Article

Marital status as a predictor of diurnal salivary cortisol levels and slopes in a community sample of healthy adults

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Abstract

Married people tend to be healthier than both the previously (bereaved, divorced, and separated) and never married, but the mechanisms through which this occurs remain unclear. To this end, research has increasingly focused on how psychological stress experienced by unmarried versus married individuals may differentially impact physiological systems related to health. One key system that is modulated by stress is the hypothalamic-pituitary-adrenal (HPA) axis, of which cortisol is a key hormonal product. Increased cortisol production and disruption of cortisol’s daily rhythm have been linked to poorer health outcomes. This study examined the association between current marital status and these two indices of cortisol in a community sample of 572 healthy men and women aged 21–55. It also tested whether marriage buffers against the effect of stress (perceived stress by marital status interaction) on cortisol production. Participants provided salivary cortisol samples during waking hours on three nonconsecutive separate days to calculate diurnal cortisol levels and slopes. Married individuals had lower cortisol levels than either their never married or previously married counterparts. Differences in cortisol levels were due at least in part to currently married individuals having a more rapid decline in cortisol through the afternoon hours compared to individuals who were never married (but not those who were previously married). Furthermore, there was an interaction between perceived stress and marital status in predicting cortisol levels. Specifically, higher stress was associated with higher cortisol levels for previously married individuals but not for the married or never married. The results of this study support cortisol as one candidate mechanism accounting for the association of marital status and health.

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... Marriage offers a direct form of social support [5,6] and it can reduce the risk of unhealthy behaviors such as poor diet or alcohol use [5][6][7]. In contrast, being unmarried has been suggested to contribute to less intimate social networks, loneliness and increased levels of stress hormones [8], which may increase risk from cardiovascular diseases (CVD) [9,10], cancer [11,12] or metabolic syndrome [13,14]. While the links between marital status and CVD mortality risk have been widely reported [15][16][17][18][19], comparatively less has been observed regarding other conditions including cancer mortality and all-causes more broadly. ...
... The potential mechanisms for such findings are likely to be biological, psychological and social in nature. From a biological standpoint, acute stressors which trigger activities of Hypothalamic-Pituitary-Adrenal (HPA) axis and sympathetic nervous system [8,35] and result in output of stress hormones such as cortisol, have been found to be pronounced in men when compared to women [55,56]. Increased cortisol production has been linked to higher rate of morbidity and poorer health outcomes [8]. ...
... From a biological standpoint, acute stressors which trigger activities of Hypothalamic-Pituitary-Adrenal (HPA) axis and sympathetic nervous system [8,35] and result in output of stress hormones such as cortisol, have been found to be pronounced in men when compared to women [55,56]. Increased cortisol production has been linked to higher rate of morbidity and poorer health outcomes [8]. In addition, HPA axis can mediate the production of sex hormones [57]. ...
Article
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Purpose: To ascertain whether sex differences exist in the relationship between marital status and cardiovascular diseases (CVD), coronary heart disease (CHD), cancer and all-cause mortality in the general population and to explore the potential effect of age, location, the duration of follow-up and publication years on these outcomes. Methods: A systematic search was performed in PubMed and EMBASE from inception through to April 2018 and review of references to obtain sex-specific relative risks and their 95% confidence intervals. These were used to derive the women-to-men ratio of RRs (RRR) and 95% CI for each study. RRs and RRRs for each outcome were then pooled using random effects inverse-variance weighted meta-analysis. Results: Twenty-one studies with 7,891,623 individuals and 1,888,752 deaths were included in the meta-analysis. Compared with married individuals, being unmarried was significantly associated with all-cause, cancer, CVD and coronary heart disease mortalities for both sexes. However, the association with CVD and all-cause mortality was stronger in men. Being divorced/separated was associated with a higher risk of all-cause mortality in men and a stronger risk of cancer and CVD mortality. The pooled ratio for women versus men showed 31 and 9% greater risk of stroke mortality and all-cause mortality associated with never married in men than in women. Conclusions: Being unmarried conferred higher risk of stroke and all-cause mortality for men than women. Moreover, divorced/separated men had higher risk of cancer mortality and CVD mortality. Further studies are warranted to clarify the biological, behavioral, and/or social mechanisms involved in sex differences by these associations.
... But as the literature review will show, marital status might also be a gender related factor that puts women in higher risk of stress and trauma. Chin et al. (2017) took an approach to the matter by measuring the cortisol level of unmarried, married and previously married couples. High cortisol levels were associated with higher stress. ...
... Married couples showed the lowest cortisol levels, and, thus, the least stress experience. Further, the reports of perceived stress predicted the cortisol levels (Chin et al., 2017). ...
... The authors suggest among other factors economic support, regular routines and less risky behavior as key factors that might justify the results. Further, they suggest that marriage might shield from social stressors such as shame and loss (Chin et al., 2017). However, the authors did not take into consideration crucial factors as gender, parenthood and work status as previous studies have done. ...
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The objective of this study is to assess main risk factors for volunteers’ mental health in general, and spontaneous volunteers’ mental health in particular, in order to provide intelligence to facilitate the integration of spontaneous volunteers in disaster and emergency response successfully in the future. The data is based on the evaluation of the work in practice of the pioneer program called Team Österreich, which integrated civilians into the Red Cross emergency response in the refugee camps and transit points in Austria during the migration movement in 2015, caused by the ongoing Syrian war. This was the largest operation of Team Österreich since its establishment in 2007. An online questionnaire, which assessed demographic and assignment related data, was created to identify the main stresses and needs on the ground. The questionnaire, which was distributed via email by the Red Cross Headquaters, included further the Impact of Event Scale – Revised (Weiss and Marmar, 1997) to assess the volunteers’ stress levels, and the Sense of Coherence Scale 29 (Aaron Antonovsky, 1979) to assess the volunteers’ sense of coherence. The data was then used to examine different hypotheses regarding the stress impact on the volunteers based on different factors, namely their role as spontaneous or regular volunteers, the amount of received psychosocial support, their sense of coherence, their gender, marital status and education level. Results approved for sense of coherence, psychosocial support, gender and being a spontaneous volunteer as significant risk factors for volunteers.
... In order to establish approximate equivalency across the three studies while still capturing the diurnal rhythm of cortisol, we used seven samples from pre-quarantine days (assessed at 1, 2, 4, 7, 9, 11, and 14 h post-waking) and the eight closest samples from the day of quarantine (0, 1, 4.25, 6.25, 7.25, 9.25, 12.75, and 16.75 h post-waking) when analyzing participants from PCS2 (Chin et al. 2017;Janicki-Deverts et al., 2016; also see www.commoncoldproject.com). Note that cortisol samples necessary to compute the cortisol awakening response (CAR; 30 minutes post-waking) were not collected in two of the three studies we aggregated data from, and the CAR was therefore not assessed as an outcome here. ...
... Samples collected outside of this range were considered missing. This was done based on previous work demonstrating that this cutoff range would allow us to maintain at least 95% of our data while also accurately capturing cortisol's diurnal rhythm (e.g., Chin et al., 2017;Janicki-Deverts et al., 2016; also see www.commoncoldproject.com). The actual time of collection (rather than the expected time of collection) was used in all analyses. ...
... Finally, because earlier analysis of this data found an association between cortisol measures and marital status (Chin et al., 2017), marital status was included as an additional covariate in secondary analyses to demonstrate that any associations between social integration, social contact frequency, and cortisol were not simply driven by marital status (see earlier description). In addition, two dummy coded interaction terms were also included in secondary analyses in order control for the interaction between marital status and age (Never Married x Age, Previously Married x Age). ...
... We selected the following socio-demographic and clinical variables a priori based on the literature and on clinical judgement identifying them as potential confounders of the association between suicidality and receipt of specific treatments in patients diagnosed with PTSD. These included: the length of time patients were known to the mental health Trust, year of suicidality assessment, gender (Klonsky et al., 2016;Klonsky & Muehlenkamp, 2007), age at PTSD diagnosis (Hawton et al., 2007;Katz et al., 2008;Nock et al., 2008;Zilcha-Mano et al., 2016), ethnicity (Curtin et al., 2016;Nock et al., 2008;Wierzbicki & Pekarik, 1993), marital status (Batty et al., 2018;Chin et al., 2017), area-level social deprivation (Batty et al., 2018;Curtis et al., 2006), drug and alcohol use (Driessen et al., 2008;Edwards et al., 2020;Poorolajal et al., 2016), depressed mood (Angst et al., 2002;Rytwinski et al., 2013) and relationship difficulties (Batty et al., 2018;Chin et al., 2017). We extracted data on these variables from the relevant structured fields within the C&I research database, or from HoNOS scales. ...
... We selected the following socio-demographic and clinical variables a priori based on the literature and on clinical judgement identifying them as potential confounders of the association between suicidality and receipt of specific treatments in patients diagnosed with PTSD. These included: the length of time patients were known to the mental health Trust, year of suicidality assessment, gender (Klonsky et al., 2016;Klonsky & Muehlenkamp, 2007), age at PTSD diagnosis (Hawton et al., 2007;Katz et al., 2008;Nock et al., 2008;Zilcha-Mano et al., 2016), ethnicity (Curtin et al., 2016;Nock et al., 2008;Wierzbicki & Pekarik, 1993), marital status (Batty et al., 2018;Chin et al., 2017), area-level social deprivation (Batty et al., 2018;Curtis et al., 2006), drug and alcohol use (Driessen et al., 2008;Edwards et al., 2020;Poorolajal et al., 2016), depressed mood (Angst et al., 2002;Rytwinski et al., 2013) and relationship difficulties (Batty et al., 2018;Chin et al., 2017). We extracted data on these variables from the relevant structured fields within the C&I research database, or from HoNOS scales. ...
Article
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Background Post-traumatic stress disorder (PTSD) is a risk factor for suicidality (suicidal ideation, and suicide attempt). This study described the prevalence of suicidality amongst a representative sample of individuals with PTSD and the association between suicidality and receipt of five PTSD treatments. Methods We analysed deidentified data for patients being treated for PTSD at Camden and Islington NHS Foundation Trust between 2009 and 2017 obtained via the Clinical Record Interactive Search tool. We described the sample’s sociodemographic and clinical characteristics and used stepwise logistic regression to investigate the association between suicidality and receipt of four, specific PTSD treatments: psychotherapy, antidepressant/antianxiety medication, antipsychotics, benzodiazepines. We used Cox proportional hazards regression to investigate the association between suicidality and hospital/crisis team admission. Results Of 745 patients diagnosed with PTSD, 60% received psychotherapy and 66% received psychotropic medication. Those who reported suicidality (6%) were no more likely than those who did not to be prescribed antidepressant/antianxiety medication, but were more likely to receive antipsychotics (AOR = 2.27, 95% CI 1.15 − 4.47), benzodiazepines (AOR 2.28, 95% CI 1.17 − 4.44), psychotherapy (AOR 2.60, 95% CI 1.18 − 5.73) and to be admitted to hospital/crisis team (AOR 2.84, 95% 1.82 − 4.45). Conclusion In this sample, patients with PTSD and suicidality were more likely to receive psychiatric medication, psychotherapy and psychiatric admission than those who were not suicidal. Overall patients were more likely to receive psychotropic medication than psychotherapy. Adherence to clinical guidelines is important in this population to improve treatment outcomes and reduce the risk of suicide. • KEY POINTS • NICE guidelines recommend psychological therapy be first in line treatment for PTSD, yet we identified that fewer people diagnosed with PTSD received therapy compared to psychotropic medication. • Patients with suicidality were more likely to receive antipsychotics and benzodiazepines, yet not antidepressant/antianxiety medication although given that suicidality is characteristic of severe depression, it might be assumed from stepped care models that antidepressant/antianxiety medication be prescribed before antipsychotics. • The high proportion of patients prescribed antipsychotics suggests a need for better understanding of psychosis symptoms among trauma-exposed populations. • Identifying which combinations of symptoms are associated with suicidal thoughts could help tailor trauma-informed approaches to discussing therapy and medication.
