alcohol consumption is not a preferred strategy for Chinese men dealing with stress.

Purpose Sensitive skin is characterized by uncomfortable sensations in response to a number of factors. We performed a large-scale study to investigate the prevalence of sensitive skin at all ages and the impacts of related factors across China. Methods A nationwide sampling of the Chinese population aged over 18 was conducted. Subjects were categorized into sensitive and non-sensitive groups, and critical differences between these two groups were investigated. Results In total, 22,085 questionnaires were collected from Chinese women with sensitive skin. The prevalence of sensitive skin is 49.6% and is associated with age, skin type, geographic area of subjects, and other factors. Heavy life stress and the application of several cosmetic products also affect the prevalence of sensitive skin. Conclusion Having a combination or oily skin type, living in the municipalities, being under heavy stress, and applying several cosmetic products will increase skin stress and contribute to the occurrence of sensitive skin.

Introduction: As they grow, young people transit through adolescence; a particularly challenging phase. Many go through without difficulties but some experience maladaptive responses in form of conduct and adjustment problems, pubertal chal- lenges and life stress. Published research from the developed societies demonstrates consistent associations between young people’s exposure to life events, psychosocial competence (PSC) and mental health problems. However, comparable research from income-constrained societies remains scarce. The purpose of this study was to determine the prevalence of life events in secondary school students and describe the relationship between life events and PSC in the same population. Methods: This was a cross-sectional study. Participants were 2,902 randomly selected in Central and Northern Uganda. They responded to self-administered questionnaires on socio-demographics, life events and PSC. Results: Northern Ugandan students were more likely to be susceptible to stress-related illness associated with major life events (p = < 0.01). Among students with a high susceptibility to stress related illness, those with low scores on self-effi- cacy (p = < 0.001), accurate self-assessment (p = < 0.001) and self-confidence (p = < 0.001) were mostly from the North. Students from Northern Uganda had experienced more negative events. Students with higher scores on empathy, emotional awareness, accurate self- assessment and self-confidence tended to have low distress. Students that had a low susceptibility to stress related illness (AOR = 1.97; 95% CI: 1.57 - 2.48); high scores on self-efficacy (AOR 1.37; 95% CI: 1.09 - 1.74), self-confidence (AOR 1.32; 95% CI: 1.02- 1.72), and accurate self-assessment (AOR 2.19; 95% CI: 1.70 - 2.80) were mostly from northern Uganda. Conclusion: It is important to help students to cope with negative life events since an association exists between negative life events and PSC domains. PSC domains of empathy, emotional awareness, accurate self-assessment and self-confidence seem to be associated with lower distress levels, implying that these should be reinforced. Keywords: Psychosocial competence; life events; adolescents; students; Uganda.

Depression is seen as a response or symptom of life stress or physical change and is not usually considered to reflect a mood disorder. There are many reasons for depression- Familial and Genetic influences. It is the tendency which makes people bring them into a negative behaviour. The aim of the study is to assess the awareness about using Becks Depression inventory among dental students in clinical practice. A cross-sectional study was done with a self-administered questionnaire with ten questions circulated among 100 dental students. The questionnaire assessed the awareness about depression, the clinical manifestation of depressive illness, psychological stress etiology of oral mucosal diseases, usage of BDI questionnaire in practice. The responses were recorded and analysed. 54% were aware of depression, and 46% were not aware of depression. 26% were aware of the clinical manifestation of depressive illness. 32% were aware of physiological stress etiology of oral mucosal diseases. 0 % use BDI questionnaire in practice. The awareness of BDI questionnaire usage in clinical practice among dental students was found to be low in this study. Our findings emphasize the importance of incorporating several educational and training programs to dental students to sensitize them to look for psychological etiology of certain orofacial diseases.

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self-reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount.

Bruxism is involuntary, excessive grinding, clenching or rubbing of teeth during non-functional movements of the mastication. it is a destructive habit that may result in tooth wear. Although research on bruxism is extensive, its etiology remains debatable. The literature suggests that bruxism is correlated with both experienced and anticipated life stress. The purpose of this article is to review describe 3 out of 8 cases of severe bruxism in children of similar age with different life histories and to discuss the factors that could have triggered this parafunctional condition..&nbsp

Introduction Residents may differentially experience high stress and poor sleep across multiple post-graduate years (PGYs), negatively affecting safety. This study characterized sleep and stress among medical and surgical residents across multiple PGYs and at specific times surrounding duty. Method Thirty-two medical and surgical residents (Mage = 28.6 years; 56% male) across PGYs 1–5 participated in 3 appointments (immediately before duty, after duty, and on an off day) providing 96 data points. Sleep, stress, and occupational fatigue were measured by both self-report and objectively (actigraphy, salivary coritsol). Results Residents averaged 7 h of actigraphy-estimated sleep per night but varied ±3 h day-to-day. Residents reported clinically poor sleep quality. Life stress decreased by PGY-2. All residents averaged elevated life stress values. Poor sleep quality did not differ among PGY cohorts. Discussion Poor sleep quality is similar between early residency cohorts (PGY-1) and later residency cohorts (PGY-3+). Persistent fatigue is highest in later residency cohorts. Even the most experienced residents may struggle with persisting fatigue. Current hour policies may have shortcomings in addressing this risk.

