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Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries.
Santosa, A, Rosengren, A, Ramasundarahettige, C, Rangarajan, S, Gulec, S, Chifamba, J, Lear, SA, Poirier, P, Yeates, KE, Yusuf, R, et al
JAMA network open. 2021;(12):e2138920
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Abstract
IMPORTANCE Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. OBJECTIVE To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. EXPOSURES All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. MAIN OUTCOMES AND MEASURES The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. RESULTS A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, 34 958 participants (29.4%) reported low stress, and 53 252 participants (44.8%) reported no stress. High stress, compared with no stress, was more likely with younger age (mean [SD] age, 48.9 [8.9] years vs 51.1 [9.8] years), abdominal obesity (2981 participants [34.3%] vs 10 599 participants [19.9%]), current smoking (2319 participants [26.7%] vs 10 477 participants [19.7%]) and former smoking (1571 participants [18.1%] vs 3978 participants [7.5%]), alcohol use (4222 participants [48.5%] vs 13 222 participants [24.8%]), and family history of CVD (5435 participants [62.5%] vs 20 255 participants [38.0%]). During a median (IQR) follow-up of 10.2 (8.6-11.9) years, a total of 7248 deaths occurred. During the course of follow-up, there were 5934 CVD events, 4107 CHD events, and 2880 stroke events. Compared with no stress and after adjustment for age, sex, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, and family history of CVD, as the level of stress increased, there were increases in risk of death (low stress: hazard ratio [HR], 1.09 [95% CI, 1.03-1.16]; high stress: 1.17 [95% CI, 1.06-1.29]) and CHD (low stress: HR, 1.09 [95% CI, 1.01-1.18]; high stress: HR, 1.24 [95% CI, 1.08-1.42]). High stress, but not low or moderate stress, was associated with CVD (HR, 1.22 [95% CI, 1.08-1.37]) and stroke (HR, 1.30 [95% CI, 1.09-1.56]) after adjustment. CONCLUSIONS AND RELEVANCE This cohort study found that higher psychosocial stress, measured as a composite score of self-perceived stress, life events, and financial stress, was significantly associated with mortality as well as with CVD, CHD, and stroke events.
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Technician-Scored Stool Consistency Spans the Full Range of the Bristol Scale in a Healthy US Population and Differs by Diet and Chronic Stress Load.
Lemay, DG, Baldiviez, LM, Chin, EL, Spearman, SS, Cervantes, E, Woodhouse, LR, Keim, NL, Stephensen, CB, Laugero, KD
The Journal of nutrition. 2021;(6):1443-1452
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BACKGROUND Prior studies of adults with constipation or diarrhea suggest that dietary intake, physical activity, and stress may affect stool consistency. However, the influence of these factors is unresolved and has not been investigated in healthy adults. OBJECTIVES We assessed the relations of technician-scored stool consistency in healthy adults with self-reported diet, objectively monitored physical activity, and quantifiable markers of stress. METHODS Stool consistency was scored by an independent technician using the Bristol Stool Form Scale (BSFS) to analyze samples provided by healthy adults, aged 18-65 y, BMI 18-44 kg/m2, in the USDA Nutritional Phenotyping Study (n = 364). A subset of participants (n = 109) were also asked to rate their sample using the BSFS. Dietary intake was assessed with two to three 24-h recalls completed at home and energy expenditure from physical activity was monitored using an accelerometer in the 7-d period preceding the stool collection. Stress was measured using the Wheaton Chronic Stress Inventory and allostatic load (AL). Statistical and machine learning analyses were conducted to determine which dietary, physiological, lifestyle, and stress factors differed by stool form. RESULTS Technician-scored BSFS scores were significantly further (P = 0.003) from the central score (mean ± SEM distance: 1.41 ± 0.089) than the self-reported score (1.06 ± 0.086). Hard stool was associated with higher (P = 0.005) intake of saturated fat (13.8 ± 0.40 g/1000 kcal) than was normal stool (12.5 ± 0.30 g/1000 kcal). AL scores were lower for normal stool (2.49 ± 0.15) than for hard (3.07 ± 0.18) (P = 0.009) or soft stool (2.89 ± 0.18) (P = 0.049). Machine learning analyses revealed that various dietary components, physiological characteristics, and stress hormones predicted stool consistency. CONCLUSIONS Technician-scored stool consistency differed by dietary intake and stress hormones, but not by physical activity, in healthy adults.This trial was registered at clincialtrials.gov as NCT02367287.
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The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study.
Myoga, Y, Manabe, H, Osaki, Y
BMC anesthesiology. 2021;(1):245
Abstract
BACKGROUND Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications. METHODS We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications. RESULTS Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48-71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications. CONCLUSIONS Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.
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Implications of electronic cigarette use for depressive mood: A nationwide cross-sectional study.
