Traumatic Brain Injury (TBI) affects approximately 1.7 million persons in the United States annually, 75% are categorized as mild (mTBI). Most persons who experience mTBI will recover, however an estimated 10% will develop Postconcussion Syndrome (PCS). Evidence supports a relationship between perceived stress, salivary cortisol, and depressive symptoms in persons after TBI; however, there are no known studies exploring these relationships in the PCS patient population. A sample of 17 men and women diagnosed with PCS were recruited from Southwest and Central Virginia. Data collection included the Rivermead Postconcussion Questionnaire, Perceived Stress Scale-10, Center for Epidemiological Studies-Depression Scale and the PROMIS Emotional Distress (ED)- Depression Short form (SF). Salivary cortisol was collected with a SalivaBio Oral Swab Collection System. Data were analyzed with Wilcoxon Rank-Sum and Pearson’s Chi Square. Spearman’s Rank Order Correlation Coefficients were used to compare variables for correlation. We found a statistically significant relationship between stress and depression (Spearman rho=0.87; p <0.0001); however, we did not find a statistically significant relationship between stress and cortisol (Spearman rho=-0.11; p =0.6887) or depression and cortisol as measured by the CES-D (Spearman rho=-0.10; p=0.6989) and the PROMIS ED-Depression SF (Spearman rho= -0.40; p=0.1327). While perceived stress may impact report of depressive symptoms in persons diagnosed with PCS, much is unknown about the influence of other factors in the development of this syndrome. More research is needed to identify mechanisms behind the presence of PCS to further inform our understanding of this condition, and to apprise the development of nursing interventions.

<p>Syftet var att undersöka graden av upplevd stress i hem- och arbetsmiljö ur ett könsperspektiv. Syftet var även att undersöka om antal barn och ansvarsnivå i hemmet har någon betydelse för upplevd stress. Självskattad stress i hem- och arbetsmiljö undersöktes med Perceived Stress Scale hos 126 arbetande eller studerande män och kvinnor.  Studien visade att kvinnor upplevde högre stress än män främst i hemmet. Det framkom också att män upplever högre stress i arbetet än i hemmet, medan kvinnor inte uppvisade någon skillnad mellan de båda miljöerna.  Huvudslutsatsen var att upplevd stress kan förklaras av kön. Det konstaterades även att de traditionella könsrollerna verkar leva kvar både i empirin och i litteraturen, trots att vi många gånger tror att vi lever i ett jämställt samhälle.</p>

Research has shown that men treated for localized prostate cancer (PC) experience physical side effects of treatment that can compromise emotional well being (EWB). Psychosocial factors such as social support can buffer decrements in EWB associated with cancer treatment. The Social Cognitive Processing (SCP) model proposes that communication between the patient and their social support network results in greater processing of cancer adjustment related information and that such processing mediates the relationship between social support and better EWB. Few studies have investigated this relationship in PC populations. The current study sought to evaluate the SCP model in a sample of men who have undergone treatment for localized PC. The study (N=260) was conducted in an ethnically (37% Caucasian, 37% Hispanic, 15% African American) and demographically diverse sample using a cross-sectional design. After controlling for factors significantly associated with EWB (ethnicity, medical co-morbidities and number of years of education), results indicated that higher levels of social support were significantly related with higher levels of EWB (beta=.30, p<.01). Results also showed that two measures of cognitive processing (illness coherence and cognitive processing as a coping strategy) partially mediated the relationship between social support and EWB (illness coherence: z=2.28, p<.05; cognitive processing as a coping strategy: z=2.00, p<.05). Furthermore, perceived stress appeared to moderate the overall mediation model (beta=.91, p<.01) such that cognitive processing mediated the relationship between social support and EWB for individuals perceiving low levels of stress (z=1.90, p<.05), but not for individuals perceiving high levels of stress (z=.09, p>.05). Results suggest the importance of cognitive processing and perceived stress as potential targets for future intervention work designed to improve the psychosocial adjustment of PC patients following treatment.

The purpose of the present study is to examine the perceived stress of Turkish graduate students in the U.S.A., based on Cognitive Appraisal Theory of Stress, by looking at their perceived social support, academic self-efficacy, length of residence in the United States, gender, age, status in the degree of study, sponsorship, perceived income, previous travel experience, TOEFL scores, and perceived English proficiency. The participants of the study were 276 Turkish graduate students attending colleges and universities in the United States. Four instruments - the demographic information form, the perceived stress scale, the multidimensional scale of perceived social support, and the academic self-efficacy scale - were used. Results showed that predictors explained 38% of the total variance. Among all of the predictors, gender, perceived income and academic self-efficacy significantly contribute to the model. When individual contributions to the predictors were examined, academic self-efficacy was the strongest predictor of the perceived stress. Since academic self-efficacy is the strongest predictor of perceived stress, a multiple regression analysis was conducted to show which variables predict the academic self-efficacy. Gender, perceived income, English proficiency, and social support significantly explain the academic self-efficacy. There were not any significant differences between groups&rsquo / perceived stress scores according to marital status, department type, degree of study and living conditions. The only significant group difference was between students who were working and not working.