BACKGROUND: Stress-induced pregnancy complications are thought to represent a significant cause of maternal morbidity and mortality; little is known regarding types of stress most predictive of adverse outcomes. METHODS: We used Utah PRAMs 2012–2014 data to evaluate links between preconception life stressors and prevalence of hypertensive disorders of pregnancy (HDP) and pre-term labor (PTB) (births

Prenatal health behaviors can strongly influence risk of poor pregnancy birth outcomes. Although stress has been implicated in structuring the likelihood that individuals will engage in various prenatal health behavior patterns, no studies to date have examined life stress exposure occurring across the entire lifespan, and few have investigated how different types of stressors are comparatively associated with these outcomes. To address these issues, we interviewed 164 women at one of two large Midwestern, urban hospitals after delivering their first infant. We used the Stress and Adversity Inventory (STRAIN) to assess women's lifetime stress exposure severity and ordinary least squares regression models to examine associations between participants' life stress exposure and prenatal health behaviors. As hypothesized, greater lifetime stress exposure was associated with engaging in more negative prenatal health behaviors and fewer positive prenatal health behaviors while controlling for relevant sociodemographic factors and current perceived stress levels. These effects were stronger for negative versus positive health behaviors, and they differed substantially as a function of stressor type, exposure timing, and primary life domain. Stressors occurring over the life course thus have negative consequences for prenatal health behaviors, but these effects are not uniform across different types of life stress exposure.

Objective: The aim of this study is to evaluate the associations between alcohol-cannabis use and forensic/stressful events with the risk of incident clinical psychosis during follow-up. Method: A community-based sample (n: 2142) was screened for clinical psychosis (schizophrenia and other psychotic disorders, affective disorders with psychotic features) at baseline and follow-up. Thus, incident clinical psychosis cases to develop during follow-up (individuals with no clinical psychosis at the baseline assessment and with clinical psychosis at the follow-up assessment) were detected (n: 27). These cases and the controls who did not report any psychotic symptoms at the follow-up assessment (n: 1691) were compared for exposure to environmental risk factors during follow-up (total n: 1718). Results: Individuals reporting heavy alcohol drinking or cannabis use during follow-up had significantly higher risk of incident clinical psychosis. The monthly frequency of drinking and cannabis use was also associated with the risk. Higher number of stressful life events exposed predicted higher risk of incident clinical psychosis. The risk of incident clinical psychosis was significantly higher in case of coexistence of two risk factors (heavy drinking, cannabis use, >= 3 stressful events), in comparison with the existence of a single risk factor (17.7 vs. 1.6%, p

In order to evaluate the effects of specific forms of childhood maltreatment (CM) upon adult C-reactive protein (CRP) concentrations, and to further describe the potentially confounding role that recent life stress and depression hold in that relationship, 221 participants from rural Australia (M age = 44yr, SD = 17.8yr) completed self-report questionnaires and provided a blood sample. There were no sex differences in any variables across the 91 males and 130 females, but depression status did confound the association between global CM and CRP. The specific aspect of CM was identified as physical and mental health abuse, and this was significantly associated with CRP level in participants with depressive symptoms and those without. There was no significant confound from recent life stressors. Results hold implications for the diagnosis of CM-related CRP elevation and (potentially) depression.

Physical activity levels during the COVID-19 pandemic have been decreasing and this may be a risk factor for development of emotional eating and its associated factors. The aim of the study was to analyze the factors associated with emotional eating among individuals with different physical activity levels during the COVID-19 pandemic. Data relating to the pandemic on physical activity, emotional eating, sociodemographic data, perceptions about lifestyle habits, body satisfaction, and perceptions about eating habits and food consumption were collected. Factors associated with emotional eating in the group of active and inactive individuals were observed using multiple linear regression controlled for age, sex, BMI, and monthly income. Emotional eating for the active group was associated with perceived stress, body dissatisfaction, and increased consumption of sweets and desserts. In addition to these factors found among the active group, working or studying &gt, 8 h/day, sleep worsening, increased amount of food consumed, increased purchase of food through delivery, and increased vegetable consumption were also associated with emotional eating for the inactive group. These findings suggest a potential protective role of physical activity in the appearance of factors associated with emotional eating during the COVID-19 pandemic.

The present study aimed to evaluate the effect of stress on haematological parameters among preclinical medical students. A cross-sectional study has been conducted on a total of 105 preclinical medical students at Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), Terengganu, Malaysia. The validated depression anxiety stress scales-21 (DASS-21) questionnaire was distributed and blood samples were collected from the subjects on the same day to perform full blood count (FBC) test. There was no significant association between levels of stress with red blood cells (RBCs) count and indices. However, a significant negative association was identified between stress level and white blood cells (WBCs) count (r= - 0.204, p ≤ 0.05). Furthermore, no significant association was found between levels of stress and platelets count and indices, except the mean platelets volume (MPV); a significant positive association between students measured MPV and their perceived stress (r= 0.195, p ≤ 0.05) has been noted. Mean WBCs count was decreased, while mean MPV was increased with increasing stress levels. Furthermore, the structural equation model predicted that some parameters were near to be significantly associated with stress, which needs further investigation. This study provided novel insights about the potential effects of stress on blood cells and platelets. The results will help the researchers to uncover the critical areas of increasing ROS and oxidative stress caused by chronic life stress.

Objectives: Evidence suggests that emotion regulation difficulty may play an important role in the association between life stress, sleep disturbance and depressive symptoms. We proposed two models depicting the possible moderating roles of prefrontal cortex activation during emotion regulation in the associations among these variables and tested them. We hypothesized that (1) the association between stress and sleep disturbance would differ across prefrontal cortex activation during emotion regulation (moderation model) and (2) the indirect effects of stress on depressive symptoms through sleep disturbance would depend on prefrontal cortex activation during emotion regulation (moderated mediation model). Methods: Forty-eight healthy adults without sleep disorders based on nocturnal polysomnography participated in this study. They received functional magnetic resonance imaging scans while performing an emotion regulation task. They also completed questionnaires assessing life stress, sleep disturbance and depressive symptoms. The proposed models were tested using the PROCESS macro for SPSS. Results: As hypothesized, there was a significant moderating effect of prefrontal cortex activation during emotion regulation on the association between life stress and sleep disturbance. Furthermore, right lateral prefrontal cortex activation had a moderating role in the indirect effect of life stress on depressive symptoms through sleep disturbance. Conclusion: These findings highlight the important role of prefrontal cortex function during emotion regulation in the associations between stress, sleep disturbance and depressive symptoms. Increasing lateral prefrontal cortex recruitment when regulating the emotional response to negative life events may be critical for the prevention and intervention of depression as well as sleep problems.