Lee, S, Oh, Y, Kim, H, Kong, M, Moon, J
Medicine. 2020;(40):e22514
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Despite the controversy surrounding electronic cigarette (e-cigarette) safety, global consumption has been rapidly increasing. We investigated the relationship between e-cigarette use and mental health conditions in adults of various ages.We conducted a secondary data analysis of adults aged 19 to 80 who participated in the first year of the 7th Korea National Health and Nutrition Examination Survey (2016). The total number of participants was 5469, including 3398 non-smokers, 1700 smokers who had never used e-cigarettes, and 371 smokers who had previously used e-cigarettes, selected based on self-report questionnaires. Mental health factors including stress status, depressive mood, suicide plan, and suicide attempt were assessed by self-reported questionnaire. The Patient Health Questionnaire (PHQ-9) was used to assess depressive mood, with a cut-off value of 10. The relationship between e-cigarette use and stress status with depressive mood were analyzed with adjustment for potential confounders.Both male and female smokers who previously used e-cigarettes showed higher levels of stress than non-smokers or smokers who had never used e-cigarettes. The average PHQ-9 score was higher among previous e-cigarette-using smokers relative to non-smokers and smokers who had never used e-cigarettes, regardless of gender. The number of participants with depressive mood was significantly higher in the group of smokers who previously used e-cigarettes. In multivariable-adjusted logistic regression analyses, there was a significantly higher odds ratio for higher stress in male smokers who had previously used e-cigarettes and for depressive mood in female smokers who had previously used e-cigarettes, compared with non-smokers.This study analyzed the association between adult e-cigarette use and mental health conditions, including stress and depressive mood, and showed that e-cigarette use was significantly related to both conditions in men and women.
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Psychological Features and Their Relationship to Movement-Based Subgroups in People Living With Low Back Pain.
Karayannis, NV, Jull, GA, Nicholas, MK, Hodges, PW
Archives of physical medicine and rehabilitation. 2018;(1):121-128
Abstract
OBJECTIVE To determine the distribution of higher psychological risk features within movement-based subgroups for people with low back pain (LBP). DESIGN Cross-sectional observational study. SETTING Participants were recruited from physiotherapy clinics and community advertisements. Measures were collected at a university outpatient-based physiotherapy clinic. PARTICIPANTS People (N=102) seeking treatment for LBP. INTERVENTIONS Participants were subgrouped according to 3 classification schemes: Mechanical Diagnosis and Treatment (MDT), Treatment-Based Classification (TBC), and O'Sullivan Classification (OSC). MAIN OUTCOME MEASURES Questionnaires were used to categorize low-, medium-, and high-risk features based on depression, anxiety, and stress (Depression, Anxiety, and Stress Scale-21 Items); fear avoidance (Fear-Avoidance Beliefs Questionnaire); catastrophizing and coping (Pain-Related Self-Symptoms Scale); and self-efficacy (Pain Self-Efficacy Questionnaire). Psychological risk profiles were compared between movement-based subgroups within each scheme. RESULTS Scores across all questionnaires revealed that most patients had low psychological risk profiles, but there were instances of higher (range, 1%-25%) risk profiles within questionnaire components. The small proportion of individuals with higher psychological risk scores were distributed between subgroups across TBC, MDT, and OSC schemes. CONCLUSIONS Movement-based subgrouping alone cannot inform on individuals with higher psychological risk features.
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Effects of office workstation type on physical activity and stress.
Lindberg, CM, Srinivasan, K, Gilligan, B, Razjouyan, J, Lee, H, Najafi, B, Canada, KJ, Mehl, MR, Currim, F, Ram, S, et al
Occupational and environmental medicine. 2018;(10):689-695
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OBJECTIVE Office environments have been causally linked to workplace-related illnesses and stress, yet little is known about how office workstation type is linked to objective metrics of physical activity and stress. We aimed to explore these associations among office workers in US federal office buildings. METHODS We conducted a wearable, sensor-based, observational study of 231 workers in four office buildings. Outcome variables included workers' physiological stress response, physical activity and perceived stress. Relationships between office workstation type and these variables were assessed using structural equation modelling. RESULTS Workers in open bench seating were more active at the office than those in private offices and cubicles (open bench seating vs private office=225.52 mG (31.83% higher on average) (95% CI 136.57 to 314.46); open bench seating vs cubicle=185.13 mG (20.16% higher on average) (95% CI 66.53 to 303.72)). Furthermore, workers in open bench seating experienced lower perceived stress at the office than those in cubicles (-0.27 (9.10% lower on average) (95% CI -0.54 to -0.02)). Finally, higher physical activity at the office was related to lower physiological stress (higher heart rate variability in the time domain) outside the office (-26.12 ms/mG (14.18% higher on average) (95% CI -40.48 to -4.16)). CONCLUSIONS Office workstation type was related to enhanced physical activity and reduced physiological and perceived stress. This research highlights how office design, driven by office workstation type, could be a health-promoting factor.
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Maladaptive Coping and Depressive Symptoms Partially Explain the Association Between Family Stress and Pain-Related Distress in Youth With IBD.