... Only samples that were collected within ±45 min of the scheduled collection time were included for analysis; any samples collected outside of this time frame were treated as missing. The actual time rather than the expected time the participant provided for each cortisol sample was used to calculate both area under the curve (AUC) and slopes [39]. To calculate average diurnal cortisol levels, the AUC for each day was computed for individuals with sufficient data, which was defined as not having missed collection of any of the first three samples of the day (for steep diurnal rhythm) or missing more than two of the day's remaining samples (for flat diurnal rhythm). ...
... To calculate average diurnal cortisol levels, the AUC for each day was computed for individuals with sufficient data, which was defined as not having missed collection of any of the first three samples of the day (for steep diurnal rhythm) or missing more than two of the day's remaining samples (for flat diurnal rhythm). The average total diurnal cortisol levels were calculated for participants who had data for a minimum of two of the three collection days by averaging total concentrations from all days with sufficient data [39]. Cortisol samples across the three study days were used to demonstrate participants' typical diurnal cortisol secretion. ...
Article
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Growing up in a family environment characterized by neglectful parenting, overt conflict, and unsupportive relationships is associated with poor health in adulthood. A risky early family environment may also be associated with obesity in adulthood, likely through the activation of the HPA axis. Likewise, the GABAergic (gamma-aminobutyric acid) T>C single nucleotide polymorphism in the 1519 nucleotide position of the GABAAα6 receptor subunit gene has been associated with a predisposition to a higher body mass index and a larger waist circumference. Participants (n = 213, Mage = 30.13 years, SD = 10.85; 57.7% men) from the Pittsburgh Cold Study 3 completed a demographic questionnaire, the Risky Families Questionnaire (RFQ) and had their height, weight, and waist circumference measured during a physical exam. Participant DNA was recovered from buccal swabs and genotyped for the various allelic types of the SNP according to published protocols. In secondary data analyses, we tested the hypothesis that early family environment and GABRA6 would be positively associated with body mass index and waist circumference. We also examined diurnal cortisol as a mechanism linking both early risky family environment and GABRA6 to metabolic outcomes. The findings provide evidence that a risky early family environment may exert more influence than genetic predisposition when determining the indices of metabolic health in adulthood.
... Then too, there were studies that indicated nonot even a limitedrole for stress. These showed that stress levels did not differ across marital-status groups (Chin et al., 2017;Holt-Lunstad et al., 2008), and that associations between marriage and morbidity/mortality remained unchanged after controlling for stress (Gardner & Oswald, 2004;Soulsby & Bennett, 2015). Such findings prompted the conclusion that, "Although marriage keeps people alive, it does not appear to work through stress levels" (Gardner & Oswald, 2004, p. 1181). ...
... Others asked participants to self-rate their stress (Muhammad & Gagnon, 2009;Wyke & Ford, 1992), which likely conflated the feelings arising from the benign and the pathogenic forms of stress. Still others assessed symptoms ostensibly associated with stress (Chin et al., 2017;Gardner & Oswald, 2004;Holt-Lunstad et al., 2008), but such symptoms (e.g., irritability, unhappiness, low self-worth) could have signaled states other than stress overload, such as depression or anxiety. In all of these studies, then, an argument can be made that the scores obtained did not accurately reflect stress overload, and thereby misrepresented the true differences between married and unmarried people as well as their relative risk for illness. ...
Article
Background and Objectives The association between marital status and health is well-established, but its causes remain unclear. This study was the first to examine stress overload, the pathogenic form of stress, as a possible explanation. Design The study employed a cross-sectional design and convenience sample to explore relationships among stress overload, marital status, social support, and illness. Methods A diverse sample (n = 455), recruited from community and social media sites, completed an anonymous online survey. Included were standardized measures of stress overload (SOS-S), perceived social support (MSPSS), and somatic symptoms (PHQ-15). Results Married participants reported lower stress overload levels than those in any other type of relationship (single, in-a-relationship, or cohabiting). They did not differ from the unmarried in overall level of social support, nor did statistically controlling social support or income levels erase the stress overload differential. They also reported lower levels of symptomology than the unmarried. SEM analyses yielded a best-fitting model showing stress overload to partially mediate the link between marital status and symptoms. Conclusions Stress overload is one mechanism that explains the marital health disparity, albeit not the only one. This holds implications for future research and practice focused on personal relationships and well-being.
... Analysis of data from three national surveys in the United States, and normative data from a German sample revealed increasing psychological stress (PSS scores) with decreasing age, income, and education and higher scores among women, unmarried, and unemployed individuals [37,38]. However, others found PSS scores not to be affected by marital status [39,40]. ...
... This was a secondary analysis of data from a cohort study which was conducted among 150 pregnant women between 22-and 28-weeks' gestation attending antenatal [37][38][39][40] Int. J. Environ. ...
Article
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Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, parity, marital status, maternal education, household income, polygyny, and intimate partner violence) and outcomes (hair cortisol, hair cortisone, and PSS score) was examined using univariate, bivariate and multivariate models. We found a negative association between PSS scores and household income (β = −2.40, p = 0.016, 95% CI = −4.36, −0.45). There was a positive association of the ratio of hair cortisone to cortisol with Adolescent age group (β = 0.64, p = 0.031, 95% CI = 0.06, 1.22), and a negative association with Cohabitation (β = −1.21, p = 0.009, 95% CI = −2.11, −0.31). We conclude that household income influenced psychological stress in pregnancy. Adolescence and cohabitation may have an influence on biological stress, but the nature of this effect is unclear.
... Among various underlying biological mechanisms accounting for the association of marital status and health, the HPA axis has gained utmost attention. Chin et al. found that being married in comparison to single was associated with a steeper daily decline in cortisol slopes (Chin et al., 2017). There are also several small-sized clinical studies among young married couples that have investigated the association of poor marital quality and diurnal cortisol slopes (DCSs) but yielded conflicting evidence (Robles et al., 2014). ...
... Evidence indicates that married individuals are healthier than their counterparts. Chin et al. (2017) proposed that elevated levels of cortisol, a potential biological consequence of interpersonal stress, could be most likely a major candidate mechanism accounting for the association of marital status and health. Therefore, the researchers examined the association between currently married vs. non-married with cortisol secretion patterns and a possible disruption of cortisol's daily rhythm in 572 healthy men and women aged 21-55 years and confirmed that married individuals had lower cortisol levels than their never married or previously married counterparts. ...
Article
Background: Despite well-established evidence on marriage as a psychosocial support for adults, there are studies that indicate loneliness may affect even married adults. Loneliness provokes a dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis. Thus, the study aims to examine the sex-specific association of loneliness and cortisol levels in the married older population. Methods: A cross-sectional analysis was conducted among 500 married participants (316 male and 184 female) aged 65 to 90 years (mean age =73.8 ± 6.4 years) of the population-based KORA (Cooperative Health Research in the Region of Augsburg) - Age study. Linear regression analyses were employed to examine the association between cortisol measurements (salivary cortisol upon waking (M1), 30 min after awakening (M2), late night (LNSC), Cortisol Awakening Response (CAR), Diurnal Cortisol Slope (DCS)) and loneliness (assessed by UCLA Loneliness Scale) in married participants with adjustments for potential confounders. Results: In total sample population, lonely married participants displayed a significantly flatter DCS after M2 peak than their not lonely counterparts. In sex-specific analyses, lonely married men showed flatter DCS and reduced CAR than non-lonely counterparts. The association between loneliness and DCS was robust even after adjustment for lifestyle and psychosocial factors. In married women, no significant associations between loneliness and cortisol levels were observed. Conclusion: These findings suggest a differential impact of loneliness on HPA axis dynamics in lonely married men. Our findings highlight the importance to address loneliness even in married people.
... The effects of social support on individuals following trauma are reported to mediate life's stressors. Social support in the form of friends, family, or a spouse, whether the support be formal or informal, displays powerful buffering effects on trauma (Chin, Murphy, Janicki-Deverts, & Cohen, 2017;Uchino, Cacioppo, & Kiecolt-Glaser, 1996) when compared to the inflammatory slopes of individuals with limited social support (Chin et al., 2017;Heinrichs et al., 2003), including individuals who have been socially isolated (Yang, McClintock, Kozloski, & Li, 2013). ...
... The effects of social support on individuals following trauma are reported to mediate life's stressors. Social support in the form of friends, family, or a spouse, whether the support be formal or informal, displays powerful buffering effects on trauma (Chin, Murphy, Janicki-Deverts, & Cohen, 2017;Uchino, Cacioppo, & Kiecolt-Glaser, 1996) when compared to the inflammatory slopes of individuals with limited social support (Chin et al., 2017;Heinrichs et al., 2003), including individuals who have been socially isolated (Yang, McClintock, Kozloski, & Li, 2013). ...
Article
Introduction: Extensive research substantiates a negative correlation between stress and health. The implications of traumatic stress are complex, affecting the physical, psychological, physiological, and social health of individuals. The aim of this study was to examine the role of social support in relation to trauma-related health consequences. Methods: Nationally representative data were obtained from the Midlife in the United States study, covering the period 2004-2006, and used in regression models to predict the relationships between types of trauma (adult vs. childhood), measures of social support, and biomarkers of stress reactivity (cortisol, high sensitivity C-reactive protein (CRP), and number of health conditions). Results: The study found that an increase in traumatic experiences during adulthood was associated with a higher logged cortisol level, but social support did not buffer these effects. No significant trends were observed with childhood trauma. Conclusions: Results suggest the importance of addressing indicators from multiple domains simultaneously to investigate the effects of trauma and social support on biomarkers of stress. Keywords: social support, trauma, cortisol, high sensitivity C-reactive protein, health conditions https://www.spotlightonresearch.com/public-health-research/a-public-health-problem
... Then, we repeated the analyses, including the following covariates: age, sex (men ¼0, women ¼1), BMI, education (years), and race (dichotomized as white or nonwhite due to the small number of non-black racial groups represented) in the model. These control variables have been used in previous studies using data from the Pittsburgh Mind-Body Center Study, given their possible effects on diurnal cortisol levels (Chin, Murphy, Janicki-Deverts, & Cohen, 2017;Janicki-Deverts, Cohen, Turner, & Doyle, 2016). Tolerance and variance inflation factor values indicate that there are no collinearity issues for the variables included in the model. ...
... Tolerance and variance inflation factor values indicate that there are no collinearity issues for the variables included in the model. To control for deviations from the saliva sampling protocol, previous studies using data from the Common Cold Project have excluded from the analyses salivary samples that were not collected within 45 min of the scheduled collection time (Chin et al., 2017;Janicki-Deverts et al., 2016). If we use the same procedure in the current study, the same statistical conclusions are observed. ...
Article
Previous studies have suggested that meaning in life may buffer the negative effects of stress. This study is the first to investigate the moderating role of meaning in life in the relationship between the perception of stress and diurnal cortisol in two independent samples of healthy adults. In study 1 (n = 172, men = 82, women = 90, age range = 21–55 years, mean age = 37.58 years), the results of moderated regression analyses revealed that there was a significant positive relationship between overall perceived stress in the past month and both diurnal cortisol levels (area-under-the-curve with respect to the ground; AUCg) and the diurnal cortisol slope (DCS) only in individuals with low levels of meaning in life conceptualized as the degree to which one engages in activities that are personally valued and important. In study 2 (n = 259, men = 125, women = 134, age range = 18–54 years, mean age = 29.06 years), we found a non-significant interaction term between meaning in life conceptualized as having goals and a sense of excitement regarding one’s future and perception of stress in a model of both adjusted AUCg and DCS. The results were independent of age, sex, body mass index, education, and race. The results shed light on the importance and the complexity of the construct of meaning in life and offer a possible explanation for why some people who face stressors may be more vulnerable than others to developing stress-related health problems.