This case report describes associations between childhood adversity, adult stress exposure, and Multiple Sclerosis (MS) to highlight the intersection between mental health and neurological illness in persons with MS (PwMS). We focus on a high-adversity, high-resource patient who self-referred to mental health services for depression and suicidal ideation, without ever being screened for past or current stress exposure. MS and common comorbid symptoms (e.g., fatigue, depression, suicidality) may be affected by adversity and compounded by pandemic-related stressors, including socio-political and economic sequelae. This case illustrates the potential benefit of screening for lifetime stressors as a mechanism to improve case conceptualizations, enable referrals to mental health specialists to promote coping and resiliency, reduce future MS morbidity, and illuminate stress as an important research focus that deserves further exploration in PwMS.

Scholars have linked cost and life stress to lower voter turnout with clear implications for voting during the COVID-19 pandemic. We ask whether COVID-19 reduces turnout intention and how election agencies can mitigate this effect. We use a series of six survey and conjoint experiments implemented in samples totalling over 28,000 Canadian respondents collected between July and November of 2020 to show that: 1) priming people to think about COVID-19 reduces turnout intention, especially among those who feel most threatened by the disease; 2) safety measures for in-person voting, such as mandatory masks and physical distancing, can improve safety perceptions and willingness to vote in-person, and 3) providing people information about safety precautions for in-person voting mitigates the negative effect of priming COVID-19. These studies illustrate the importance of both the implementation and communication of measures by election agencies designed to make people safe – and feel safe – while voting in-person.

Objective: To analyze the prevalence of stress among doctors serving at various Government and private hospitals in Faisalabad. Methods: The cross-sectional study was conducted at Allied hospital, DHQ hospital, Government General Hospital and independent hospital Faisalabad, from July to December 2019. The study comprised doctors in service for at least one year, who volunteered to fill out the Perceived Stress Scale Questionnaire (PSS-14), excluding house officers and the doctors on administrative posts. Demographic features and job factors were taken as independent variables and perceived stress score was taken as the dependent variable. SPSS-20 was used for the determination of mean perceived stress score, standard deviation values, analysis of variance (ANOVA) and Pearson correlation analysis (R-values) . Results: Out of total 162 respondents, female doctors (n=75, 46.3%) were found to have significantly higher (p < 0.05) perceived stress scores (mean PSS = 27.56, SD = 8.305) as compared to male doctors (n=87, 53.7%, mean PSS = 24.82, SD = 7.823). There was a negative correlation of doctors’ age (R-value = -0.246, p-value = 0.002), number of years in job (R-value =-0.187, p-value 0.017) and number of children (R-value =-0.178, p-value = 0.023), with the perceived stress scores. Stress score was found significantly lower for doctors who managed to usually get time-out for relaxation (p < 0.01) and do private practice (p < 0.05). The effect of doctor’s marital status, type of specialty and residence was not found statistically significant. Continuous...

Current and early life stress (ELS) are associated with diurnal cortisol patterns, which themselves are associated with mental and physical health. The pubertal recalibration hypothesis suggests that the social environment can impact dysregulated cortisol patterns for previously ELS-exposed youth as they transition through puberty. This study examined longitudinal change in cortisol awakening response (CAR) and diurnal slope (DS) across puberty as a function of ELS in infancy, current stress, and social support (N = 290, 7-17 years). The CAR and DS were examined thrice annually with an accelerated longitudinal design with nurse-assessed puberty to assess associations between diurnal cortisol and pubertal recalibration with ELS and the current social environment. Exposure to ELS was associated with less steep DS but not changes in CAR, and no evidence of pubertal calibration was found. The DS became less steep for youth in later pubertal stages and as youth progressed through puberty. The CAR was steeper for youth in later pubertal stages. Across the cohort, current life stress and support were associated with changes in the DS and the CAR through the pubertal transition. The pubertal stage and the peripubertal and pubertal social environment may have important implications for adrenocortical functioning with or without exposure to ELS.

Billions of users around the world are using social networking sites (SNS) to express everyday thoughts and feelings. Investigating motives of using SNS is attracting scholarly attention. The common way to assess users' motives is analyzing data from self-report questionnaires. The current research aims to identifying undergraduate students' motives of using Weibo from digital traces, in an effort to alleviate the distortion in self-report data. The term frequency-inverse document frequency (Tf-idf) was employed to obtain key terms and their weights in digital traces crawled from Weibo. Top frequent terms, based on Tf-idf, indicate that entertainment, information seeking and sharing, and alleviating life stress are among the major motives of using Weibo. This study underscores the feasibility and importance of directly detecting motives of using SNS from digital traces.