Reed-Knight, B, van Tilburg, MAL, Levy, RL, Langer, SL, Romano, JM, Murphy, TB, DuPen, MM, Feld, AD
Journal of pediatric psychology. 2018;(1):94-103
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OBJECTIVE To extend existing research on the pain burden experienced by youth with inflammatory bowel disease (IBD) by examining the complexity of psychosocial factors involved in pain-related distress. METHODS Parents completed measures of family stress and their child's pain-related expressions of distress and coping. Youth with IBD rated their depressive symptoms (n = 183 dyads). Mediation analyses were performed using regression-based techniques and bootstrapping. RESULTS Greater family stress was positively related to children's pain-related expressions of distress and passive coping. Significant indirect effects were found in the relationship between family stress and expressed pain-related distress through parent-reported passive coping, depressive symptoms, and both passive coping and depressive symptoms sequentially. CONCLUSIONS Results suggest that family stress can place children at risk for greater expressed pain-related distress through effects on coping and depressive symptoms. Addressing psychosocial difficulties is important for closing the gap between disability and health in youth with IBD.
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Using Behavioral Analytics to Increase Exercise: A Randomized N-of-1 Study.
Yoon, S, Schwartz, JE, Burg, MM, Kronish, IM, Alcantara, C, Julian, J, Parsons, F, Davidson, KW, Diaz, KM
American journal of preventive medicine. 2018;(4):559-567
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INTRODUCTION This intervention study used mobile technologies to investigate whether those randomized to receive a personalized "activity fingerprint" (i.e., a one-time tailored message about personal predictors of exercise developed from 6 months of observational data) increased their physical activity levels relative to those not receiving the fingerprint. STUDY DESIGN A 12-month randomized intervention study. SETTING/PARTICIPANTS From 2014 to 2015, 79 intermittent exercisers had their daily physical activity assessed by accelerometry (Fitbit Flex) and daily stress experience, a potential predictor of exercise behavior, was assessed by smartphone. INTERVENTION Data collected during the first 6 months of observation were used to develop a person-specific "activity fingerprint" (i.e., N-of-1) that was subsequently sent via email on a single occasion to randomized participants. MAIN OUTCOME MEASURES Pre-post changes in the percentage of days exercised were analyzed within and between control and intervention groups. RESULTS The control group significantly decreased their proportion of days exercised (10.5% decrease, p<0.0001) following randomization. By contrast, the intervention group showed a nonsignificant decrease in the proportion of days exercised (4.0% decrease, p=0.14). Relative to the decrease observed in the control group, receipt of the activity fingerprint significantly increased the likelihood of exercising in the intervention group (6.5%, p=0.04). CONCLUSIONS This N-of-1 intervention study demonstrates that a one-time brief message conveying personalized exercise predictors had a beneficial effect on exercise behavior among urban adults.
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Perceived life stress and anxiety correlate with chronic gastrointestinal symptoms in runners.
Wilson, PB
Journal of sports sciences. 2018;(15):1713-1719
Abstract
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.
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Early Childhood Stress and Child Age Predict Longitudinal Increases in Obesogenic Eating Among Low-Income Children.
Miller, AL, Gearhardt, AN, Retzloff, L, Sturza, J, Kaciroti, N, Lumeng, JC
Academic pediatrics. 2018;(6):685-691
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OBJECTIVE To identify whether psychosocial stress exposure during early childhood predicts subsequent increased eating in the absence of hunger (EAH), emotional overeating, food responsiveness, and enjoyment of food. METHODS This was an observational longitudinal study. Among 207 low-income children (54.6% non-Hispanic white, 46.9% girls), early childhood stress exposure was measured by parent report and a stress exposure index calculated, with higher scores indicating more stress exposure. Eating behaviors were measured in early (mean, 4.3; standard deviation, 0.5 years) and middle (mean, 7.9; standard deviation, 0.7 years) childhood. Observed EAH was assessed by measuring kilocalories of palatable food the child consumed after a meal. Parents reported on child eating behaviors on the Child Eating Behavior Questionnaire. Child weight and height were measured and body mass index z score (BMIz) calculated. Multivariable linear regression, adjusting for child sex, race/ethnicity, and BMIz, was used to examine the association of stress exposure with rate of change per year in each child eating behavior. RESULTS Early childhood stress exposure predicted yearly increases in EAH (β = 0.14; 95% confidence interval, 0.002, 0.27) and Emotional Overeating (β = 0.14; 95% confidence interval, 0.008, 0.27). Stress exposure was not associated with Food Responsiveness (trend for decreased Enjoyment of Food; β = -0.13; 95% confidence interval, 0.002, -0.26). All child obesogenic eating behaviors increased with age (P < .05). CONCLUSIONS Early stress exposure predicted increases in child eating behaviors known to associate with overweight/obesity. Psychosocial stress may confer overweight/obesity risk through eating behavior pathways. Targeting eating behaviors may be an important prevention strategy for children exposed to stress.