... The higher risk of stress among women than men is consistent with other research [29][30][31]. The lower risk of stress in married individuals is consistent with another study in which married people had lower levels of the stress hormone cortisol compared with those who were previously or never married [32]. Spousal support has been shown to attenuate stressful events [33]. ...
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The purpose of this study was to compare associations between stress and sleep disorders (insomnia, hypersomnia, and sleep apnea), identify potential modifying effects, and compare associations between stress and types of sleep disorders with selected mental health conditions. Analyses were based on 21,027 employees aged 18-64 years in 2020 who were insured by the Deseret Mutual Benefit Administrators (DMBA). The risk of stress (2.3%) was significantly greater in women, singles, and those with dependent children. The risk of a sleep disorder was 12.1% (2.1% for insomnia, 1.0% for hypersomnia, and 10.1% for sleep apnea). The risk of stress was significantly greater for those with a sleep disorder (136% overall, 179% for insomnia, and 102% for sleep apnea after adjusting for age, sex, marital status, dependent children, and sleep disorders). The risk of stress among those with sleep apnea was significantly greater for singles than for married individuals. Approximately 9.5% had anxiety, 8.5% had depression, 2.0% had ADHD, 0.6% had bipolar disorder, 0.4% had OCD, and 0.1% had schizophrenia. Each of these mental health conditions was significantly positively associated with stress and sleep disorders. Bipolar disorder and schizophrenia were more strongly associated with stress and sleep disorders than were the other mental health conditions. Insomnia was more strongly associated with anxiety, bipolar disorder, OCD, and schizophrenia than was sleep apnea.
... In addition, increased level of cortisol was related to poorer cardiovascular outcomes. Unmarried patients had higher cortisol levels than married patients (33), which induced cardiac dysfunction (34) and further increases the risk of cardiovascular disease (35). ...
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Background: The influences of marital status on cardiovascular death risk in patients with breast cancer remained unclear. This study aimed to evaluate the associations of different marital status with cardiovascular death risk in patients with breast cancer. Methods: A total of 182,666 female breast cancer patients were enrolled in this study from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2014, and was divided into two groups: married (N=107,043) and unmarried (N=75,623). A 1:1 propensity score matching (PSM) was applied to reduce inter-group bias between the two groups. Competing-risks model was used to assess the associations between different marital status and cardiovascular death risk in patients with breast cancer. Results: After PSM, marital status was an independent predictor for cardiovascular death in patients with breast cancer. Unmarried condition was associated with increased cardiovascular death risk than married condition among breast cancer patients [unadjusted model: hazard ratio (HR) =2.012, 95% confidence interval (CI): 1.835–2.208, P<0.001; Model 1: HR =1.958, 95% CI: 1.785–2.148, P<0.001; Model 2: HR =1.954, 95% CI: 1.781–2.144, P<0.001; Model 3: HR =1.920, 95% CI: 1.748–2.107, P<0.001]. With the exception of separated condition (adjusted HR =0.886, 95% CI: 0.474–1.658, P=0.705), further unmarried subgroups analysis showed that the other three unmarried status were associated with increased cardiovascular death risk as follows: single (adjusted HR =1.623, 95% CI: 1.421–1.853, P<0.001), divorced (adjusted HR =1.394, 95% CI: 1.209–1.608, P<0.001), and widowed (adjusted HR =2.460, 95% CI: 2.227– 2.717, P<0.001). In particularly, widowed condition showed the highest cardiovascular death risk in all 4 unmarried subgroups. Conclusions: Unmarried condition (e.g., single, divorced and widowed) was associated with elevated cardiovascular death risk compared with their married counterparts in patients with breast cancer, suggesting that more attention and humanistic care should be paid to unmarried breast cancer patients (especially the widowed patients) in the management of female breast cancer patients.
... This result has been confirmed in various kinds of cancers (23)(24)(25). The married patients tend to enjoy good psychological state, healthy lifestyles, and sound social support networks (26), and this could contribute to their survival advantages to a large extent. Taken together, we strongly recommend integration of non-biological factors into the prognosis prediction system for cancer patients. ...
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Background The study aimed to build and validate practical nomograms to predict overall survival (OS) and cancer-specific survival (CSS) for patients with synovial sarcoma (SyS). Methods A total of 893 eligible patients confirmed to have SyS between 2007 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into the training cohort (n = 448) and validation cohort (n = 445). Clinically independent prognostic and important factors were determined according to the Akaike information criterion in multivariate Cox regression models when developing the nomograms with the training cohort. The predictive accuracy of nomograms was bootstrapped validated internally and externally with the concordance index (C-index) and calibration curve. Decision curve analysis (DCA) was performed to compare the clinical usefulness between nomograms and American Joint Commission on Cancer (AJCC) staging system. Results Two nomograms shared common indicators including age, insurance status, tumor site, tumor size, SEER stage, surgery, and radiation, while marital status and tumor site were only included into the OS nomogram. The C-index of nomograms for predicting OS and CSS was 0.819 (0.873–0.764) and 0.821 (0.876–0.766), respectively, suggesting satisfactory predictive performance. Internal and external calibration curves exhibited optimal agreement between the nomogram prediction and the actual survival. Additionally, DCA demonstrated that our nomograms had obvious superiority over the AJCC staging system with more clinical net benefits. Conclusions Two nomograms predicting 3- and 5-year OS and CSS of SyS patients were successfully constructed and validated for the first time, with higher predictive accuracy and clinical values than the AJCC staging system regarding OS and CSS.
... Second, this subgroup had better economic support to receive good medical services than other subgroups, thus the phys-ical condition of patients may play a critical role in the mortality of this group of CKD patients [47]. Previous studies showed that marriage influences the function of the body physiologically, partially through modulating the level of endocrinal hormones which may influence the mortality of CKD [48]. ...
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Background: The relationship between marital status and CKD is rarely studied. We aimed to explore the effect of marital status on the depression and mortality of patients with CKD. Methods: The data sources came from the NHANES database during 2005-2014 and 3,865 participants were included in this study. We used logistic regression models to examine the relationship between marital status and depression of CKD patients. The Cox proportional hazard models were used to evaluate the association between marital status and mortality of CKD patients. Results: In terms of depression in CKD patients, unmarried patients had a worse situation than married patients. Meanwhile, after adjusting the covariables, unmarried patients had increased risk of depression (OR = 1.26, 95% CI: 1.01-1.57) compared with married CKD patients, especially in males (OR = 1.45, 95% CI: 1.02-2.06) and patients with more than college education level (OR = 12.4, 95% CI: 3.75-41.02). There was a significant relationship between marital status and mortality of general CKD patients (HR = 1.36, 95% CI: 1.17-1.58). Moreover, marriage showed a protective effect against death among male patients, patients with school graduate or less and more than college educational level, patients with high income, and patients in different estimated glomerular filtration rate groups. Conclusions: The use of large numbers of participants has revealed the effect of marital status on CKD patients. Unmarried ones had a higher risk of depression than married ones among CKD patients. Meanwhile, the risk of death was higher in unmarried ones than married ones among CKD patients in this study.
... Previous studies identified several variables that seem to impact cortisol concentrations. Since adequate control should be made for variables that confound the relationship between the independent variables and the outcome of interest (Schisterman et al. 2009), we have subsequently controlled for the following variables: self-reported time of awakening (Hucklebridge et al. 2000), sex (Larsson et al. 2009), age (Van Cauter et al. 1996), marital status (Chin et al. 2017), season of sampling (Persson et al. 2008), cigarette smoking (Steptoe and Ussher 2006), alcohol consumption (Badrick et al. 2008), regular physical activity (Hansen et al. 2010), psychotropic drug use (Granger et al. 2009), health problems (Kudielka and Kirschbaum 2003), body mass index (Björntorp and Rosmond 2000), self-esteem, locus of control, openness, extraversion, agreeableness, conscientiousness and neuroticism (Hauner et al. 2008;Hill et al. 2013;Quirin et al. 2008;Sjögren et al. 2006;van Santen et al. 2011;Wüst et al. 2000) and workers' depression (Hakulinen et al. 2015;Marchand et al. 2015; Parent-Lamarche and Marchand 2019). As for mental health, those variables were controlled for: parental status, educational level and household income (xie et al. 2011), social support outside of the workplace (Sundin et al. 2011), marital and parental stress (Clays et al. 2007) and stressful childhood life events (Marchand and Blanc 2011). ...
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Abstract Purpose: The purpose of this study was to verify the mediating role salivary cortisol intensity plays between work organization conditions and depression. This study simultaneously considered psychological and physiological (salivary cortisol) stress indicators on workers’ depression in a single model. Methods: We relied on cluster sampling of 341 workers in 34 Quebec establishments. Five saliva samples (on awakening, 30 minutes after awakening, at 2:00 p.m., 4:00 p.m., and bedtime) were collected per day. The weekly collection period spanned a period of 2 work days. We evaluated the main effects of work organization conditions on salivary cortisol intensity and depression, as well as the mediation effect of salivary cortisol intensity between work organizations conditions and depression. To adjust for design effects, the direct and indirect (mediation) associations between the variables were evaluated while accounting for the non-independence of the data. Results: Skill utilization and job insecurity were associated with salivary cortisol intensity, while psychological demands and job insecurity were associated with higher depression levels. Work-related variables were not found to have an indirect effect on depression via worker’s salivary cortisol (AUC) intensity. Conclusion: Work-related stressors examined in this study did not indirectly affect worker’s depression levels. Additional studies are necessary to be able to identify all work-related stressors that could potentially increase worker’s depression levels through salivary cortisol. Keywords: salivary cortisol; depression; work organization conditions; mediation analysis; work-related stressors; stress response.
... Also noteworthy is the relationship seen between marital status and increased basal ganglia structures in RLS patients. Married individuals are suggested to be healthier 35,36 and therefore less likely to be exposed to stressors compared to those who either never married or were previously married 37 . We suggest that the positive relationship between brain volume in the striatum and frontal areas and such factors as higher HCC reflecting the cumulative cortisol exposure during the last trimester, iron supplementation or being married are likely to be associated with more favorable prognoses with respect to RLS symptoms. ...
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Restless legs syndrome (RLS) in pregnancy is a common disorder with a multifactorial etiology. A neurological and obstetrical cohort of 308 postpartum women was screened for RLS within 1 to 6 days of childbirth and 12 weeks postpartum. Of the 308 young mothers, 57 (prevalence rate 19%) were identified as having been affected by RLS symptoms in the recently completed pregnancy. Structural and functional MRI was obtained from 25 of these 57 participants. A multivariate two-window algorithm was employed to systematically chart the relationship between brain structures and phenotypical predictors of RLS. A decreased volume of the parietal, orbitofrontal and frontal areas shortly after delivery was found to be linked to persistent RLS symptoms up to 12 weeks postpartum, the symptoms' severity and intensity in the most recent pregnancy, and a history of RLS in previous pregnancies. The same negative relationship was observed between brain volume and not being married, not receiving any iron supplement and higher numbers of stressful life events. High cortisol levels, being married and receiving iron supplements, on the other hand, were found to be associated with increased volumes in the bilateral striatum. Investigating RLS symptoms in pregnancy within a brain-phenotype framework may help shed light on the heterogeneity of the condition.