Background: Insight into patient characteristics that predict response to treatment for major depressive disorder (MDD) may help to personalize treatment and improve outcomes. One mechanism that has been linked to the success of treatment for MDD is brain-derived neurotropic factor (BDNF). BDNF is implicated in learning and memory and may play a role in the effects of psychotherapy that involves changing cognitions and behaviors. In addition, only in individuals with low BDNF, low working memory capacity has been associated with increased symptoms of depression. However, the role of BDNF and working memory capacity in psychotherapy outcome is unclear. The aim of this study was to investigate the role of BDNF and its interaction with working memory capacity in psychotherapy outcomes for MDD.Method: Adult patients with MDD were randomized to weekly or twice weekly sessions of cognitive behavioral therapy or interpersonal psychotherapy. BDNF Val66Met polymorphism (rs6265) (n = 138) was defined and serum BDNF was quantified before (n = 138) and after psychotherapy (n = 82).Results: Baseline serum BDNF and the Val66Met polymorphism were not associated with outcome and associations did not differ between treatment conditions. Working memory capacity significantly moderated the relation between baseline serum BDNF and outcome: high serum BDNF at baseline was related to less depressive symptoms following psychotherapy in the presence of high working memory capacity, but not low working memory capacity.Discussion: These findings, if replicated, might indicate that while BDNF may not be related to psychotherapy outcomes in general, they may play a role in the presence of specific learning processes such as working memory capacity.

This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants’ stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.

Objective The relationship between psychosocial stress and chronic pain is bidirectional. An improved understanding regarding the relationships among chronic pain, life stress, and ethnicity/race will inform identification of factors contributing to health disparities in chronic pain and improve health outcomes. This study aims to assess relationships between measures of clinical pain, life stress, sociodemographics, and salivary cortisol levels. Methods A cross-sectional analysis involving data from 105 non-Hispanic White (NHW) and non-Hispanic Black (NHB) participants aged 45–85 years old with or at risk for knee osteoarthritis. Data included sociodemographics, clinical pain, psychosocial stress, and salivary cortisol across five time points over an approximate 12-hour period. Non-parametric correlation analysis, sociodemographic group comparisons, and regression analyses were performed. Results Clinical pain and psychosocial stress were associated with salivary cortisol levels, particularly morning waking and the evening to morning awakening slope. With the inclusion of recognized explanatory variables, the Graded Chronic Pain Scale characteristic pain intensity and financial satisfaction were identified as the primary pain and psychosocial measures associated with cortisol levels. Sociodemographic group differences were indicated such that NHB participants reported higher pain-related disability, higher levels of discrimination, lower financial and material satisfaction, and showed higher evening salivary cortisol levels compared to NHW participants. In combined pain and psychosocial stress analyses, greater financial satisfaction, lower pain intensity, and lower depression were associated with higher morning waking saliva cortisol levels while greater financial satisfaction was the only variable associated with greater evening to morning awakening slope. Conclusion Our findings show relationships among clinical pain, psychosocial stress, sociodemographic factors, and salivary cortisol levels. Importantly, with inclusion of recognized explanatory variables, financial satisfaction remained the primary factor accounting for differences in morning waking cortisol and evening to morning awakening cortisol slope in an ethnic/racially diverse group of middle aged and older adults with or at risk for knee osteoarthritis.

Significant childhood adversity and chronic life stress are highly prevalent in patients with severe obesity. Such stress has been found to increase risk of adulthood obesity by up to 50% and it can also substantially degrade the effectiveness of evidence-based treatments for this chronic disease condition. Despite general appreciation of these facts, though, stress is not frequently measured in obesity research or routinely assessed during treatment for obesity or obesity-related complications. To address this important issue, we describe several validated tools that can be used for assessing life stress and discuss how information obtained from these instruments can be integrated into obesity treatment and research. Given the ease with which stress can be assessed, we argue that stress assessment and management should be widely included in clinical treatments for obesity, and that stress should be routinely measured in studies examining the long-term effects of obesity and obesity treatment.

Background: Contemporary literature focuses on various socio-demographic, clinical profile and psychiatric comorbitidies in patients with first attempt suicide. Aim: 1. To study the socio-demographic factors and the clinical profile of subjects with the first attempt suicide. 2. To assess the severity of depression and severity of stress due to various stressful events in patients with first attempt suicide. 3. To assess the severity of the suicide intent in patients with first attempt suicide. 4. To study the association between socio demographic profile of the patients with severity of depression, severity of suicide intent and severity of stress. Materials and Methods: Hundred fifteen patients were assessed using Hamilton rating scale for depression, becks suicide intent scale, Holmes-Rahe life stress inventory, MINI international neuropsychiatric interview. The data was analysed using the statistical software SPSS version 20. Results: The sample of 115 patients showed mean age to be 29 years, majority of them being males (58%). With most common mode of attempting suicide to be drug overdose and most of the patients had adjustment issues due to various domestic household issues and financial stressors. The severity of depression was mild and suicide intent were low (67%). In our study chi square finding association between various socio demographic variables and severity of depression found to be highly significant. It was strongest among gender at p value 0.009, occupation in which depression was found mostly among employed patients and housewives at p value 0.001. Results also found depression more common among participants with urban background at p value 0.03 and family type being nuclear at p value 0.05. Conclusion: Promoting healthy coping mechanism and reduction in stress is required to reduce self-harm. As is evident from the study, modifying the interpersonal relationship problems in the family might help in preventing many of suicide attempts/intentional self-harm and therefore important to address their various life events that might be stressful for them forcing them to take this step. In a country like India, where formal mental health resources are limited and are attached to a stigma, it is important to provide adequate information also among people hailing from lower economic status.

