As all couples experience stressful life events, understanding how couples adapt to stress is imperative for understanding marital development. Drawing from theories of stress inoculation, which suggest that the successful adaptation to mild stressors may help individuals develop a resilience to future stress, this project examined whether couples who have more experience effectively coping with minor stressors early in the marriage would be most resilient to declines in marital satisfaction when faced with future, larger stressors. Study 1 examined whether couples who enter marriage with good relationship skills and some experience coping with minor stressors exhibit the most stress resilience during the first two years of marriage. Study 2 examined whether couples who enter marriage with good skills and some experience with stress exhibit a greater resilience to the declines in marital satisfaction that often follow the transition to parenthood. Both studies revealed that spouses who have both good relationship skills and early stress experience exhibit better marital outcomes than spouses who have good skills, but little or no experience with stress. Thus, simply possessing good relationship skills may not be sufficient to shield marital satisfaction from stress. Rather, couples also may need practice applying those skills to minor stressors. / text

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Background and objectives: Physical fitness and stress resilience may influence the risk of gastrointestinal (GI) disease. High physical fitness level may reduce levels of systemic inflammation while psychosocial stress exposure can increase inflammation levels and intestinal permeability. The main objectives are to evaluate if poorer physical fitness and stress resilience in adolescence are associated with a raised risk of inflammatory bowel disease (IBD), peptic ulcer disease (PUD) and GI infections in adulthood and to assess evidence of causality. Materials and methods: Swedish registers provided information on a cohort of approximately 250,000 men who underwent military conscription assessments in late adolescence (1969 –1976) with follow-up until December 2009 (up to age 57 years). Cox regression evaluated the associations of physical fitness and stress resilience in adolescence with subsequent GI disease risk in adulthood. Results and conclusions: IBD: Poor physical fitness was associated with an increased risk of IBD. The association may be explained (in part) by prodromal disease activity reducing exercise capacity and therefore fitness. Low stress resilience was associated with an increased risk of receiving an IBD diagnosis. Stress may not be an important cause of IBD but may increase the likelihood of conversion from subclinical to symptomatic disease. PUD: Low stress resilience was associated with an increased risk of PUD. This may be explained by a combination of physiological and behavioural mechanisms that increase susceptibility to H. pylori infections and other risk factors. GI infections: Low stress resilience was associated with a reduced risk of GI infections, including enteric infections rather than the hypothesised increased risk.

The aim of the study is to examine how well MSB (Swedish Civil Contingencies Agency) prepare the Swedish humanitarian aid workers to face stressful situations, looking at the pre- deployment preparation received. The study investigates how effective and relevant the pre- deployment preparation is in terms of building resilience against stress, according to the humanitarian aid workers’ experience. This study has been conducted with a quantitative online survey, combined with a qualitative open- ended survey. The surveys were based on research models on work-related stress and on resilience- building among humanitarian aid workers. The frameworks point out criteria needed to be fulfilled by an organization in order to build sufficient stress- resilience among humanitarian aid workers in the pre- deployment phase. The results reveal that MSB is able to fulfill most of the criteria set in accordance with the theoretical framework. The one and only criterion MSB fails in providing is an open, in- depth discussion about mental health before the aid worker is deployed. This also corresponds to the aid workers experience of not being provided with this. The aid workers’ experience reveals that resilience against stress is important, however, many seem to build resilience independently from MSB.

Habitual suppression of emotions has been linked to adverse consequences such as avoidant attachment, lower social support, and reduced relationship closeness (e.g. John & Gross, 2004). However, accumulating evidence that expression and suppression can be both adaptive and maladaptive in different contexts suggests the importance of flexibility in emotional regulation. The present study examined the mechanisms underlying the only laboratory measure of emotional flexibility: the Expressive Flexibility (EF) task (Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). This measure has been linked to adjustment over a one-year period, especially in the context of social threat, and among people who have experienced higher levels of life stress (Westphal, Seivert & Bonanno, 2010). We sought to test whether EF is related to physiological recovery from stress in the immediate term. Participants completed questionnaire measures, the EF Task and a stressful public speaking task. In the EF task, participants were filmed suppressing, exaggerating, and not altering facial reactions to negative and positive pictures. A “balanced EF” score was calculated reflecting their ability to suppress and exaggerate with equal success. Regression analyses used EF scores as predictors for psychophysiological indices of stress (SCR and HR) during and after the public-speaking task. The interaction of EF and social safeness (SSPS) was predictive of the magnitude of SCR recovery, such that for people with lower EF, higher SSPS is predictive of greater SCR recovery. These results converge with previous findings on the suggestion that EF is related to resilience, especially in the context of adversity.

Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.