... However, in the present study we included people with a relationship duration of at least 6 months to control for this (Verhallen et al., 2019), and although we did not measure more direct indicators of stress such as cortisol levels, depression scores differed between our sample of individuals who experienced a breakup in the preceding 6 months and individuals currently in a romantic relationship, indicating stressrelated mood disturbances. In addition, using individuals who have been single for a considerable period of time as a reference group would have been less optimal, as this group possibly is heterogeneous in terms of dating activity and associated stress levels (Chin et al., 2017). Last, a potential limitation of our study concerns the order of the fMRI session. ...
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Experiencing stress can have a disadvantageous effect on mental well-being. Additional to the relation between suffering from chronic stress and depression, both stress (acute and chronic) and depression are associated with cognitive alterations, including working memory. The breakup of a relationship is considered to be a stressful event that can lead to symptoms of depression in otherwise healthy people. Additional to elevated depression scores, stress-related cognitive alterations may occur in this population as well. Therefore, in the present fMRI study we investigated whether experiencing a relationship breakup is associated with working memory alterations and whether this is related to depressive symptom severity. A three workload version of the n-back task (0-back, 1-back, 2-back) was used to measure working memory in subjects who experienced a breakup in the preceding 6 months (“heartbreak group”, n = 70) and subjects in a romantic relationship (“relationship group”, n = 46). Behavioral task performance was compared between the two groups. Functional MRI scans were analyzed using General Linear Model (GLM) activation analyses. Workload conditions were contrasted to each other and to baseline and group differences were assessed. To investigate whether brain networks are associated with depressive symptom severity within the heartbreak group specifically, a post hoc feature-based Independent Component Analysis was performed on the 2-back > 0-back contrast images to identify brain regions that covaried across subjects. Behaviorally, the heartbreak group performed similar at high workload (i.e., 2-back) and better at moderate workload (i.e., 1-back) than the relationship group. GLM analysis revealed an interaction between group and 2-back > 0-back, 2-back > 1-back and 2-back > baseline; the heartbreak group showed less precuneus activation compared to the relationship group. Furthermore, within the heartbreak group, we found a negative association between depressive symptom severity and a brain network representing mostly the precuneus, anterior cingulate gyrus and supplementary motor cortex. Our findings suggest that the effect of a breakup is accompanied by workload-dependent working memory alterations. Therefore, we propose that this population can potentially be used to investigate the interplay between stress, cognitive functioning and depression.
... Older people are more likely to succumb to tiredness due to overwork and single HCWs were probably more stressed because they were handling their emotional and physical burden single-handedly. The result is consistent with a recent study that found lower levels of stress hormones in healthy married adults (Chin et al., 2017). Greater duration of service, quarantine, and a greater level of risk contributed to irritability. ...
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Background: Risks to healthcare workers have escalated during the pandemic and they are likely to experience a greater level of stress. This cross-sectional study investigated mental distress among healthcare workers during the early phase of Coronavirus disease-2019 (COVID-19) outbreak in India. Method: 140 healthcare workers of a tertiary care hospital in India were assessed for perceived stress and insomnia. A factor analysis with principal component method reduced these questions to four components which were categorized as insomnia, stress-related anxiety, stress-related irritability, and stress-related hopelessness. Further statistical analyses were done on these factor scores to identify the predictors and investigate the differences between the different categories of healthcare workers. Result: Doctors had the highest level of anxiety among the healthcare workers. Both doctors and nurses perceived a greater level of irritability than the other HCWs. Compared to doctors and nurses, other HCWs were more likely to experience insomnia. Lower age, higher education, female gender, and urban habitat were associated with greater perception of anxiety. Older age, being quarantined, and single marital status were the significant predictors of irritability. Female gender, single marital-status, and higher number of medical ailments contributed to perceived hopelessness. Quarantine significantly predicted insomnia. Conclusion: Different categories of healthcare workers are experiencing varied mental health problems owing to their heterogeneous socio-demographic backgrounds. Tailored and personalized care, as well as policies, might help in alleviating their problems. Further research is warranted to explore the psychological distress and remedies among these frontline workers during and after the ongoing pandemic crisis.
... Interestingly, the mean stress and anxiety scores of married couples and those living with children were lower compared to those being unmarried and living without children (Table 4). This may be explained on the premise that being surrounded by the loved ones result in reassurance and helps in buffering against the feelings of vulnerability and inability to control (Chin et al., 2017;Ta et al., 2017). ...
Article
COVID-19 has caused unprecedented disruption of all spheres of life, including health, nancial, and socio behavioral. Given the rampant nature of the pandemic, several nations, including India has instituted stringent public health measures, with one being nationwide lockdown, to mitigate COVID-19 transmission. Previous studies reported increased stress and anxiety levels among general population during phase 1 (complete) lockdown, however, the effect of extended lockdown (phase 2) on mental health outcomes remains the subject of investigation till today. Therefore, this cross-sectional study endeavors to assess the psychological outcomes among general population during phase 2 lockdown. The online questionnaire surveyed 627 individuals from the general population using a non-probability snowball sampling technique. Descriptive statistics, including the frequency distribution, mean and standard deviations were generated. Mean differences across groups were analyzed through independent-samples- t and analysis of variance tests. Consistent with previous studies, our results indicated a higher mean score of anxiety and stress among females compared to males. Young adults aged between 21-39 years had the highest mean stress and anxiety scores compared to other categories. The mean anxiety score increased from retired (M=3.96, SD=4.76, to students (M=7.04, SD=7.11), to unemployed (M=9.0, SD=6.53) occupation groups. The ndings of this study highlight the need for designing psychosocial regulatory frameworks and suitable interventions to address the needs of those being mentally traumatized by the pandemic and associated lockdowns. The study also advocates for establishing psychological health monitoring and telepsychiatry systems for identifying and treating mental health problems.
... An accentuated AUC G has been observed in many pathological conditions such as chronic burnout (Melamed et al., 1999), depression (Belanoff et al., 2002), and chronic stress (Bauer et al., 2000). In healthy populations, a lower AUC G is associated with lower loneliness in college students (e.g., Lai et al., 2019) and better adjustment (Chin et al., 2017;Lai et al., 2017). A recent study in healthy participants has demonstrated that a lower AUC G is associated with a lower risk of experimentally induced upper respiratory infection (Janicki-Deverts et al., 2016). ...
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This study aimed to examine the relationship between trait resilience and salivary cortisol in a group of Chinese undergraduates. The Chinese versions of the Brief Resilience Scale and a measure of optimism, the revised Life Orientation Test were administered to 49 Chinese undergraduates who provided self-collected saliva samples six times per day (immediately after waking; 0.5, 3, 6, and 12 h thereafter; and at bedtime) over 3 consecutive weekdays. The cortisol data were aggregated across the 3 days to examine the association between resilience and components of the diurnal rhythm of cortisol using multiple regression. The results showed that higher resilience was associated with a stronger cortisol response to awakening and a steeper diurnal decline in cortisol from waking to bedtime. Resilience was positively associated with cortisol output over the course of the day but this relationship was not significant (p = 0.065). This pattern of diurnal rhythm is consistent with that typically observed in better adjusted individuals. Generated by an intensive protocol with compliance objectively monitored, these findings clearly indicate the important role of the hypothalamic-pituitary-adrenocortical axis in health and adjustment and contribute to the growing literature on resilience and cortisol in humans.
... With respect to sex, this may reflect putative greater stress responsivity in females 7 or the increased social burdens that many experience in the home. 8,9 With respect to marital status, while there are data to indicate that under typical circumstances married status is associated with reduced stress responsiveness, 10 data also indicate that the impact of external stressors (potentially such as concern over a pandemic) often becomes exaggerated within a married couple and significantly increase interspouse conflict. 11 In addition, the stress of prolonged enforced proximity faced by spouses could contribute to increased feelings of unease during stringent lockdowns. ...
Article
Sahil Bajaj,1,2 Karina S Blair,1,2 Ru Zhang,1,2 Johannah Bashford-Largo,1,2 Matthew Dobbertin,1,2 R James Blair1,2 1Multimodal Clinical Neuroimaging Laboratory (MCNL), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USA; 2Program for Trauma and Anxiety (PTAC), Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, NE, USACorrespondence: Sahil BajajCenter for Neurobehavioral Research, Boys Town National Research Hospital, 14015 Flanagan Blvd. Suite #102, Boys Town, NE, USAEmail sahil.bajaj@boystown.org
... Interestingly, the mean stress and anxiety scores of married couples and those living with children were lower compared to those being unmarried and living without children (Table 4). This may be explained on the premise that being surrounded by the loved ones result in reassurance and helps in buffering against the feelings of vulnerability and inability to control (Chin et al., 2017;Ta et al., 2017). ...
Article
Full-text available
COVID-19 has caused unprecedented disruption of all spheres of life, including health, financial, and socio behavioral. Given the rampant nature of the pandemic, several nations, including India has instituted stringent public health measures, with one being nationwide lockdown, to mitigate COVID-19 transmission. Previous studies reported increased stress and anxiety levels among general population during phase 1 (complete) lockdown, however, the effect of extended lockdown (phase 2) on mental health outcomes remains the subject of investigation till today. Therefore, this cross-sectional study endeavors to assess the psychological outcomes among general population during phase 2 lockdown. The online questionnaire surveyed 627 individuals from the general population using a non-probability snowball sampling technique. Descriptive statistics, including the frequency distribution, mean and standard deviations were generated. Mean differences across groups were analyzed through independent-samples- t and analysis of variance tests. Consistent with previous studies, our results indicated a higher mean score of anxiety and stress among females compared to males. Young adults aged between 21-39 years had the highest mean stress and anxiety scores compared to other categories. The mean anxiety score increased from retired (M=3.96, SD=4.76, to students (M=7.04, SD=7.11), to unemployed (M=9.0, SD=6.53) occupation groups. The findings of this study highlight the need for designing psychosocial regulatory frameworks and suitable interventions to address the needs of those being mentally traumatized by the pandemic and associated lockdowns. The study also advocates for establishing psychological health monitoring and telepsychiatry systems for identifying and treating mental health problems.
... The classic Selye (1956) model of physiological stress describes how repeated acute stressors can lead to a blunted or flatter cortisol diurnal profile and exhaustion when stress compromises bodily systems whereas the buffering hypothesis (Cohen and Wills, 1985) advocates social support protects individuals' health from the adverse consequences of psychosocial stress. Specific physiological alterations (e.g., reductions in cortisol) when a romantic partner is present may provide a buffering effect ultimately resulting in beneficial health outcomes (Chin et al., 2017). Adam et al. (2017) spoke to a host of individual variables predicting diurnal cortisol, specifically highlighting the predictive nature of psychosocial stressors. ...
Article
Significant evidence supports the link between relationships and health including the potential for interpartner regulation of intrapersonal physical and mental homeostasis. Physiological interdependence is proposed as a term to summarize the adaptive process in which partners demonstrate physiological contagion that evolves with repetition to create a new homeostatic state regulating individual physiological functioning. Through a systematic review consistent with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), the present study reviewed the literature examining the interdependent role of diurnal cortisol with romantic couples. The literature search yielded thirteen articles that included statistical modeling testing interdependence between couples and at the individual level. Five themes emerged from the literature including cortisol synchrony, cortisol and health, cortisol and emotions, cortisol and internal relationship factors, and cortisol and factors external to the romantic relationship. Findings suggest a potential for romantic partners to regulate one another’s emotional and physiological states, but this process may not be present in both partners. More research is needed to substantiate a regulatory role as the current literature supports correlations.