Background: The serotonergic and noradrenergic systems have a strong impact on several affective disorders and are key targets for psychopharmacological therapy. With respect to pathogenesis, there is a growing body of evidence showing an influence of a promoter repeat polymorphism (MAOA-uVNTR) altering the expression rate of monoamine oxidase A. However, only a few studies investigate its influence on depression with only 2 of them considering the moderating effects of life stress. For burnout, there are no studies so far investigating the genetic basis. Objectives: The aim of the present study was to replicate an interaction effect of MAOA-uVNTR and life stress on depression, and extend these possible findings to the burnout syndrome. Especially, the latter one might help in understanding the underlying mechanisms of burnout and its association to depression. Method: A total of n = 1,541 participants (n = 1,099 healthy controls, n = 442 inpatients with affective disorders) provided genetic samples and filled in self-report questionnaires measuring depression, burnout, and the extent of experienced stressful life events (SLEs). Results: A life stress x MAOA-uVNTR interaction on depression and burnout was observed in women suggesting that carriers of the high expressing allele (MAO-H) with many SLEs had the highest scores in both burnout and depression. In men, there was only a weak effect of MAOA-uVNTR on depression. Conclusions: The results suggest a more pronounced reactivity to adverse environmental factors in carriers of the MAO-H allele. Especially the effect of life stress and MAOA-uVNTR on burnout should be independently replicated in the future as this is the first study showing this association.

This study tested the effect of 8-week endurance and resistance training programmes on cardiovascular stress responses, life stress, and coping. Fifty-two untrained but healthy female students were randomised to an 8-week endurance training, an 8-week resistance training, or a wait list control group. Before and after the training intervention, we assessed the groups' cardiorespiratory fitness (VO2max test), self-reported life stress, coping strategies and cardiovascular reactivity to and recovery from a standardised laboratory stressor. Both endurance and resistance training programmes caused physiological adaptation in terms of increased VO2max after the intervention. For stress and coping parameters, participants in the training groups improved cardiovascular recovery from stress and reported having less stress in their everyday life after the intervention than participants in the control group, while the two training groups did not differ from each other. We did not find any significant differences in heart rate reactivity and coping strategies between the study groups. These results partly support that exercise training has stress-reducing benefits regardless of the type of exercise. Both endurance and resistance exercise activities may be effectively used to improve stress regulation competence while having less impact on changing specific coping strategies.

Patients with major depressive disorder (MDD) are at high risk for suicide. As the worst outcome of MDD and common self-concealment in patients with suicide risk, studies of biomarkers may provide useful tools for suicide prevention and treatment.This study recruited 168 patients with MDD from the Objective Diagnostic Markers and Personalized Intervention in MDD patients (ODMPIM), including 50 patients with suicide risk. Based on previous evidence and hypothesis, 23 targeted serum biomarkers involving immune-inflammation, neurotrophins, hypothalamic-pituitary-adrenal (HPA) axis and metabolism, were measured. We used path analysis and principal components analysis (PCA) to clarify the associations among serum biomarkers, childhood adversities, adulthood life events, severity of depression and suicide risk.We identified that patients with suicide risk had a higher level of inflammatory markers in serum than patients without suicide risk (P 0.001), especially chemokine (C-X-C motif) ligand 1 (CXCL-1). After using the Bonferroni correction, there were no differences in biomarkers related to neurotrophins, HPA-axis and metabolism. In addition, a higher proportion of patients with suicide risk had adulthood adversity (assessed by Life Events Scale) (P = 0.003). Intriguingly, path analysis demonstrated that the association between adulthood adversity and suicide risk mainly depended on severity of depression and inflammatory index.This study highlights the possible role of inflammation involved in suicide risk of MDD patients. Inflammatory markers have the potential for early identification and then reducing suicidal behaviors or becoming novel treatment targets in suicide risk management.

This study explored the stressors and coping mechanisms of older adults, 60 years old and over, who teach in three state higher education institutions in Manila, Philippines. Descriptive correlation method of research was employed. One hundred eighty-eight were randomly selected from the roster of 356 target participants. The Older Adults Life Stress Inventory was used to identify the severity of stressors as experienced by the respondent senior professionals for the past 3 years along the areas of physical, health, social, family, occupational and financial domains. The Coping Strategy Inventory Short Form 32 was used to determine typical coping strategies that involve problem-solving, cognitive restructuring, express emotions and social contact. Tests of correlation, however, revealed that all the six stressors areas have a significant positive correlation with problem avoidance, wishful thinking, self-criticism and social withdrawal (p < 0.01). Multiple regression analyses disclosed that older adult men have a greater preponderance to experience stressors than older adult women Keywords: Older adult professionals, stressors, coping mechanisms, physical-related stressors, health-related stressors, social-related stressors, family-related stressors, occupational stressors, financial stressors.

Respective associations between uncertainty stress and three dimensions of social capital with suicidal ideation were assessed among 4446 undergraduates from 22 Chinese universities in a cross-sectional study. Multiple logistic regression model and structural equation modeling were used to examine these relationships. Uncertainty stress was more strongly and uniquely associated with suicidal ideation than with life stress. Social capital, especially social networks, shared a dual role as a correlate of suicidal ideation and means to reduce the impact of uncertainty stress. School-based gender- and age-specific suicidal ideation interventions should emphasize social capital enhancement and uncertainty stress coping.