The World Health Organization has called stress-related illness “the health epidemic of the 21st century.” While the biochemical pathways associated with the acute stress response are well-characterized, many of the pathways behave differently under conditions of chronic stress. The purpose of this project is to apply high-sensitivity mass spectrometry (MS)-based targeted and untargeted metabolomics approaches to generate new insights into the biochemical processes and pathways associated with the chronic stress response, and potential mechanisms by which chronic stress produces adverse health effects. Chapter 1 describes the application of sets of targeted and untargeted metabolomics approaches to analyze serum samples from a human epigenetic model of chronic stress in order to identify potential targets for further analysis. To test the resulting hypothesis that oxidative stress is a key feature of chronic stress, a new targeted multiple reaction monitoring (MRM)-MS assay was developed for the accurate quantitation of aldehyde products of lipid peroxidation, as described in Chapter 2. In Chapter 3, the validated method for quantitation of malondialdehyde (MDA) was t applied to mouse plasma samples from a model of chronic social defeat stress to determine whether animals exposed to psychosocial stress show increases in oxidative stress. Mouse plasma samples from this model were also analyzed by untargeted metabolomics using Fourier-transform (FT)-MS to identify other important metabolite features, particularly those that overlap with metabolites identified in the human epigenetic model. Analysis of metabolomic data from two very different models of chronic stress supports the consistent detection of a metabolomic phenotype for chronic stress that is characterized by the dysregulation of energy metabolism associated with decreased concentrations of diacyl-phospholipids in blood. Increased blood concentrations of fatty acids, carnitines, acylcarnitines, and ether phospholipids were also observed. In addition to metabolites associated with energy metabolism, chronic stress also significantly influenced metabolites associated with amino acid metabolism and cell death. This characteristic pattern of differences in metabolite concentrations was observed in the plasma of mice exposed to chronic social defeat stress, irrespective of whether or not they displayed outward signs of a chronic stress response; In fact, mice that were “resilient” to the behavioural effects of chronic social defeat stress displayed an exaggerated phenotype over mice that showed depressive-like symptoms following chronic stress exposure. This may suggest that the observed changes in fatty acid composition are protective against stress. However, changes in fatty acid composition are also known to be associated with a wide variety of pathologies including heart disease, neurodegenerative diseases, and mood disorders, so the lipidomic changes associated with chronic stress may also contribute to its health impact. Overall, the results provide further evidence that changes in energy metabolism are a central part of allostatic adaptation to chronic stress. / Graduate / 0487 / csobsey@gmail.com

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24088号 / 医博第4864号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 林 康紀, 教授 渡邉 大, 教授 髙橋 良輔 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Well-being is fundamental for health. However, health and well-being are under threat by increased prevalence of depression and physical inactivity. Interaction with the natural environment may prevent these critical health issues, as research has shown that walking outdoors contributes to better well-being than walking indoors. The aim of this thesis was to investigate outdoor group walks as a potential public health intervention to enhance positive mental and emotional well-being, reduce stress, and foster resilience. This thesis evaluated Walking for Health, a national group walking programme in England using a nonexperimental, longitudinal design. Individuals who did (Group Walkers) and did not (Non-Group Walkers) take part in outdoor group walks completed two online questionnaires about their mental and emotional well-being, and covariates. To gain a broader understanding of how outdoor group walks may contribute to positive well-being, integrations were proposed between the Attention Restoration Theory and the psycho-evolutionary model, and the theories of coping and resilience. Findings show that Group Walkers had greater mental well-being and positive affect, and less negative affect, depression and perceived stress than Non-Group Walkers. Group walking had no affect on social well-being, connectedness to nature or resiliency. Outdoor group walk participation affected positive well-being through a decrease in perceived stress, and an increase in physical activity. Group Walkers demonstrated resilience against adversity on negative affect. No evidence of resilience from outdoor group walks was found for mental well-being, positive affect or depression. Group walks in farmland and green corridor environments may further boost mental well-being, and reduce negative affect and perceived stress, when compared to group walks in the urban environment. This research suggests that outdoor group walks are effective at improving mental and emotional well-being, and could be a useful public health intervention to reduce stress and foster resilience. Implications for theory are discussed.

Pochi studi hanno indagato le conseguenze psicologiche di incidenti stradali che coinvolgono adolescenti e giovani adulti (Blanchard at al., 2005; Steil et al., 2001). Attraverso un approccio multi-metodo la ricerca indaga le reazioni psicologiche di genitori e ragazzi ad incidenti stradali, le risposte familiare in grado di svolgere una funzione protettiva e l'impatto psicologico delle modalità di comunicazione del personale sanitario. 50 ragazzi (13/23 anni), vittime di incidenti stradali e i rispettivi genitori hanno risposto a 3 questionari e ad un'intervista narrativa. La reazione dei ragazzi risulta indipendente dalla gravità dell'incidente, mentre la risposta familiare è organizzata in funzione di tale gravità. Emerge un effetto di mediazione della comunicazione del personale sanitario. / Few researches focused on psychological impact of motor vehicle accidents on adolescents and young adults (Blanchard et al., 2005; Steil et al., 2001). This research uses a multi-method approach to explore adolescents' and their parents' psychological reaction to motor vehicle accidents and family patterns protective. The study also investigates the impact of doctors' and nurses' communication strategies. 50 subjects aged 13-23 involved in motor vehicle accidents and their parents answered to 3 questionnaires and a narrative interview. Adolescents' stress response is not related to severity of physical injuries. Severity of physical injuries organizes family answer. The research underlines a mediation effect of doctors' and nurses' communication strategies.