The Hypothalamus-Pituitary-Adrenal axis (HPA-axis) with its end product cortisol mediates the physiological response to stress thereby promoting mobilization of energy. The cortisol levels follow a diurnal rhythm with a distinct awakening response. Regulation of the HPA-axis differs among persons with certain psychiatric disorders when compared with controls. Some reports concern Attention-Deficit/Hyperactivity Disorder (ADHD) but findings are inconclusive. The main aim of the present thesis was to investigate diurnal levels of saliva cortisol in school aged children with ADHD and age matched non-affected comparisons, also taking early adversity, perceived stress and ADHD-medication into consideration. Children with ADHD had lower cortisol levels at awakening, 30 minutes later and before going to bed than comparisons. When the study group was split into three different age groups similar results were found only for children above 10 years of age. Within the ADHD group, subtype of ADHD or co-occurring symptoms did not affect the cortisol levels. Furthermore, children in the ADHD group had to a higher degree been exposed to foetal and childhood psychosocial adversity than comparisons. Since exposure to early adversity has been associated with both ADHD and HPA-axis functioning, such exposures could theoretically explain the low cortisol levels in ADHD via early programming of the HPA-axis. However, no relation was found between exposures to psychosocial adversity and diurnal cortisol levels. Neither did continuous medication with stimulants or atomoxetine explain the low cortisol levels. Possibly, medication may rather increase the levels. Finally, children with ADHD scored higher on perceived stress, measured by the Pressure-Activation-Stress (PAS) scale, than the comparison group. Female sex was also associated with higher stress in both groups, as well as increasing age in the comparison group. As with psychosocial adversity, no association was found between the higher PAS-scores and the lower cortisol levels, indicating the complexity of the stress regulating system. The results indicate a down-regulated or displaced HPA-axis with lower cortisol levels in children with ADHD. Stress related fragility – with more exposure to early stressors, higher perceived stress and lower diurnal cortisol levels – seem to accompany ADHD during childhood.

Den aktuella studien syftade till att undersöka sambandet mellan självmedkänsla ochgenerell, upplevd stress hos svenska ungdomar, 15-19 år. Förutom att undersökaovanstående fråga undersöktes även hur väl självmedkänsla predicerade generell,upplevd stress i samma stickprov, när effekten av ålder och kön kontrollerades för.Studiens deltagare bestod av 226 ungdomar studerande vid högstadie- ellergymnasieskola i södra Sverige och data samlades in via Self-Compassion Scale ShortForm (SCS-SF) och Perceived Stress Scale (PSS-14) och i klassrumsmiljö. Resultatetvisade en signifikant, negativ korrelation mellan självmedkänsla och generell, upplevdstress. Självmedkänsla var också en signifikant prediktor för stress, efter det att effektenav ålder och kön hade kontrollerats för, och förklarade ensam 29,3 % av variansen istress. Detta resultat indikerar att självmedkänsla kan komma att spela en viktig roll iden fortsatta utvecklingen av förebyggande och stressreducerande behandlingar. / The current study aimed at exploring the correlation between self-compassion andgeneral, perceived stress among Swedish adolescents, age 15-19 years. Furthermore, theextent to which self-compassion predicted general perceived stress, when controlling forthe effect of age and gender, was explored. The participants of the study consisted of226 adolescents attending the Swedish equivalent to high-school (year 9-12) in southernSweden, and data was collected with Self-Compassion Scale Short Form (SCS-SF) andPerceived Stress Scale (PSS-14) in classroom settings. Results showed a significant,negative correlation between self-compassion and general, perceived stress. Selfcompassionremained a significant predictor for stress, after controlling for the effect ofage and gender, and uniquely explained 29,3 % of the variance in stress. This resultindicates that self-compassion may be useful in the future development of preventionand stress-reducing treatments.