There is increasing recognition that traumatic stress encountered throughout life, including those prior to military service, can put individuals at increased risk for developing Posttraumatic Stress Disorder (PTSD). The purpose of this study was to examine the association of both traumatic stress encountered during deployment, and traumatic stress over one's lifetime on probable PTSD diagnosis. Probable PTSD diagnosis was compared between military personnel deployed in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF; N = 21,499) and those who have recently enlisted (N = 55,814), using data obtained from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Probable PTSD diagnosis was assessed using the PTSD Checklist. The effect of exposure to multiple types (i.e. diversity) of traumatic stress and the total quantity (i.e. cumulative) of traumatic stress on probable PTSD diagnosis was also compared. Military personnel who had been deployed experienced higher rates of PTSD symptoms than new soldiers. Diversity of lifetime traumatic stress predicted probable PTSD diagnosis in both groups, whereas cumulative lifetime traumatic stress only predicted probable PTSD for those who had been deployed. For deployed soldiers, having been exposed to various types of traumatic stress during deployment predicted probable PTSD diagnosis, but cumulative deployment-related traumatic stress did not. Similarly, the total quantity of traumatic stress (i.e. cumulative lifetime traumatic stress) did not predict probable PTSD diagnosis among new soldiers. Together, traumatic stress over one's lifetime is a predictor of probable PTSD for veterans, as much as traumatic stress encountered during war. Clinicians treating military personnel with PTSD should be aware of the impact of traumatic stress beyond what occurs during war.

Purpose: The purpose of this study was to explore and describe the meaning and essence of experiences of stress in mothers of preschoolers with atopic dermatitis. Methods: This study employed a qualitative research design. Seven mothers of preschoolers with atopic dermatitis were interviewed and the data were analyzed using Giorgi’s phenomenological method. Results: Five main themes and 12 theme clusters emerged. The 5 main themes were 1) the mother’s enduring heartache from the conflict that arise among family members, 2) the complete loss of daily happiness, 3) the steady stream of emotional fluctuations, 4) struggling to bear the heavy financial burden, and, 5) a life of hope accompanied by stress. Conclusion: The results of this study provide an in-depth understanding of stress among mothers of preschoolers with atopic dermatitis. These results can be used in the development of nursing interventions to provide psychological and emotional support for mothers and family members.

Background Borderline Personality Disorder (BPD) affects 0.9%–3.2% of adolescents, and more than 20% of inpatient adolescents. Life stress has been linked to BPD across the lifespan, and previous research in adults has linked BPD to dependent stress (i.e., stress induced by the individual). However, prior research has not examined dependent stress alongside BPD in adolescents. Additionally, the potential protective effect of maternal care has not been considered in this relation. This study tested a moderation model expecting that (1) BPD would be positively associated with dependent life stress, (2) maternal care would be negatively associated with BPD, and (3) maternal care would moderate the relation between BPD and dependent life stress. Method The sample consisted of 184 adolescents recruited from an inpatient psychiatric facility serving a diverse population in the Southwestern United States. Dependent life stress, BPD, and maternal care were measured using the UCLA Life Stress Interview, DSM-IV Childhood Interview for BPD, and Kerns Security Scale, respectively. Results Results supported the first two hypotheses; BPD diagnosis was significantly, positively associated with dependent life stress, and negatively associated with maternal availability and dependability. Contrary to the third hypothesis, no significant evidence that maternal care acts as a buffer in the relation between BPD and dependent life stress was found. Conclusions Although maternal care was not found to moderate the association between BPD and dependent life stress, results supported previously found relations between BPD, dependent life stress, and maternal care, and did so within a diverse inpatient adolescent sample.

Background: This study aimed at investigating the coping strategies with stress in patients with acute myocardial infarction (MI) and individuals without a history of fixed MI and cardiovascular disorders. Methods: This case-control crossover study was conducted from March 2015 to February 2016 on 220 patients with acute MI (MI patients) as case group and 220 patients without any history of MI and cardiovascular diseases as the control group using availability sampling method. To collect the required data, demographic information questionnaire, Holms-Raheh life stress inventory, perceived stress questionnaire, and coping inventory for stressful situations (CISS) were applied. Results: On the basis of our findings, 118 patients (53.6%) with MI used emotion-focused coping strategy. Ninety-seven patients (82.2%) with MI who used emotion-focused coping strategy had negative perceived stress. Additionally, 71 patients (60.2%) with MI who had used emotion-focused coping strategy suffered from very high level of stress. Conclusion: The most MI patients had very high level of stress while most people in control group had high level of stress. Most MI patients that had very high level of stress cope with it in emotion-focused coping strategy and it proves that people with higher levels of stress are more likely to use inefficient coping strategies. Cardiol Res. 2018;9(1):35-39 doi: https://doi.org/10.14740/cr655w Â

The purpose of the study was to find out the analysis of life stress obesity and cardiovascular risks among professional of different sectors. To achieve this purpose of the study 150 different professional sectors from Chennai city were randomly selected as subjects. The age of the subjects were ranged from 25 -35 years. The subjects were further classified at random into participants were divided in five groups. The group I consist of thirty Teachers, the group II consist of thirty Drivers, the group III consist of thirty Medical, the group IV consist of thirty IT, and the group V consist of thirty Sports professional of Different Sectors. The selected criterion variables such as Life stress, Obesity and cardiovascular risk. All the participants were tested on the selected variables. The collected data were statistically analysed by using Analysis of Variance (ANOVA) was used to find out significant difference if any, between the groups on selected criterion variables separately.

Numerous causes of exercise-related gastrointestinal (GI) distress exist but scarce research has evaluated potential psychological causes. Runners (74 men, 76 women) prospectively recorded running duration, intensity (Rating of Perceived Exertion [RPE]), and GI symptoms for 30 days. Six GI symptoms were rated on a 0-10 scale. The percentage of runs over 30 days that participants reported at least one upper, lower, or any GI symptom ≥3 was calculated. After 30 days, participants completed a questionnaire on GI distress triggers (demographics, anthropometrics, experience, analgesic use, antibiotic use, probiotic consumption, fluid/food intake, stress, anxiety). Stress and anxiety were measured via the Perceived Stress Scale (PSS) and Beck Anxiety Inventory (BAI). The median percentage of runs that participants experienced at least one GI symptom ≥3 was 45.6% (interquartile range [IQR], 16.6-67.3%). Age and running experience negatively correlated with GI distress occurrence (rho = -0.17 to -0.34; p 0.05). Run RPE, probiotic food consumption, PSS scores, and BAI scores positively correlated with GI distress occurrence (rho = 0.18 to 0.36; p 0.05). Associations between GI distress, stress and anxiety remained significant after adjustment for covariates, except for lower GI symptoms. This study suggests that stress and anxiety contribute to running-related GI distress.