Syftet var att undersöka graden av upplevd stress i hem- och arbetsmiljö ur ett könsperspektiv. Syftet var även att undersöka om antal barn och ansvarsnivå i hemmet har någon betydelse för upplevd stress. Självskattad stress i hem- och arbetsmiljö undersöktes med Perceived Stress Scale hos 126 arbetande eller studerande män och kvinnor.  Studien visade att kvinnor upplevde högre stress än män främst i hemmet. Det framkom också att män upplever högre stress i arbetet än i hemmet, medan kvinnor inte uppvisade någon skillnad mellan de båda miljöerna.  Huvudslutsatsen var att upplevd stress kan förklaras av kön. Det konstaterades även att de traditionella könsrollerna verkar leva kvar både i empirin och i litteraturen, trots att vi många gånger tror att vi lever i ett jämställt samhälle.

Pregnancy is a time of alternating states of inflammation. The establishment of pregnancy is marked by controlled inflammation and transition toward an anti-inflammatory state for much of the gestational period before returning to an inflammatory state at the onset of labor. Stress and depression trigger the HPA Axis to produce cortisol and levels are maintained in a state of elevation during pregnancy and continue to rise before parturition. The aim of this research was to explore the relationship of gestational age at delivery with mid-pregnancy levels of cytokines, stress and depression. Participant samples (N = 122) were collected between 16 and 26 weeks gestation and analyzed for 14 cytokines using a bead-based multiplex assay. Plasma cortisol was also measured along with demographic variables and measures of perceived stress and dysphoric mood. Results of Pearson's correlations showed that gestational age at delivery was significantly inversely correlated with pro-inflammatory cytokine IFN-ã and anti-inflammatory IL-13. A significant positive correlation was noted with the number of pregnancies in the obstetric history and pregnancy length. Both cortisol and stress were not correlated with gestational age at delivery.

Bacterial Vaginosis is an inbalance of vaginal flora which has been associated with increased risk of numerous gynecological and obstetric morbidities including increased risk of acquisition of HIV from an infected partner and increased risk of preterm delivery. Black race has been consistently identified as a risk factor for BV. Black women also suffer from significant disparities in most of the morbidities also associated with BV when compared to women of other ethnicities and races. Traditional predictors of BV such as douching practices and sexual behaviors do not fully account for the racial disparities in BV prevalence. Researchers have begun to explore the potential relationship between stress and BV. Also, perceived racism has been identified as a potential stressor contributing to the health outcomes of Black women. The purpose of this study was to test a predictive model of bacterial vaginosis among Black women. The Allostatic Load Model was the theoretical framework. Participants (N=94) completed a self administered questionnaire and interview including measures of perceived stress, preceived racism, behavioral responses to stress and specific behavioral responses to racism along with traditional predictors of BV. Measurement scales included the Cohen Perceived Stress Scale, the John Henryism Scale of Active Coping, the Everyday Perceived Racial Discrimination Index, the Experiences of Discrimination Scale and the Vines Telephone Administered Perceived Racism Scale (TPRS) which included a behavioral responses to racism subscale. Bacterial vaginosis was diagnosed utilizing a self-collected vaginal swab which was analyzed utilizing the BVBlue point of care testing kit. Twenty percent (N=19) of participants screened positive for bacterial vaginosis. Douching and sexual activity in the last three months and education were significantly associated with bacterial vaginosis. Age, income, hormonal contraceptive use and condom use were not associated with BV. Neither perceived stress nor perceived racism were associated with bacterial vaginosis. After logistic regression analysis, only education continued to be a significant predictor of BV. The lack of an association between BV and the main study variables may have been related to young age of the sample or the low rates of high perceived stress and high perceived racism. Perceived stress was positively associated with perceived racism and behavioral responses to stress. This association is likely a reflection of the stressful nature of perceived racism. Further research is needed to better understand how the stressful nature of racism and behavioral responses to stressors may influence health outcomes and if interventions can be utilized to promote adaptive behavioral responses.