... Additionally, research is needed to identify factors associated with cortisol and CRP in BCS to help identify women at risk of physiological dysregulations and thus in need of intervention. Factors associated with elevated cortisol and CRP levels in healthy individuals include older age, lower education level, and single or divorced civil status [19,20]. Post-menopausal status, higher cancer stage, and overweight or obese status have also been associated with elevated cortisol and CRP levels in cancer survivors [3,21]. ...
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Background: Breast cancer survivors (BCS) may exhibit dysregulated patterns of cortisol and C-reactive protein (CRP). The aims of this study were to describe BCS’ cortisol and CRP levels over a 1-year period after treatment, and assess how levels relate to socio-demographic- (age, education level, marital status), health- (body mass index [BMI] category, menopausal status), and cancer-related factors (cancer stage, chemotherapy exposure, time since diagnosis). Methods: Participants (N=201) provided data at 3 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2–T5). At T1, participants completed self-report questionnaires and had their weight and height measured by a trained technician. At T1–T5, they provided five saliva samples at awakening, 30 min after awakening, 2:00 pm, 4:00 pm, and before bedtime on two nonconsecutive days to measure diurnal cortisol, and provided capillary whole blood to measure CRP. Data were analyzed using repeated-measure analyses of variance (ANOVAs) and mixed-design ANOVAs. Results: Diurnal cortisol and CRP levels fluctuated over time. In univariate models, older age and post-menopausal status were associated with higher cortisol and CRP levels, higher cancer stage and chemotherapy were associated with lower cortisol levels, and higher BMI category was associated with higher CRP levels. In adjusted models, age was no longer associated with CRP levels and shorter time since diagnosis was significantly associated with higher CRP levels. Conclusions: Socio-demographic-, health-, and cancer-related factors may help identify BCS at risk of physiological dysregulation who need intervention. Identifying modifiable factors associated with cortisol and CRP will inform cancer care interventions.
... This aligns with another study that found married couples from a community sample of healthy adults in the US had lower stress hormone levels. 22 The present study found that risky alcohol consumption was associated with being female and with not taking a holiday, and factors associated with psychiatric morbidity were insufficient sleep, not taking a holiday and being female. Nash et al. 8 found that not taking a holiday in the previous year was a factor associated with increased risk of psychiatric morbidity and being male was associated with hazardous alcohol use. ...
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Objective The aim of this study was to evaluate the prevalence of psychiatric morbidity, alcohol use, burnout and compassion satisfaction among physician trainees in New South Wales, Australia, and examine links between personal, demographic and lifestyle factors. Methods A total of 67 physician trainees were recruited to the study. Fifty-nine completed the online survey (88% response rate). Outcome measures included the Depression Anxiety Stress Scale, Professional Quality of Life Scale and Alcohol Use Disorders Identification Test. Results Approximately half the respondents met screening criteria for depression (53%), stress (51%) and anxiety (46%). Secondary traumatic stress was exceptionally high across the cohort, with higher scores in females (P=0.001). The main reasons for not seeking help for depression or anxiety were lack of time (81%), fear of lack of confidentiality or privacy (41%), embarrassment (39%) and effect on registration (27%). Eighty-eight per cent of respondents agreed that doctors feel they need to portray a healthy image, but only 54% engaged in regular exercise and 24% slept ≤6h each day. Conclusion The results demonstrate high levels of non-psychotic psychiatric morbidity among physician trainees and a need to improve their well-being. Workplace systems need to promote healthy work environments and support physician trainees through good mentorship and supervision. What is known about the topic? Doctors' health and patient care can be affected when doctors experience burnout and psychiatric morbidity. What does this paper add? This paper adds to the evidence of psychiatric morbidity, burnout, secondary trauma and increased demographic data on a cohort of junior doctors undertaking speciality training. In addition, it provides reasons for not seeking help and positive and negative coping methods used by these junior doctors. What are the implications for practitioners? The level of distress is high and requires system changes to support both individual health measures and structural change to work and study programs.
... An accentuated AUC G has been observed in many pathological conditions such as chronic burnout (Melamed et al., 1999), depression (Belanoff et al., 2002), and chronic stress (Bauer et al., 2000). In healthy populations, a lower AUC G is associated with lower loneliness in college students (e.g., Lai et al., 2019) and better adjustment (Chin et al., 2017;Lai et al., 2017). A recent study in healthy participants has demonstrated that a lower AUC G is associated with a lower risk of experimentally induced upper respiratory infection (Janicki-Deverts et al., 2016). ...
Article
This study used an intensive protocol to examine the effects of daily hassles and loneliness on diurnal salivary cortisol levels. Fifty Chinese undergraduates (28 females) provided six saliva samples each day for two consecutive days (at 0, 0.5, 3, 6, and 12 h after waking and at bedtime) and completed a questionnaire that included scales to measure daily hassles experienced over the previous month, trait loneliness, and depression. Cortisol data were aggregated over two days and used in subsequent analyses, focusing on the cortisol awakening response, diurnal slope, and overall cortisol output operationalized as the area under the curve with reference to the ground (AUCG). Multiple regression analysis showed that an increase in loneliness had a significant association with an increase in the AUCG and with a steeper diurnal slope. Loneliness also showed a significant interaction with daily hassles in that the positive association between daily hassles and AUCG was accentuated in the participants who reported a greater degree of loneliness. Our findings demonstrate for the first time the importance of trait loneliness in modulating the association between daily hassles and diurnal cortisol levels, which has significant clinical implications. Interventions to reduce loneliness should help college students to better cope with daily stressors. Increased attention should also be paid to the health implications of an elevated cortisol level in this relatively young and healthy population.
... Participants who were widowed, separated or never married exhibited higher NLR than married persons. Previous studies suggest that married individuals experience less psychological stress, leading to lower levels of cortisol and improved inflammatory regulation when compared to unmarried individuals [23]; such a potential biologic mechanism is in line with observations in the present study which found reduced NLR in married persons even after controlling for lifestyle and other demographic factors. ...
Article
Purpose: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation with established prognostic value in patients with cancer. Although high NLR is associated with poorer clinical outcomes, factors that influence the magnitude of NLR independently of disease are poorly understood. Methods: We identified 48,023 adults who participated in the National Health and Nutrition Examination Survey (1999-2016). Demographic, socioeconomic, and lifestyle factors associated with the magnitude of NLR after adjusting for comorbidities including heart disease, cancer, diabetes, and hypertension, and medications including aspirin, were identified. Effect modification by comorbidity status and demographics was explored. Results: Female gender, age less than 60 years, and non-Hispanic black race/ethnicity were associated with lower NLR. Marital statuses of widowed, separated, or never married demonstrated increased NLR as compared with those who were currently married. Never-smoking and moderate alcohol consumption were associated with lower NLR. Participation in physical activity was associated with decreased NLR after adjustment for potential confounders, primarily among non-Hispanic whites. Conclusions: Multiple demographic and lifestyle factors are independently associated with NLR. Sex, age, race, marital status, body mass index, physical activity, smoking history, and alcohol consumption should all be routinely collected and adjusted for to improve the accuracy of assessment of the prognostic power of NLR.
... Male partners may be more vulnerablefor good or for illto a romantic partner's biopsychosocial variables than females, suggesting that men may be internalizing their partners' stress levels. Meyer and Paul (2011) noted married couples report higher perceived stress than non-married individuals (but see Chin, Murphy, Janicki-Deverts, & Cohen, 2017). On the contrary, positive partner interventions may benefit men. ...
Article
Individuals in stable relationships tend to be healthier than those not in stable relationships. Despite this general positive influence of relationships on health, the mechanisms for the impact of relationship quality on health are not clear. Research has focused on many factors to explain this connection, including inter- and intra-couple dynamics of physiology and behavior. To address this issue, we examined the relationship between perceived health, depressive symptoms, and relationship quality on diurnal cortisol in 30 male/female romantic dyads (N = 60). Participants provided saliva samples on two weekdays to assess total cortisol output. Females’ lower perceived physical health, lower relationship satisfaction, and higher depression scores were each related to higher cortisol output in their male partners. Males’ physical health, relationship satisfaction, and depression scores were unrelated to females’ cortisol output. Further, physical health, relationship satisfaction, and depression scores did not predict intra-individual cortisol levels for either sex. Measures of diurnal cortisol slope (DCS) were unrelated to psychosocial factors in males and females. Results provide further support for the interpersonal influence of partners’ mental and physical health on physiological outcomes and suggest females may influence their male partners more than vice versa.
... Fifth, marriage influences the function of body physiologically, partially through modulating the level of endocrinal hormones that affect the prognosis of GBM. [19][20][21] In addition, the offspring of married couples provide additional support that is often unavailable to single patients. 22 The influence of offspring also partially explains why the survival of divorced/separated and widowed patients is better than that of single patients. ...
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The relationship between marital status and glioblastoma multiforme (GBM) has not been addressed in depth. Here, we aimed to investigate the association between marital status and survival in GBM. We searched the Surveillance, Epidemiology, and End Results (SEER) database and extracted the data of eligible patients diagnosed with GBM after 2004. Marital status was classified as married, divorced/separated, widowed, and single. A Kaplan‐Meier test was conducted to compare the survival curves of different groups. Multivariate Cox regression was performed to evaluate overall survival (OS) and cause‐specific survival (CSS) in different groups. Subgroup analysis was applied according to demographics, typical education and income levels in the locale, and insurance status. A total of 30 767 eligible patients were included. The median OS values were 9, 7, 3, 9 months in married, divorced/separated, widowed, and single patients, respectively. After adjustment for other covariates, married patients had better OS and CSS than other patients had. In addition to marital status, demographic factors, disease progression factors, local educational level, and insurance status were also associated with survival in GBM. Furthermore, subgroup analyses revealed the protective effect of marriage in most of the comparisons. Notably, the protective effect of marriage becomes more and more apparent as time goes on. The advantageous effect of marriage on GBM survival is especially prominent in patients who are male, older than 60 years of age, White, or living in middle‐income counties. In conclusion, marital status is an independent prognostic factor for GBM.
... Demographic and behavioral factors are suggestive determinants of NCDs established by existing literature. Behavioral factors, include consumption of alcohol and tobacco are the major risk, factors of chronic diseases which often modified by marital status, it is often propounded that widowed, separated and divorced people are often indulged in unhealthy lifestyle patterns owing to higher levels of psychological stress which further results by affecting physiological health (Sugathan et al. 2008;Chin et al. 2017;Trivedi et al. 2009). ...
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AimTo examine the burden of noncommunicable diseases (NCDs) in the Indian agro-climatic and political regions. Subjects and methodsData from two rounds of National Sample Survey (NSS) 68th (2011–12) and 71st (2014) was used to estimate the subnational spatial heterogeneity of NCD burden across 87 agro-climatic and political regions in India. Quantile maps, local Moran’s I, LISA cluster and significance maps were generated. ResultsResults show a high spatial heterogeneity in disease burden across the agro-climatic regions. Moran’s I scatterplot depict a significantly high level of regional dependence (Moran’s I = 0.558) of NCDs with larger concentration of disease in southern states like Kerala (northern and southern), Tamil Nadu (inland, coastal, and northern-coastal), Karnataka (inland, coastal and Ghats) and Pondicherry. The proportion of the elderly population, those belonging to urban areas, widowed/divorced/separated population, high per capita alcohol and tobacco consumption were more likely to affect the prevalence of NCDs. Conclusion Findings call for an immediate programmatic attention at the subnational level due to significantly high regional dependence of NCDs. Policies and programme should focus on strengthening the implementation of existing policies with a special focus on geriatric population to combat the disease burden.
... Married individuals had lower cortisol levels than their never married and previously married counterparts. Cortisol could be regarded as one candidate mechanism accounting for the association of marital status and health [24]. Additionally, the hypothalamus-pituitary-adrenal axis may also have an effect on the immune system, leading to poorer survival [25,26]. ...