The study of stress is limited in professional nursing, but it is nearly non-existent in professional military nursing. The purpose of this study was to explore the relationships among psychological, environmental, biological and demographic factors of stress in new Army nurses during the Army Medical Department’s 8-week Officer Basic Leadership Course (OBLC). Using a descriptive prospective, correlational repeated measures design, 33 study participants completed two psychological stress measures (Perceived Stress Scale [PSS] and the Impact of Event Scale – Revised[IES-R]), an environmental measure (Life Experiences Survey [LES]), a biologic measure (salivary cortisol) and a demographic questionnaire at three different time points during OBLC: at the beginning of OBLC, during the field training exercise and at the end of OBLC. The majority of participants were single, Caucasian females under 30 years of age with no RN experience and no deployment experience. No significant gender differences were detected among study variables. A simple (single-group) repeated measures analysis of the PSS scores, IES-R scores, and salivary cortisol was conducted using the LES score as a covariate. While the PSS scores and salivary cortisol levels did not change significantly over time, the IES-R score did change significantly over time (p = 0.001). The environmental factor (LES score) was not significant as a covariate in any of the three models. The unique baseline findings in this study may provide a springboard for further studies in stress particularly with military nurses who will eventually be deployed and experience a variety of stressful events. Longitudinal research could yield important predictive information related to how the stress response evolves over the course of one’s military career which may include frequent deployments to the combat zone.

The purpose of the study was to perform a quantitative occupational stress risk assessment (OSRA) to evaluate the impact of health promotion (HP) lifestyle and perceived nature contact on the consequences of perceived stress from exposure to nursing stress risk factors. Perceived stress is defined as the employee’s personal interpretation of his or her work circumstance and any discrepancy between workplace demands (stressors) and individual capacities (resources). Registered nurses (RNs) in patient care settings are prone to high levels of perceived stress, which can cause errors in clinical care giving. High perceived stress is a consequence of risk factors from a nurse’s daily work routine including: workload, death and dying, inadequate preparation for role, staff support, uncertainty concerning treatment, communication with physicians, and communication with other nurses. Mitigating perceived stress improves nursing job performance, job satisfaction, and overall employee health, while reducing mental fatigue, absenteeism, and burnout. Methods performed included: Aim 1) a systematic literature and meta-analysis to establish benchmarks for perceived stress in nursing professionals for comparison of United States (US) and International healthcare settings; Aim 2) a cross-sectional study using a 125-item survey instrument administered online to an RN study population to evaluate relationships between perceived stress, HP lifestyle, and perceived nature contact; and Aim 3) a quantitative OSRA to rank nursing stress risk factors and examine differences by gender, ethnicity, and race. Results were: Aim 1) Perceived Stress Scale 14-item (PSS14) value for International nursing studies was 25.41 (95% CI 21.1 to 29.7), while US PSS14 nursing studies yielded a value of 23.8 (95% CI 19.8 to 27.7). Aim 2) the present study found Southern California RNs (n=161) had the same perceived stress (m = 22.8, 7.06 SD, p=0.082) as other US nursing professionals. RN perceived stress scores were negatively correlated (p<0.001) to HP lifestyle. HP lifestyle was positively correlated (p<0.001) to perceived nature contact. Aim 3) the OSRA model using HP lifestyle for coping exhibited the highest strength (92%) and reliability (90%); this model established RNs' risk factor rankings (RFRs) from high to low as: 1) communication with physicians, 2) workload, 3) uncertainty concerning treatment, 4) death and dying, 5) inadequate preparation for role, 6) communication with other nurses, and 7) staff support. High nursing RFRs were the same by gender. Differences were found with Hispanic RNs who ranked communication with other nurses as RFR 3 compared to non-Hispanic RNs at RFR 7. Also, non-white RNs ranked inadequate preparation for role as RFR 2 compared to white RNs at RFR 5. Although present study results focused on a single health provider RN population using self-reported survey instruments, the OSRA process can be applied to any occupational setting. This study supports introducing a quantitative OSRA process initiated in Europe to US worksites to identify and rank occupational stress risk factors for strategic prioritization and alignment with interventional resources. With continuous replication of OSRA within and between work-sectors, this process could elucidate US industry health and safety best practices. The present study focused on nurses as a first-test-case high-stress occupation. More OSRA nursing studies are recommended across a wider US geographic area to create normative values of comparison including stratum for gender, ethnicity, and race. Intervention, intervention effectiveness, and organizational change studies are needed to mitigate high nursing stress risk factors emanating from healthcare organizational challenges and to emphasize implications for improved patient care outcomes.