A large body of evidence supports the notion that chronic stress and strain may impact healing from physical trauma. However, no evidence exists to substantiate whether chronic stress impacts recovery from exercise-induced muscle damage. In this study, a group of 31 undergraduate weight-training students completed the Perceived Stress Scale (PSS), Undergraduate Stress Survey (USQ, a measure of life event stress) a series of fitness tests and then returned 5 to 10 days later for an exhaustive resistance exercise stimulus (E-RES) workout. This workout was performed on a leg press to the cadence of a metronome to ensure a strong eccentric component of exercise. Participants were monitored for 1 hour after this workout and every day for 4 days afterwards. Hierarchical Linear Modeling (HLM) multi-level growth curve analyses demonstrated that stress measures were related to recovery from maximal resistance exercise for both functional muscular (maximal isometric force, jump height, and cycling power) and psychological (perceived energy, perceived fatigue, and soreness) outcomes. Stress was not related to outcomes immediately post-workout (except maximal cycling power) after controlling for pre-workout values. Thus, the effect of stress on recovery is not likely due to magnitude of disruption from maximal exercise. After controlling for significant covariates, including fitness and percent disruption from baseline, individuals scoring a 10 on the PSS at their first visit reached baseline 288% (2.88 times) faster than individuals who scored a 19 at this same time point. There were significant moderating effects of stress on affective responses during exercise. Feeling (pleasure/displeasure), activation (arousal), muscular pain and RPE (exertion) trajectories were moderated by stress. Exploratory analyses found that stress moderated physical recovery, but not psychological recovery in the first hour after the E-RES workout. Also, stress was related to the increase in IL-1[beta], a pro-inflammatory cytokine, in the 48 hour period after exercise for a sub-set of participants. These findings likely have important theoretical and clinical implications for those undergoing vigorous physical activity. Those experiencing chronic loads of stress and mental strain should include more rest time to ensure proper recovery. / text

BACKGROUND: There are many studies that have documented the increasing impact of stress and anxiety on an individual’s health and well-being. Everyone handles stress and anxiety differently with these conditions having varying physiological effects. To better recognize whether or not a person may need help in tackling these conditions, scholars have developed reliable validated instruments. Two prominent instruments that effectively assess stress and anxiety levels are the Perceived Stress (PSS) and Generalized Anxiety Disorder (GAD-7) scales. Furthermore, the literature has shed light onto the importance of the carotid intima-media thickness (c-IMT) measurement as a tool in evaluating the risk of cardiovascular disease. After all, heart disease has been reported as being the number one killer of Americans in recent years. The specific aims of this study were to determine if there was an association between perceived stress / generalized anxiety and c-IMT (static association), and also if higher levels of perceived stress / generalized anxiety result in a significant increase in c-IMT (changes over time). METHODS: Data was collected on about 700 participants comprised of employees from Emory University in Atlanta, Georgia. At baseline, six, twelve, and twenty-four months, the largest number of participants had completed and calculated their scores on the PSS and GAD-7 scales. At these same time points, participants had their IMT measured and recorded for the left and right common carotid arteries by a trained sonographer of the Emory Predictive Health Institute. Due to incomplete measurements and scores, only 228 participants were included for statistical analyses. This was still considered a suitable sample size given that this study only involved four measurement time points. Various statistical models were fitted for the data. All variables in the models were treated as categorical except for time which was continuous. Four separate models were built that included the variables perceived stress, age group, gender and time. In a similar manner, four models were built that included the variables generalized anxiety, age group, gender and time. AIC values, -2 log-likelihoods, partial correlations, p-values, and other relevant information were reported for these models. All statistical analyses were performed using the Statistical Analysis System (SAS), version 9.2. RESULTS: The mean c-IMT measurements for the Emory participants were higher than established normal ranges. A strong correlation existed between the PSS and GAD-7 two-year averages when treated as continuous variables (.7316, p <.0001). Likewise, a meaningful relationship existed when both scales were categorical (.4154, p < .0001). The analyses revealed that the left and right mean IMT measurements for the common carotid arteries modeled a linear trend with an unstructured covariance the best. The partial correlations for perceived stress and generalized anxiety revealed weak, but significant positive associations with the mean c-IMT measurement. Although the slope coefficients were not significant for perceived stress, an increase from below average to above average perceived stress level still resulted in an increase in mean c-IMT measurement. Conversely, mild generalized anxiety was found to be statistically significant in the regression model of the left mean c-IMT. This was after controlling for age group and gender. The p-value for mild generalized anxiety was 0.0258, and the slope coefficient was 0.04856. IMT measurements were consistently higher for males on both sides compared to females. They were also higher on the left side compared to the right. CONCLUSIONS: Failure to control anxiety could lead to c-IMT soaring to dangerous levels resulting in a myocardial infarction and/or cerebrovascular accident. Individuals should engage in healthy lifestyle practices that lower stress and anxiety levels to decrease the chances of cardiovascular disease. Based on this study’s findings, a person can certainly use their c-IMT readings, as well as their perceived stress and generalized anxiety scores, as indicators that lifestyle modifications may be needed.

Previous research has reported positive associations between anger, perceived stress and blood pressure. These associations have largely been based on cross-sectional data and a small number of longitudinal works. Using a prospective longitudinal cohort design, this study more directly tested the relationships between anger, perceived stress and blood pressure by using a psychological therapeutic intervention (mindfulness-based stress reduction) to manipulate anger and perceived stress. Anger and perceived stress were in turn evaluated for association with blood pressure. Despite improvements in psychosocial functioning and reductions in blood pressure, findings from this study failed to demonstrate an association between change in anger or perceived stress with change in daytime or 24-hour ambulatory blood pressure. A model where these variables interact indirectly via stress coping mechanisms or health behaviours may be the linking mechanism in this study. Results from this thesis have contributed evidence to a divided field dominated by cross-sectional research.