Article
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Background The relationship between marital status and prognosis of kidney cancer has not been explored in detail. In this study, we aimed to investigate the impact of marital status on survival outcomes in kidney cancer. Methods We used the Surveillance, Epidemiology and End Results (SEER) program to identify 112860 patients with kidney cancer diagnosed in 2004 through 2013. Kaplan-Meier methods and multivariable Cox regression models were used to analyze the influence of marital status on overall survival (OS) and cancer-specific survival (CSS). Results Married patients had better 5-year OS and CSS compared with patients who were divorced/separated, widowed, and single. After adjusting for known confounders, unmarried patients were at greater risk of overall and cancer-specific mortality, especially the widowed. Moreover, subgroup analysis showed that married still had better prognosis across different SEER stages, ages and sexes. Conclusions Our study revealed that marriage is associated with better outcomes of both OS and CSS in kidney cancer patients.
Article
To investigate the clinicopathological features and prognosis of postoperative major salivary acinar cell carcinoma (MSACC) and develop a prognostic model. Retrospective cohort analysis of a public database. Patients with MSACC were identified from the Surveillance, Epidemiology, and End Results database (1975‐2019). Overall survival (OS) was evaluated using Kaplan‐Meier curves and a log‐rank test. Univariate and multivariate Cox analyses were performed to explore independent prognostic factors. The prognostic model was constructed using screened variables and further visualized with a nomogram and web calculator, and assessed by concordance index, the area under the curve, calibration curve, and decision‐making curve analysis. An upward trend in the incidence of MSACC was observed throughout the study period. A total of 1398 patients were enrolled (training cohort: 978; validation cohort: 420), and the 5‐ and 10‐year OS rates were 97.7% and 81.6%, respectively. Age, marital status, sex, histological grade, T stage, and lymph node status were identified as prognostic factors for OS. A novel nomogram was developed and showed excellent discrimination and clinical applicability. Additionally, a web calculator was designed to dynamically predict patient survival. Based on the nomogram‐based score, a risk stratification system was constructed to distinguish patients with different risks. The OS of high‐risk patients was significantly lower than that of the low‐risk subgroup. Long‐term survival in postoperative MSACC was influenced by 6 prognostic factors. The proposed model enables individualized survival prediction and risk stratification, prompting us to be vigilant in high‐risk subgroups and consider timely adjustment of subsequent treatment.
Article
Background: During stressful situations such as pandemic-associated lockdowns, individuals' diets may change towards (cariogenic) "comfort food". This study assessed the dietary patterns in lockdown in Colombia population. Methods: A cross-sectional online survey was designed. A convenience sample 489 adults was drawn, with 50% of them being in COVID-19 lockdown and the other being not or only partially in lockdown. The questionnaire collected data about the type and frequency of food consumed, with a special focus on cariogenic (i.e. rich in free sugars and starches) food. Descriptive analyses were performed, and a Generalized Linear Model was estimated to predict the frequency of cariogenic diet consumption in this period of time. Results: Sweet whole wheat bread (38.2%, P= 0.005), flavored milk (26.4%, P= 0.002), sugar-sweetened bubble gums (39.8%, P= 0.001), toffees (35.4%, P= 0.004), soft candies (e.g. gums, etc.) (35.4%, P= 0.018), chocolates (55.3%, P= 0.017) filled donuts (28.5%, P= 0.013) or grapes (51.2%, P= 0.002), among others were significantly more consumed in lockdown. Multivariable generalized linear modeling showed being single, having children and being in lockdown were significantly associated with higher frequency of cariogenic food consumption. Conclusions: Lockdown was found to be associated with detrimentally altered food consumption patterns and, specifically, a more cariogenic diet. Healthcare professionals should consider this when re-opening services and political decision-makers may want to reflect on unwarranted side effect of lockdown. This article is protected by copyright. All rights reserved.
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We rigorously investigated potential longitudinal associations of hair cortisol and cortisone with verbal memory, time orientation, and dementia, adjusting for sociodemographic and health confounders. Data from the English Longitudinal Study of Ageing wave 6–9 (6-year follow-up, covering 4399 persons aged 50+) were analysed using linear random effects and cox regression models. In unadjusted models, hair cortisol was associated with worsened verbal memory (β 0.19; SE 0.08), but not with time orientation (β 0.02; SE 0.01), or dementia (β 0.07; SE 0.16). Hair cortisone was associated with worsened verbal memory (β 0.74; SE 0.14) and time orientation (β 0.06; SE 0.02), but not with dementia (β 0.47; SE 0.28). However, in the fully adjusted models, neither hair cortisol nor cortisone was associated with verbal memory, time orientation, or dementia. Consistent with prior studies, we found that more advanced age was associated with worsened verbal memory (β 0.15; SE 0.01), time orientation (β 0.01; SE 0.00), and dementia risk (β 0.11; SE 0.02). Our rigorous analyses did not detect robust associations of neither hair cortisol nor cortisone with cognitive functioning or dementia across 6 years. More detailed insights into potential mechanisms are discussed.
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Loneliness and social isolation have become increasing concerns during COVID-19 lockdown through neuroendocrine stress-reactions, physical and mental health problems. We investigated living situation, relationship status and quality as potential moderators for trait and state loneliness and salivary cortisol levels (hormonal stress-responses) in healthy adults during the first lockdown in Germany. N = 1242 participants (mean age = 36.32, 78% female) filled out an online questionnaire on demographics, trait loneliness and relationship quality. Next, N = 247 (mean age = 32.6, 70% female) completed ecological momentary assessment (EMA), collecting twelve saliva samples on 2 days and simultaneously reporting their momentary loneliness levels. Divorced/widowed showed highest trait loneliness, followed by singles and partnerships. The latter displayed lower momentary loneliness and cortisol levels compared to singles. Relationship satisfaction significantly reduced loneliness levels in participants with a partner and those who were living apart from their partner reported loneliness levels similar to singles living alone. Living alone was associated with higher loneliness levels. Hierarchical linear models revealed a significant cross-level interaction between relationship status and momentary loneliness in predicting cortisol. The results imply that widowhood, being single, living alone and low relationship quality represent risk factors for loneliness and having a partner buffers neuroendocrine stress responses during lockdown.
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The number of single women in Indonesia is increasing, but single women in Indonesia are also vulnerable to negative stereotypes. Unpleasant experiences experienced by single women can have a negative impact. This study examines the association between negative stereotypes and psychological well-being and the mediating effect of fear of being single. The study participants were 196 single women aged 25 – 55 years, had completed their high school, and staying in Indonesia. Participants reported their experiences as single such as psychological well-being, happiness, negative stereotypes, fear of being single, dating experience, and desire to marry. Those experiences were measured by Ryff’s psychological well-being scale (α=0,80), Pignotti’s & Abell’s negative stereotyping of single persons scale(α=0,754-0,88) , Spielman’s fear of being scale (α=0,829), conscientiousness of BFI personality scale (α=0,821) and open questionnaire. Linear regression analysis was performed to test the relationship between variables. The results show that negative stereotypes reduce the psychological well-being of single women in Indonesia, and the fear of being single mediates the association between the two variables. Findings of this study indicate the need for social change to replace unfavourable labels received by single women in Indonesia and provide information for improving the psychological well-being of single Indonesian women. Keywords: fear of being single; negative stereotypes; psychological well-being; single women Abstrak Jumlah perempuan lajang di Indonesia semakin meningkat, namun perempuan lajang di Indonesia juga rentan mengalami stereotip negatif. Pengalaman tidak menyenangkan yang dialami perempuan lajang ini dapat membawa dampak negatif. Penelitian ini mengkaji asosiasi antara stereotip negatif dan kesejahteraan psikologis serta efek mediasi dari ketakutan menjadi lajang. Partisipan penelitian adalah 196 perempuan lajang berusia 25 – 55 tahun, berpendidikan minimal setara dengan SMA dan berdomisili di Indonesia yang melaporkan pengalaman sebagai lajang seperti kesejahteraan psikologis, kebahagiaan, stereotip negatif, ketakutan menjadi lajang, pengalaman berpacaran, dan keinginan untuk menikah. Pengalaman partisipan diukur dengan skala kesejahteraan psikologis Ryff (α=0,80), skala stereotip negatif individu lajang Pignotti dan Abell (α=0,754-0,88), skala fear of being single Spielman (α=0,829), skala BFI kepribadian conscientiousness (α=0,821). Analisis regresi linear dilakukan untuk menguji hubungan antar variabel. Hasil menunjukkan stereotip negatif menurunkan kesejahteraan psikologis perempuan lajang di Indonesia dan ketakutan menjadi lajang memediasi asosiasi kedua variabel tersebut. Temuan penelitian ini menunjukkan perlunya perubahan sosial untuk mengganti label buruk yang diterima perempuan lajang di Indonesia serta menjadi informasi bagi peningkatan kesejahteraan psikologis perempuan lajang Indonesia. Kata kunci: ketakutan menjadi lajang; kesejahteraan psikologis; perempuan lajang; stereotip negatif
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Importance: Marital status has been shown to be associated with mortality, but evidence in Asian populations is limited. Objective: To examine the association of marital status with total and cause-specific mortality. Design, setting, and participants: This cohort study included individual participant data from 16 prospective studies in the Asia Cohort Consortium conducted between 1963 and 2015. Asian participants with complete information on marital and vital status were included. Study-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards model and then pooled using a random-effects meta-analysis. The analysis began in February 2021 and ended in August 2021. Exposures: Marital status. Main outcomes and measures: All-cause and cause-specific mortality. Results: Of 623 140 participants (326 397 women [52.4%] and 296 743 men [47.6%]; mean [SD] age, 53.7 [10.2] years; mean [SD] follow-up time, 15.5 [6.1] years), 123 264 deaths were ascertained. Compared with married individuals, those who were unmarried had pooled HRs of 1.15 (95% CI, 1.07-1.24) for total mortality, 1.12 (95% CI, 1.03-1.22) for cerebrovascular disease mortality, 1.20 (95% CI, 1.09-1.31) for coronary heart disease mortality, 1.17 (95% CI, 1.07-1.28) for circulatory system diseases mortality, 1.06 (95% CI, 1.01-1.11) for cancer mortality, 1.14 (95% CI, 1.05-1.23) for respiratory diseases mortality, and 1.19 (95% CI, 1.05-1.34) for external causes of death. Positive associations with total mortality were also observed for those who were single (HR, 1.62; 95% CI, 1.41-1.86), separated (HR, 1.35; 95% CI, 1.13-1.61), divorced (HR, 1.38; 95% CI, 1.13-1.69), and widowed (HR, 1.09; 95% CI, 1.04-1.13). In subgroup analyses, the positive association persisted across baseline health conditions, and the risk of death was more pronounced among men or people younger than 65 years. Conclusions and relevance: This large pooled cohort study of individual participant data provides strong evidence that being unmarried, as well as belonging to the unmarried subcategories, was positively associated with total and cause-specific mortality. Investment of targeted social support services might need to be considered in light of the mortality differences between married and unmarried individuals.