Syftet med studien var att undersöka studenters stressnivå genom attstudera huruvida olika examinationsformer kan leda till olikastresstyp, prestationsmotivation och upplevd stress. Metoden somgenomfördes var en enkätundersökning där man undersökte hurstudenter upplevde nivån av stress och prestationsmotovation inför treolika examinationstyper; salstentamen, hemtentamen och muntligpresentation. I studien deltog 112 universitetsstudenter, 87 kvinnoroch 25 män. Hypoteserna var att hemtentamen genererar lägst stressmen även minst positiva effekter, medan det omvända gäller försalstentamen. Resultatet visade att studenter upplever inge skillnad pånivån av stress gentemot examinationsformerna, de upplever ingenskillnad av stresstyp emellan examinationsformerna samt att det inteförekom könsskillnader. / A cross-sectional study based on a survey was handed out to studentsat a university in a Swedish city. The purpose of the study was toinvestigate the stress levels of students by examining whetherdifferent forms of examination could lead to differenteffects;specifically, achievement motivation and experienced stress.The survey questions investigated how students felt regarding stresslevels and symptoms in relation to exam types. Our hypotheses werethat take-home written exams would result in lower stress levels butalso lead to less motivation, whereas the opposite would be true forwritten exams during observation. The study showed that studentsdon’t experience any difference in the level of stress towards theexaminations types. The result also showed that the type of stress,achievement motivation and experienced stress didn’t effect theexaminations type and finally there were no difference in stress levelbetween genders.

Stressrelaterade besvär är ett stort samhällsproblem inte minst bland studenter. Tidigare forskning tyder på att stress är ett multifaktoriellt fenomen. Syftet med studien var att undersöka relationen mellan stress och kön, akademisk self-efficacy, copingstrategier samt fysisk aktivitet. Hundratjugosju högskolestudenter, varav 43 män besvarade en enkät innehållande frågor om kön, fysisk aktivitet, stress, copingstrategier och akademisk self-efficacy. De etablerade instrumenten var: Perceived Stress Scale, Brief Cope och College Academic Self-Efficacy Scale. Resultaten visade att kvinnor upplevde högre grad av stress än män. Resultatet visade positiv korrelation mellan stress och undvikande emotionella copingstrategier. En negativ korrelation visades mellan stress och akademisk self-efficacy, samt mellan stress och problemfokuserade copingstrategier. Vidare resultat visade att akademisk self-efficacy och copingstrategier (problemfokuserade, aktiva emotionella, undvikande emotionella) kunde förklara störst varians i högskolestudenternas upplevda stress. Framtida forskning bör var av kvalitativ karaktär och bedrivas med copingstrategier som utgångspunkt för att fånga individens subjektiva upplevelse av stresshantering.

Föreliggande studies syfte var att studera socialt stöd som moderator i relationen mellan stress och idrottsrelaterad utbrändhet bland idrottande ungdomar. Deltagarna valdes via ettstrategiskt bekvämlighetsurval och krav att ha minst 3 träningar i veckan utöver tävling inom sin idrott. Totalt deltog 91 ungdomar i studien (M=17,3 SD=0.98). Studien är kvantitativ tvärsnittsdesign och data samlades i form av frågeformulär och internetbaserade formulär. Frågeformuläret bestod av demografiska frågor och tre mätinstrument Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Stress Scale (PSS) och Athlete burnout Questionnaire (ABQ). Enkäten bestod av 41 påståenden och sju bakgrundsfrågor. I resultatet framkom att det inte fanns en statistisk signifikant interaktionseffekt mellan socialt stöd och stress i relation till idrottsrelaterad utbrändhet. Socialt stöd är inte moderator i relationen mellan stress och idrottsrelaterad utbrändhet. Det fanns inget statistiskt signifikant samband mellan stress och idrottsrelaterad utbrändhet. Det fanns ett statistiskt signifikant samband mellan socialt stöd och idrottsrelaterad utbrändhet. / The purpose of the study was to examine if social support can buffer the relation between perceived stress and athlete burnout in youth athletes. Through strategic convenience sample were 91 participants recruited (M=17, 3 SD= .98).  The study used a quantitative cross-sectional design were data was collected via questionnaire and internet-based questionnaire. Data was collected from youth athletes whom practice sports at least 3 times a week. The questionnaire was based on following instruments: Demographic questions, Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Stress Scale (PSS) and Athlete Burnout Questionnaire (ABQ). The questionnaire included 41 statements and seven background questions. The result showed no statistical significant interaction between social support and perceived stress in relation with athlete burnout. Social support is not a moderator in the relation between stress and athlete burnout. The result showed no statistical significant correlation between perceived stress and athlete burnout. There was showed a statistical significant correlation between social support and athlete burnout.