To examine the association between life stress, uncertainty stress and self-reported illness among Chinese college students. Participants were 11,942 students who were identified through a multistage survey sampling process that included 50 universities. Stress and illness status were obtained by self-report. Both unadjusted and adjusted methods were considered in the analyses. Self-reported short- and long-term illness prevalences were 27.4% (95% CI: 23.9%–30.8%) and 20.0% (95% CI: 17.0%–23.1%), respectively. The logistic regression model found that while uncertainty stress was associated with both categories of illness, life stress was not related to either category of illness. These findings underscore the importance of controlling uncertainty stress and can be used to inform future policies and reinforce the need for uncertainty stress management in China.

Health problems may occur in mothers and can persist during the postpartum. Life event stress (LES) is a risk factor for poor maternal health. We examined the relations of LES and rise in LES over time to maternal health during the first three years postpartum. We used data from 1,364 mothers obtained between 1991 and 2007 in the U.S. National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Information on maternal sociodemographics and early postpartum health was collected 1 month after childbirth. Maternal reports on health status and LES were obtained at 6, 15, 24, and 36 months postpartum. Latent growth curve analyses were performed, with maternal sociodemographics and early postpartum health as covariates for which statistical adjustment was made. Maternal health declined steadily in a linear pattern with marked individual differences, whereas maternal LES increased gradually in a linear pattern. Moreover, faster maternal health decline was associated with poorer early health at 1 month postpartum, greater exposure to LES at 6 months postpartum, and faster rise in LES exposure over time. Decline in maternal health may be explained at least in part by the deleterious effects of exposure to stressful life events.

This study examined associations between anxiety, stress, and resting metabolic rate (RMR). Thirty women and 23 men had RMR measured at two visits. Participants also had body composition assessed and completed several questionnaires: State–Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Anxiety Sensitivity Index (ASI)-3, and Perceived Stress Scale (PSS)-14. The state version of the STICSA was completed at both visits, while the other questionnaires were completed at visit one. RMR was expressed in kilocalories per day and relative to lean mass (RMRrelative). Participants were divided into low-, medium-, and high-anxiety groups based on STICSA trait scores, and RMR was compared among groups using one-way ANOVA. Changes between visits were evaluated using paired t tests and Wilcoxon signed-rank tests. RMR did not change from visit one to visit two (1589 to 1586 kcal/day, p = 0.86) even though STICSA state scores slightly declined (Z-statistic = –2.39, p = 0.017). RMRrelative values were 30.3 ± 3.7, 29.0 ± 1.9, and 29.9 ± 3.6 kcal/kg of lean mass among low, medium, and high trait anxiety groups, respectively (F = 0.70, p = 0.50). No RMR variable significantly correlated with PSS-14, ASI-3, or STICSA scores. This study provides evidence that trait anxiety and life stress do not impact RMR. Whether an association between these factors exists in anxiety disorders remains to be evaluated. Novelty Contrary to previous research, this study found no associations between anxiety and RMR. It is doubtful whether practitioners need to account for healthy subjects’ trait anxiety and stress when analyzing RMR data.

Chronic stress leads to poor well-being, and it has effects on life quality and health. Society may have significant benefits from an automatic daily life stress detection system using unobtrusive wearable devices using physiological signals. However, the performance of these systems is not sufficiently accurate when they are used in unrestricted daily life compared to the systems tested in controlled real-life and laboratory conditions. To test our stress level detection system that preprocesses noisy physiological signals, extracts features, and applies machine learning classification techniques, we used a laboratory experiment and ecological momentary assessment based data collection with smartwatches in daily life. We investigated the effect of different labeling techniques and different training and test environments. In the laboratory environments, we had more controlled situations, and we could validate the perceived stress from self-reports. When machine learning models were trained in the laboratory instead of training them with the data coming from daily life, the accuracy of the system when tested in daily life improved significantly. The subjectivity effect coming from the self-reports in daily life could be eliminated. Our system obtained higher stress level detection accuracy results compared to most of the previous daily life studies.