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Loneliness and social isolation have become increasing concerns during COVID-19 lockdown through neuroendocrine stress-reactions, physical and mental health problems. We investigated living situation, relationship status and quality as potential moderators for trait and state loneliness and salivary cortisol levels (hormonal stress-responses) in healthy adults during the first lockdown in Germany. N=1242 participants (mean age = 36.32, 78% female) filled out an online questionnaire on demographics, trait loneliness and relationship quality. Next, N=247 (mean age = 32.6, 70% female) completed ecological momentary assessment (EMA), collecting twelve saliva samples on two days and simultaneously reporting their momentary loneliness levels. Divorced/widowed showed highest trait loneliness, followed by singles and partnerships. The latter displayed lower momentary loneliness and cortisol levels compared to singles. Relationship satisfaction significantly reduced loneliness levels in participants with a partner and those who were living apart from their partner reported loneliness levels similar to singles living alone. Living alone was associated with lower loneliness levels. Hierarchical linear models revealed a significant cross-level interaction between relationship status and momentary loneliness in predicting cortisol. The results imply that widowhood, being single, living alone and low relationship quality represent risk factors for loneliness and having a partner buffers neuroendocrine stress responses during lockdown.
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Background Stress and anxiety are relatively common, particularly in females and college students. Stress can impact students’ overall performance and their physical and mental health. The COVID-19 pandemic has affected all aspects of life and is associated with high levels of psychological distress. It has considerably affected the education sector, not only locally but worldwide, forcing a shift in the education system from on-site to virtual learning. This cross-sectional study was undertaken to evaluate the prevalence of anxiety and stress regarding virtual learning among health sciences college students in the Kingdom of Saudi Arabia (KSA) after introducing blended virtual classes and exams and in-person laboratory training. The study was carried six months after the COVID-19 outbreak. Methodology Participants were recruited by convenient sampling and snowballing strategies. Our study was conducted between November 18 and December 6, 2020. Questionnaires were employed; they included the General Anxiety Disorder-7 (GAD-7) scale and focused on the participants’ attitudes toward virtual learning. The present research was validated by a pilot study, followed by implementing some amendments. Results A total of 418 health sciences college students, aged 18-27 (M = 20.88, SD = 1.97), participated in the study. Our analysis indicated that more than half the sample (51.44%) reported a risk of moderate to severe GAD. Anxiety was recognized more frequently in women (72.09%) than in men (27.91%). Interestingly, our Χ2 analysis revealed an association between marital status and anxiety, with a higher risk of GAD found in single people (compared with married). In addition, we found that the risk of anxiety increased in junior students (1st-3rd year) compared to senior students (4th-6th year). Conclusion Our study highlights the need to establish gender-based tailored mental health support systems that provide preventive measures. The study findings also recommend that institutions develop programs and platforms that safely support students to interact and seek guidance, particularly those at higher risk of stress, such as females and first-year students. Overall, our study underlines the need to pursue an understanding of the complicated nature of anxiety disorders.
Article
The Information Technology (IT) industry in India is an integral part of the nation’s economy. The COVID-19 pandemic is a cause of disquietude and is probably the gravest challenge encountered by the IT industry at present. Although the IT industry has contributed to varied sectors globally amid the crisis, IT professionals encounter a profusion of mental health challenges. Despite this, there have as yet been limited studies focusing on the mental health impact on IT professionals during this period. This study strives to explore the role of socio-demographic factors on perceived stress and to examine the association between gratitude and perceived stress among IT professionals in India during the pandemic. Data from 219 participants were included for analysis in this cross-sectional, correlational study. Findings suggest that there exists a significant difference in perceived stress based on gender, marital status, and parental status. Furthermore, the results demonstrate a significant negative association between gratitude and perceived stress. The study contributes to the field of cognitive ergonomics and broadens the theoretical knowledge base of perceived stress based on socio-demographic elements. Findings also have positive implications for organisational psychologists as they suggest that encouraging a focus on gratitude could aid in lower perceived stress.
Article
Experimental and observational evidence agreed on two interconnected biological mechanisms responsible for the links between social isolation/loneliness and health: alterations in the activity of the hypothalamic-pituitary-adrenal (HPA) axis and compromised functioning of the innate immune system. However, most existing studies did not consider the simultaneous impact of social isolation and loneliness on biological outcomes. Further, they only assessed one biological outcome at a time and did not test any moderation by age, despite empirical and theoretical evidence supporting the plausibility of this hypothesis. To address these gaps in the literature, we tested the associations between two indicators of social isolation (living status and frequency of social contacts) and loneliness and daily cortisol secretion and two markers of systemic inflammation (C-reactive protein [CRP] and interleukin-6 [IL-6]) in a sample of adults aged between 25 and 75 years old. Data were drawn from the Midlife in the United States (MIDUS) Refresher study (N = 314). We found that, above and beyond loneliness, living alone was associated with a flattened diurnal cortisol slope (i.e., reduced changes in cortisol levels during waking hours that are indicative of a dysregulated HPA axis) and higher CRP levels. On the other hand, higher loneliness was associated with higher IL-6 levels, above and beyond our measures of social isolation. Loneliness did not mediate any of the effects of social isolation on either cortisol or CRP, and age did not moderate any of the relationships reported above. Our findings support the idea that social isolation and loneliness have unique and independent endocrine and immune effects despite being linked to each other. Understanding the specific biological pathways through which these aspects of social well-being exert their effects on health across the lifespan has critical consequences for both intervention development and public health policies.
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Background To limit the rapid spread of COVID‐19, countries have asked their citizens to stay at home. As a result, demographic and cultural factors related to home life have become especially relevant to predict population well‐being during isolation. This pre‐registered worldwide study analyses the relationship between the number of adults and children in a household, marital status, age, gender, education level, COVID‐19 severity, individualism–collectivism, and perceived stress. Methods We used the COVIDiSTRESS Global Survey data of 53,524 online participants from 26 countries and areas. The data were collected between 30 March and 6 April 2020. Results Higher levels of stress were associated with younger age, being a woman, lower level of education, being single, staying with more children, and living in a country or area with a more severe COVID‐19 situation. Conclusions The COVID‐19 pandemic revealed that certain people may be more susceptible to experience elevated levels of stress. Our findings highlight the need for public health to be attentive to both the physical and the psychological well‐being of these groups.
Article
Objective: The Couples Coping with Cancer Together program (CCCT) is used to illustrate practical strategies to implement, evaluate and grow a successful couples-based program in a NCI-Designated CCC. CCCT is multi-modal program utilizing psychoeducational, strategic, strengths-based, and problem-solving theoretical frameworks. CCCT integrates multiple intervention modalities, as the standard of care: patients/partners biopsychosocial screening, a standardized psychoeducational session, group intervention, and short-term couples counseling. Methods: Implementation strategies included: (1) identifying Values-Benefits-Outcomes for key stakeholders (2) recruiting an interdisciplinary team (3) utilizing a concurrent development model (implementing program components in small iterations) (4) integrating program into existing institutional processes (5) collecting data and credibility. Results: CCCT prospectively screened 1995 patients/partners simultaneously for biopsychosocial distress and 913 patient/partner completed program evaluations. Program satisfaction was extremely high: "I recommend this program, for other patients/partners (Patients 95.4% Partners 96.4%). Ten of the 11 participating physicians anonymously surveyed responded and indicated 100% likely/very likely "to recommend the program to other physicians". Conclusions: Couples-based programs are under-utilized and have been shown to be important for adjustment and increased longevity. Despite barriers in the healthcare environment, implementing couples-based programs into standard of care are feasible. These strategies may be applicable to develop supportive care programs in various healthcare settings. This article is protected by copyright. All rights reserved.
Article
Purpose: The purpose of this study was to elucidate the impact of being unmarried on coronary computed tomography (CT) imaging biomarkers and mortality in a lung cancer screening population. Materials and methods: In this retrospective case-control study, 5707 subjects (3777 married; mean age: 61.9±5.1 y and 1930 unmarried; mean age: 61.9±5.3 y) underwent low-dose CT as part of the National Lung Screening Trial (NLST). The median follow-up time was 6.5 (Q1-Q3: 5.6 to 6.9) years. Being unmarried was defined as never married, widowed, separated, or divorced. Being married was defined as married or living as married. Our primary endpoint was cardiovascular disease (CVD)-related death; our secondary endpoint was all-cause mortality. Coronary CT imaging biomarkers (calcium score, density, and volume) on low-dose chest CT scan were calculated using dedicated automatic software. Weighted Cox proportional-hazards regression was performed to examine the association between marital status and death. Kaplan-Meier curves were generated to visualize subject survival. Results: Being unmarried was significantly associated with an increased risk for CVD-related death (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.31-1.91) and all-cause mortality (HR: 1.39; 95% CI: 1.26-1.53), which remained significant even after adjusting for traditional cardiovascular risk factors (HR CVD death: 1.75; 1.44-2.12 and HR all-cause mortality: 1.58; 95% CI: 1.43-1.74) and coronary calcium score (HR CVD death: 1.58; 95% CI: 1.31-1.91 and HR all-cause mortality: 1.40; 95% CI: 1.27-1.54). Conclusions: Being unmarried is associated with an increased CVD-related death and all-cause mortality mainly due to cardiovascular etiology. On the basis of this, marital status might be taken into consideration when assessing individuals' health status.
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Background: The aim of the study was to build and validate practical nomograms to better predict the overall survival (OS) and cancer-specific survival (CSS) of the patients with soft tissue sarcomas (STS) who underwent surgery. Methods: Patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We identified 8804 patients who underwent surgery with STS between 2007 and 2015, and randomly divided them into the training (n=6164) and validation (n=2640) cohorts. The Cox regression analysis and cumulative incidence function were performed to identify the independent prognostic factors associated with OS and CSS, respectively. The performance of the nomograms was evaluated using Harrell’s concordance index (C-index) and the calibration curves. Decision curve analysis (DCA) was introduced to compare the clinical practicality between the nomograms and the AJCC staging system. Results: Eight independent prognostic factors for OS and seven for CSS were determined and then used to build the nomograms for 3- and 5-year OS and CSS, respectively. The C-indexes of the nomograms for predicting OS were 0.788 in the internal validation and 0.823 in external validation, significantly higher than C-index of the AJCC staging system (P<0.001). The similar results were obtained in the validation cohort. Internal and external calibration curves for the predicting 3- and 5-year OS and CSS showed excellent agreement between the prediction and the actual survival outcomes. In addition, DCA demonstrated that our nomograms were superior over the AJCC staging system with obtaining more clinical net benefits. Conclusions: We established and validated the nomograms that could accurately predict the 3- and 5-year OS and CSS for STS patients who underwent surgery. The nomograms showed more robust and applicable performance than the AJCC staging system for predicting OS and CSS.
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In gerontology, the issue of pets as a "negative effect killer during retirement" has long been believed to be an activity that can improve living welfare. This study used 77 male retired employees. This study aims to determine the effect of pet ownership on stress levels, differences in stress levels between groups that have animals and do not have animals and know the characteristics of the group of pet owners related to stress levels. The research data will be analyzed using simple regression, Mann Whitney test and Chi square. The research instruments used were the Perceived Stress Scale from Cohen (1988) and the questionnaire. Obtained overall results of respondents at moderate stress levels. The research findings are that pet ownership has an effect on stress levels of 37, 2%. It was also found that groups that had pets had lower stress levels than those who did not have pets. In addition, it was concluded that there was a correlation between the level of education and the level of stress that was not significant, the correlation between marital status and residence status with stress levels significantly. Keywords: :Pet, Retirement, Stress Levels
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Introduction: In the retirement age, people experience conflicts and marital problems as they go through one of the transitional stages of life and spend more time at home and face new sources of stress. Therefore, the present study was conducted to investigate the role of coping strategies, purposefulness in life, and quality of life in the level of marital adjustment in retirees. Methods: The present study was a correlational survey. The population consisted of 200 retirees of Nahavand during year 2016, selected by simple random sampling method, as the study sample. The research tools were Coping Inventory for Stressful Situations (CISS), Meaning of Life Questionnaire (MLQ), Marital Status Inventory and WHO Quality of Life (WHOQOL-26), and Golombok-Rust marital status inventory. The data were analyzed using Pearson correlation and multiple regression analysis. Results: The results showed that there was a negative correlation between task-oriented strategy and marital adjustment (-0.22), a significant positive correlation between emotion-oriented strategy and marital adjustment (0.20), and a significant negative correlation between the avoidance strategy and marital adjustment (-0.19). Meaning of life was also negatively correlated with marital adjustment (-0.37). Quality of life had a moderate negative correlation with marital adjustment (-0.46). The results of multiple regression analysis showed that coping strategies, meaning of life, and quality of life with multiple correlation coefficient of 0.56 could significantly predict 31% of marital adjustment variance. Conclusions: According to the results of the current study, effective coping strategies, meaningful life, and good quality of life are predictors of marital adjustment in retirees. Consideration of these issues is necessary for employees of government and nongovernmental organizations, who are on the brink of retirement, in order to cope with marital problems during the retirement period.