Multiple Sclerosis (MS), an autoimmune disorder marked by inflammation of the central nervous system, is associated with a myriad of symptoms. Individuals with MS are more likely to experience depressive symptoms, perhaps due to perceived cognitive impairments. Thus, we aimed to explore perceived stress and sleep deficits as potential mediators of the association between perceived cognitive deficits and depressive symptoms. We recruited a sample of 77 MS participants from an outpatient, university-based MS clinic in the United States. Participants ranged in age between 30 and 75 years old (M = 51.12; SD = 9.6), with more females than males (83% female; n = 64). Participants completed the Perceived Deficits Questionnaire, the Pittsburgh Sleep Quality Index, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Scale – Revised. Correlation analyses and mediation analyses were conducted with bootstrapping technique. Statistical analyses revealed that higher levels of perceived cognitive deficits were associated with lower quality of sleep, more perceived stress, and higher levels of depressive symptoms. Additionally, both perceived stress and sleep quality served as a significant mediator in the perceived cognitive impairments and depressive symptoms linkage. Our novel findings demonstrate the importance of underlying mechanisms (e.g., sleep quality and perceived stress) in the conceptualization of MS. Perceived stress and sleep quality are potentially modifiable factors, perhaps serving as a target for future treatment, to buffer risk of MS patients developing depression.

Because of the impact of stress on health, it is important to understand the variables that underlie cardiovascular reactivity to stress because it may lead to more focused targets of intervention for helping people to reduce or otherwise better manage their stress. The purpose of the present study was to answer the following questions: does lack of eudaimonic well-being (a combination of psychological and social well-being) predict increased cardiovascular reactivity to stress in a clinically distressed population? And does increased eudaimonic well-being protect against increased cardiovascular reactivity to stress when hedonic well-being (a combination of positive affect and life satisfaction) is low and depression and stress are high? If so, then it may be possible to reduce the effects of stress on health even if depression and stress are present. One hundred twenty-nine college students (ages 18-29) who were clinically distressed were administered a questionnaire that included questions about demographic variables and measures of hedonic and eudaimonic well-being, depression, and general perceived stress. After answering the questionnaire, a baseline reading of cardiovascular activity was taken. After the baseline reading, participants were subjected to the Trier Social Stress Test (TSST), an interpersonal stressor that consists of an anticipation period, a speech, and a math task. Measurements of cardiovascular activity were taken throughout the TSST. I predicted that lower levels of eudaimonic and hedonic well-being, mental health, and higher amounts of general perceived stress would predict increased cardiovascular reactivity to the TSST as measured by systolic blood pressure, diastolic blood pressure, and heart rate. Then, should the prior hypothesis be true, I predicted that higher eudaimonic well-being will suppress the effect of lower hedonic will-being, lower mental health, and higher general perceived stress on cardiovascular activity to acute stress. Results of the study found no effect of eudaimonic well-being, hedonic well-being, depression, and general perceived stress on cardiovascular reactivity during the TSST. The results suggest that there is no relationship between well-being, depression, and general perceived stress and cardiovascular reactivity to stress in a young college student population.

The study of stress on police task performance is important as this relationship can positively or negatively impact encounters with the public. This study focused on protective factors of positive psychology within the measured construct of dispositional optimism as a possible mediator of stress effects on physical task performance. The cognitive processing models used were the performance efficiency theory and attentional control theory as they apply in perceptual motor skill. Using a mediation model, the research question asked whether dispositional optimism mediated the relationship between stress and a pistol performance accuracy task. This study used a limited data set collected by a law enforcement training center (N = 80). The survey instruments used to measure stress and dispositional optimism were the Perceived Stress Scale and the Life Orientation Test - Revised, respectively. Correlation and multiple regression were used to analyze the significance of the mediation model. Ultimately, the results were unable to detect significance between dispositional optimism (p > .05) and stress (p > .05) on pistol accuracy outcomes. However, a significant relationship was found between dispositional optimism and stress (p < .05). Future research recommendations include an intervention protocol with several levels of pistol shooting difficulty and biological stress measurements. Implications for social change include further understanding of how to better manage stress for increased accuracy in pistol performance tasks along with increased mental processing and increased positive outcomes. Overall, better education and training for the officer will contribute to more positive encounters with the public.