Within this study 117 drug and alcohol addicts (97 males and 20 females) were compared with a matching group of healthy controls. All respondents were questioned regarding negative life events (NLE) that have happened to them during different periods of their life, in particular when they were 0-6, 7-14, 15-18 and 19 and more years old. The questionnaire consisted of 69 questions which covered such issues as “assault”, “divorce/separation”, “major financial problems”, “serious illness or injury”, “legal problems”, “loss of confidant”, “serious marital problems”, “being robbed”, “serious difficulties at work”, “serious housing problems” and “job loss”, etc. Events related to the personal network and early life period included death of a parent, loss of an individual in the network, alcohol and drug addiction of a parent, problems in relations with parents, separation from parents, being brought up by persons other than parents, housing problems, having very bad relations with a parent, etc. It was found that the life course of NLE accumulation in addicts is 3 times higher than in controls, the differences were statistically significant (p, U ovom je istraživanju 117 ovisnika o drogama i alkoholu (97 muškaraca i 20 žena) uspoređeno sa skupinom zdravih ispitanika. Svi ispitanici ispitivani su o negativnim životnim događajima (engl. Negative Life Events – NLEs) koji su im se dogodili u različitim razdobljima života, posebno u dobi od 0 do 6, 7 do 14, 15 do 18 te 19 i više godina. Upitnik se sastojao od 69 pitanja koja su se odnosila na događaje kao što su „napad”, „razvod/razdvajanje”, „veliki financijski problemi”, „teške bolesti ili ozljede”, „pravni problemi”, „gubitak osobe od povjerenja”, „ozbiljni bračni problemi”, „pljačka”, „ozbiljne poteškoće na poslu”, „ozbiljni stambeni problemi”, „gubitak posla” itd. Događaji koji obuhvaćaju mrežu bliskih ljudi u ranom životnom razdoblju uključuju smrt roditelja, gubitak bliske osobe, ovisnost roditelja o alkoholu i o drogama, probleme u odnosima s roditeljima, odvojenost od roditelja, odgajanje od strane drugih osoba, stambene probleme, vrlo loše odnose s roditeljem itd. Utvrđeno je da je broj negativnih životnih događaja kod ovisnika tri puta veći nego kod skupine zdravih ispitanika – razlike su bile statistički značajne (p < 0,001) u svim životnim razdobljima. U hijerarhijskom regresijskom modelu koji je primijenjen negativni životni događaji u ranom djetinjstvu i ranoj odrasloj dobi (nakon 19 godina) imaju veći utjecaj od negativnih događaja u školskoj dobi i adolescenciji. Analiza negativnih životnih događaja u najranijoj životnoj dobi (do šest godina) kod ovisnika je pokazala da su problemi roditelja s alkoholom i osjećaj da ih roditelji ne vole, pa čak i emocionalno muče bili mnogo češći nego kod skupine zdravih ispitanika. Druge jake asocijacije uočene su kod odgoja od strane drugih osoba. Tjelesno i seksualno nasilje nisu bili među prioritetima i nisu bili tako snažno povezani s ovisnošću. O rezultatima se raspravlja u smislu mogućih kulturoloških karakteristika koje mogu utjecati na određivanje prioriteta kod dječjih negativnih događaja i njihovu važnost za daljnji razvoj ovisničkog ponašanja. Dobiveni rezultati mogu biti korisni za izradu rehabilitacijskih mjera za ovisnike, posebno tijekom obiteljske terapije.

Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to aspects of diurnal cortisol secretion in adolescents, but little is known about gender differences in these associations. A school-based sample of Sri Lankan adolescents aged 13–16 years took part in this study 4.5 years after the 2004 tsunami had impacted many of their lives to varying degrees. Saliva samples were obtained 4 times a day for 3 days in 84 participants, who also completed measures of lifetime trauma, current stressors, and posttraumatic stress symptoms (PTSS). We used multilevel regression to estimate effects of trauma exposure and symptoms on cortisol level, diurnal slope, and awakening response (CAR). Results indicated higher cortisol in girls and older adolescents. Although trauma, PTSS, and recent PTSD had non-significant main effects, these three variables interacted with gender, with higher cortisol in girls than in similarly traumatized or symptomatic boys. Co-occurrence of internalizing symptoms and PTSS was also associated with higher cortisol. The 28 adolescents with recent PTSD displayed flatter diurnal slopes, reflecting relatively low morning cortisol. Among the 56 trauma-exposed participants, negative trauma appraisals were associated with higher cortisol. Girls were more likely than boys to display elevated cortisol in relation to re-experiencing and hyperarousal symptoms. In contrast to significant findings for cortisol level and diurnal slope, the CAR showed no association with either trauma or PTSS, irrespective of gender. Findings, viewed in light of normative gender differences in HPA activity during adolescence, can contribute to understanding heightened female vulnerability to posttraumatic stress disorder.

Aim: To develop a multi-dimensional Patient Reported Outcomes (PRO) questionnaire to improve person-centered care for type 1 and 2 diabetes across sectors in Denmark. Methodology: A stepwise cross-regional multi-stakeholder multi-disciplinary co-development process was undertaken: 1) Patient-important PRO domains for value based diabetes care defined (ADA 2018), 2) Multi-sector strategy for active use of PRO to benefit People With Diabetes (PWD) and care quality 3) Conceptual measurement model and psychometric methodological foundation, 4) Literature review and mapping of PRO items/scales 5) Iterative item selection/testing and design of PRO dialogue tool 7) Qualitative, clinical and psychometric evaluation. Results: The final e-PRO questionnaire (53-78 items) consisted of pre-existing/adapted items (from e.g., WHO-5, PROMIS-10, MDI, DSC-R) and newly developed global essence domain and single items covering: General health, social support, life stress, psychological well-being, symptom distress (neuropathic pain, heart, gastro-intestinal, sexual, sleep, fatigue, foot problems), diabetes well-being, worries, limitations and support, self-care, lifestyle and technology confidence, wishes for support, confidence in care access, medicine burden and satisfaction, blood sugar regulation (stability, moderate/severe hypoglycemia), preferred topics for next visit. Workshops and selective item testing (n=85) supported item acceptability and content coverage. A novel web dialogue tool with algorithms/resources to enable PWD and providers to interpret and follow-up on each PRO output was designed as part of the project. Conclusions: A systematic collaborative process led to a new PRO questionnaire and dialogue tool for use in routine diabetes care. Research is now ongoing to validate scoring and evaluate benefits of real-world use of intervention for PWD, clinicians and payers. Disclosure S.E. Skovlund: Stock/Shareholder; Self; Novo Nordisk A/S. L. Nørgaard: None. S. Stefansen: None. T. Honnens de Lichtenberg: None. L. Troelsen: None. A. Pietraszek: None. P.H. Kjær: None. H. Ravn Larsen: None. P.O. Jakobsen: None. N. Ejskjaer: None. Funding Danish Health Care System