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The prognostic role of marital status in patients with astrocytoma has not been fully explored. In this study we investigated the association of marital status and survival of astrocytoma. We extracted the eligible patients with astrocytoma diagnosed after 2000 from the Surveillance, Epidemiology, and End Results (SEER) database. The marital status was classified into married, divorced/separated, widowed, and single. The differences in OS and CSS were compared using the Kaplan-Meier log-rank test, and multivariate Cox regression was applied to analyze the risk factors for OS and CSS. Subgroup analyses were conducted to explore the association of marital status with patients in different sex, age, race, histologic type based on 2016 WHO grade, year of diagnosis, median household income and surgery status. A total of 43, 324 eligible patients were included. The median overall survival is 17, 11, 9, 3 months in single, married, divorced/separated patients, and widowed patients, respectively. Although single patients seemed to have the longest overall survival, after adjusted for other co-variables, married patients had the best OS and CSS compared with others, while divorced/separated or widowed patients had the worst CSS in different subgroups. Furthermore, subgroup analyses revealed some interesting results such as the CSS showed no difference between single and married for women (P = 0.122). In conclusion, marital status was an independent prognostic factor for astrocytoma patients. The healthcare system should aware of that patients with an aborted marriage need more social and physiological support.
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In this article, we argued that the term stress has served as a valuable heuristic, helping researchers to integrate traditions that illuminate different stages of the process linking stressful life events to disease. We provided a short history of three traditions in the study of stress: the epidemiological, psychological, and biological. The epidemiological tradition focuses on defining which circumstances and experiences are deemed stressful on the basis of consensual agreement that they constitute threats to social or physical well-being. The psychological tradition focuses on individuals’ perceptions of the stress presented by life events on the basis of their appraisals of the threats posed and the availability of effective coping resources. The biological tradition focuses on brain-based perturbations of physiological systems that are otherwise essential for normal homeostatic regulation and metabolic control. The foci of these three traditions have informed elements of a stage model of disease, wherein events appraised as stressful are viewed as triggering affective states that in turn engender behavioral and biological responses having possible downstream implications for disease.
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The immunosuppressive effects of glucocorticoids (GCs) are well-established. However, whether the net effect of GC-elicited alterations in immune function is sufficient to influence a clinically relevant outcome in healthy adults has yet to be shown. The aim of the present study was to investigate whether inter-individual differences in basal salivary cortisol production are associated with increased risk and severity of infection and subsequent illness following experimental exposure to a virus that causes the common cold. The present analyses combine archival data from three viral-challenge studies. Participants were 608 healthy adults, aged 18 to 55 years (49.2% female; 65.8% white), who each completed a three-day saliva collection protocol; was subsequently exposed to a virus that causes the common cold; and monitored for 5 days for objective signs of infection (presence of challenge virus in nasal secretions) and clinical illness (mucus weight, mucociliary clearance time). Basal cortisol production (operationalized as the calculated area-under-the-curve averaged across the 3 days) showed a graded association with infection risk, with those producing higher levels of cortisol being at greater risk. Cortisol also showed a continuous association with duration of viral shedding, an indicator of viral replication and continuing infection, such that higher cortisol concentrations predicted more days of shedding. Cortisol was not, however, related to severity of objective illness. These findings are the first to demonstrate in healthy adults an association between basal cortisol production and an objectively measured and clinically relevant infectious disease outcome.
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In this article we focus on the psychological well-being of the widowed and divorced. The data are from a national stratified probability sample in which the divorced and widowed, particularly divorced and widowed males, were oversampled. Seven different indicators of psychological well-being are used. Compared to the married and, to a lesser extent the never married, the psychological well-being of the divorced and widowed is poor. Overall the psychological well-being of divorced males, divorced females and widowed females is roughly comparable and better than the psychological well-being of widowed males.
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Social isolation may operate as a psychosocial stressor which disrupts functioning of the hypothalamic-pituitary-adrenocortical axis. Using data from the MRC National Survey of Health and Development, we tested whether living alone, not being married and social network size were associated with diurnal cortisol patterns at 60-64 years. We hypothesised that recent onset compared with long-term isolation would be more strongly associated with cortisol awakening response, cortisol decline over the day and evening cortisol. Models were adjusted for sex, smoking, body mass index, alcohol intake, psychological distress and financial difficulties. Those widowed within the last three years had a 36% (95%CI 6%, 73%) higher night time cortisol than those who were currently married. Those newly living alone also had a higher night time cortisol and flatter diurnal slope than those living with others. Independently of multiple behavioural and psychosocial correlates, recent onset of social isolation is related to diurnal cortisol patterns that increase the risk of morbidity and mortality.
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This meta-analysis reviewed 126 published empirical articles over the past 50 years describing associations between marital relationship quality and physical health in more than 72,000 individuals. Health outcomes included clinical endpoints (objective assessments of function, disease severity, and mortality; subjective health assessments) and surrogate endpoints (biological markers that substitute for clinical endpoints, such as blood pressure). Biological mediators included cardiovascular reactivity and hypothalamic-pituitary-adrenal axis activity. Greater marital quality was related to better health, with mean effect sizes from r = .07 to .21, including lower risk of mortality (r = .11) and lower cardiovascular reactivity during marital conflict (r = –.13), but not daily cortisol slopes or cortisol reactivity during conflict. The small effect sizes were similar in magnitude to previously found associations between health behaviors (e.g., diet) and health outcomes. Effect sizes for a small subset of clinical outcomes were susceptible to publication bias. In some studies, effect sizes remained significant after accounting for confounds such as age and socioeconomic status. Studies with a higher proportion of women in the sample demonstrated larger effect sizes, but we found little evidence for gender differences in studies that explicitly tested gender moderation, with the exception of surrogate endpoint studies. Our conclusions are limited by small numbers of studies for specific health outcomes, unexplained heterogeneity, and designs that limit causal inferences. These findings highlight the need to explicitly test affective, health behavior, and biological mechanisms in future research, and focus on moderating factors that may alter the relationship between marital quality and health.
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Objective: Neuroendocrine abnormalities, such as activation of the hypothalamic-pituitary-adrenal (HPA) axis, are associated with obesity; however, few large-scale population-based studies have examined HPA axis and markers of obesity. We examined the cross-sectional association of the cortisol awakening response (CAR) and diurnal salivary cortisol curve with obesity. Design and methods: The Multiethnic Study of Atherosclerosis Stress Study includes 1,002 White, Hispanic, and Black men and women (mean age 65 ± 9.8 years) who collected up to 18 salivary cortisol samples over 3 days. Cortisol profiles were modeled using regression spline models that incorporated random parameters for subject-specific effects. Cortisol curve measures included awakening cortisol, CAR (awakening to 30-min postawakening), early decline (30 min to 2-h postawakening), late decline (2-h postawakening to bedtime), and the corresponding areas under the curve (AUC). Body mass index (BMI) and waist circumference (WC) were used to estimate adiposity. Results: For the entire cohort, both BMI and WC were negatively correlated with awakening cortisol (P < 0.05), AUC during awakening rise, and early decline and positively correlated to the early decline slope (P < 0.05) after adjustments for age, race/ethnicity, gender, diabetes status, socioeconomic status, β-blockers, steroids, hormone replacement therapy, and smoking status. No heterogeneities of effects were observed by gender, age, and race/ethnicity. Conclusions: Higher BMI and WC are associated with neuroendocrine dysregulation, which is present in a large population sample, and only partially explained by other covariates.
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The authors analyzed the effects of marital dissolution on sickness absence and discussed the social role, crisis, and social selection models as well as the impact of gender and children. They used administrative data that covers the Norwegian population for the years 1992–2008 and panel methods to investigate lags and leads of the effects of divorce, controlling for time-varying variables and time-constant unobserved factors. The results revealed that 6 years before divorce, the sickness absence rate among divorced people was at a level similar to that among those who remained married. The sickness absence rate increased in the year preceding divorce, peaked in the year of divorce, and decreased in the following year, but not to the level before divorce. The authors found strong support for the social role model, and the results show that the gender–parenthood interaction is important. Limited support for the crisis and selection models was found.
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Importance The period immediately after bereavement has been reported as a time of increased risk of cardiovascular events. However, this risk has not been well quantified, and few large population studies have examined partner bereavement.Objective To compare the rate of cardiovascular events between older individuals whose partner dies with those of a matched control group of individuals whose partner was still alive on the same day.Design, Setting, and Participants Matched cohort study using a UK primary care database containing availale data of 401 general practices from February 2005 through September 2012. In all, 30 447 individuals aged 60 to 89 years at study initiation who experienced partner bereavement during follow-up were matched by age, sex, and general practice with the nonbereaved control group (n = 83 588) at the time of bereavement.Exposures Partner bereavement.Main Outcomes and Measures The primary outcome was occurrence of a fatal or nonfatal myocardial infarction (MI) or stroke within 30 days of bereavement. Secondary outcomes were non-MI acute coronary syndrome and pulmonary embolism. All outcomes were compared between the groups during prespecified periods after bereavement (30, 90, and 365 days). Incidence rate ratios (IRRs) from a conditional Poisson model were adjusted for age, smoking status, deprivation, and history of cardiovascular disease.Results Within 30 days of their partner’s death, 50 of the bereaved group (0.16%) experienced an MI or a stroke compared with 67 of the matched nonbereaved controls (0.08%) during the same period (IRR, 2.20 [95% CI, 1.52-3.15]). The increased risk was seen in bereaved men and women and attenuated after 30 days. For individual outcomes, the increased risk was found separately for MI (IRR, 2.14 [95% CI, 1.20-3.81]) and stroke (2.40 [1.22-4.71]). Associations with rarer events were also seen after bereavement, including elevated risk of non-MI acute coronary syndrome (IRR, 2.20 [95% CI, 1.12-4.29]) and pulmonary embolism (2.37 [1.18-4.75]) in the first 90 days.Conclusions and Relevance This study provides further evidence that the death of a partner is associated with a range of major cardiovascular events in the immediate weeks and months after bereavement. Understanding psychosocial factors associated with acute cardiovascular events may provide opportunities for prevention and improved clinical care.
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Objective: To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection. Design: After reporting the extent of participation in 12 types of social ties (eg, spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing 1 of 2 rhinoviruses and monitored for the development of a common cold. Setting: Quarantine. Participants: A total of 276 healthy volunteers, aged 18 to 55 years, neither seropositive for human immunodeficiency virus nor pregnant. Outcome measures: Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication. Results: In response to both viruses, those with more types of social ties were less susceptible to common colds, produced less mucus, were more effective in ciliary clearance of their nasal passages, and shed less virus. These relationships were unaltered by statistical controls for prechallenge virus-specific antibody, virus type, age, sex, season, body mass index, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1 to 3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds. Conclusions: More diverse social networks were associated with greater resistance to upper respiratory illness.