Are Individual and Community Acceptance and Witnessing of Intimate Partner Violence Related to Its Occurrence? Multilevel Structural Equation Model

Background

Intimate partner violence against women (IPVAW) is a serious and widespread problem worldwide. Much of the research on IPVAW focused on individual-level factors and attention has been paid to the contextual factors. The aim of this study was to develop and test a model of individual- and community-level factors associated with IPVAW.

Methods and Findings

We conducted a (multivariate) multilevel structural equation analysis on 8731 couples nested within 883 communities in Nigerian Demographic and Health Survey 2008. Variables included in the model were derived from respondents'' answers to the experience of IPVAW, attitudes towards wife beating and witnessing physical violence in childhood. We found that women that witnessed physical violence were more likely to have tolerant attitudes towards IPVAW and women with tolerant attitudes were more likely to have reported spousal IPVAW abuse. Women with husbands with tolerant attitudes towards IPVAW were more likely to have reported spousal abuse. We found that an increasing proportion of women in the community with tolerant attitudes was significantly positively associated with spousal sexual and emotional abuse, but not significantly associated with spousal physical abuse. In addition, we found that an increasing proportion of men in the community with tolerant attitudes and an increasing proportion of women who had witnessed physical violence in the community was significantly positively associated with spousal physical abuse, but not significantly associated with spousal sexual and emotional abuse. There was a positive correlation between all three types of IPVAW at individual- and community-level.

Conclusions

We found that community tolerant attitudes context in which people live is associated with exposure to IPVAW even after taking into account individual tolerant attitudes. Public health interventions designed to reduce IPVAW must address people and the communities in which they live in order to be successful.     

Measuring Exposure in Hurricane Katrina: A Meta-Analysis and an Integrative Data Analysis

To date there is no consensus on the operationalization of exposure severity in the study of the impact of natural disasters. This is problematic because incomplete and inconsistent measurement of exposure limits the internal and external validity of disaster studies. The current paper examined the predictive validity of severity measures in two interrelated studies of Hurricane Katrina survivors. First, in a meta-analysis of eight studies that measured both exposure severity and posttraumatic stress, the effect size was estimated to be r = .266. The moderating effects of sample and study characteristics were examined and we found that minority status and number of stressors assessed were significant moderators. Second, in an integrative data analysis of five independent samples of Hurricane Katrina survivors, the impact of specific disaster-related stressors on mental health was compared. Threat to physical integrity of self and others were found to have the strongest association with posttraumatic stress (PTS) and general psychological distress (GPD). The lack of basic necessities, such as food, water, and medical care, and loss of pet were also found to be strongly associated with both PTS and GPD. The results from the two studies are integrated and their implication for disaster research and relief are discussed.     

Mental Health Functioning in the Human Rights Field: Findings from an International Internet-Based Survey

Human rights advocates play a critical role in promoting respect for human rights world-wide, and engage in a broad range of strategies, including documentation of rights violations, monitoring, press work and report-writing, advocacy, and litigation. However, little is known about the impact of human rights work on the mental health of human rights advocates. This study examined the mental health profile of human rights advocates and risk factors associated with their psychological functioning. 346 individuals currently or previously working in the field of human rights completed an internet-based survey regarding trauma exposure, depression, posttraumatic stress disorder (PTSD), resilience and occupational burnout. PTSD was measured with the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) and depression was measured with the Patient History Questionnaire-9 (PHQ-9). These findings revealed that among human rights advocates that completed the survey, 19.4% met criteria for PTSD, 18.8% met criteria for subthreshold PTSD, and 14.7% met criteria for depression. Multiple linear regressions revealed that after controlling for symptoms of depression, PTSD symptom severity was predicted by human rights-related trauma exposure, perfectionism and negative self-appraisals about human rights work. In addition, after controlling for symptoms of PTSD, depressive symptoms were predicted by perfectionism and lower levels of self-efficacy. Survey responses also suggested high levels of resilience: 43% of responders reported minimal symptoms of PTSD. Although survey responses suggest that many human rights workers are resilient, they also suggest that human rights work is associated with elevated rates of PTSD and depression. The field of human rights would benefit from further empirical research, as well as additional education and training programs in the workplace about enhancing resilience in the context of human rights work.     

Posttraumatic Stress in Survivors 1 Month to 19 Years after an Airliner Emergency Landing

Posttraumatic stress (PTS) is common in survivors from life-threatening events. Little is known, however, about the course of PTS after life threat in the absence of collateral stressors (e.g., bereavement, social stigma, property loss) and there is a scarcity of studies about PTS in the long term. This study assessed the short- and long-term course of PTS, and the influence of gender, education and age on the level and course of PTS, in survivors from a non-fatal airliner emergency landing caused by engine failure at an altitude of 1 km. There were 129 persons on board. A survey including the Impact of Event Scale was distributed to 106 subjects after 1 month, 4 months, 14 months, and 25 months, and to 95 subjects after 19 years (response rates 64–83%). There were initially high levels of PTS. The majority of changes in PTS occurred from 1 to 4 months after the event. There were small changes from 4 to 25 months but further decrease in PTS thereafter. Female gender was associated with higher levels of PTS whereas gender was unrelated to the slope of the short- and long-term trajectories. Higher education was related to a quicker recovery although not to initial or long-term PTS. Age was not associated with PTS. The present findings suggest that a life-threatening experience without collateral stressors may produce high levels of acute posttraumatic stress, yet with a benign prognosis. The findings further implicate that gender is unrelated to trajectories of recovery in the context of highly similar exposure and few collateral stressors.     

Resiliencia en cuidadores de personas con demencia: estudio preliminar

Introduction

Caring for a relative with dementia often has negative effects on the caregive?s physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables.

Material and methods

Resilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health).

Results

The participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies.

Conclusions

Higher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers’ resilience and, consequently, their health.     

5‐HTTLPR genotype potentiates the effects of war zone stressors on the emergence of PTSD,depressive and anxiety symptoms in soldiers deployed to iraq

Exposure to war zone stressors is common, yet only a minority of soldiers experience clinically meaningful disturbance in psychological function. Identification of biomarkers that predict vulnerability to war zone stressors is critical for developing more effective treatment and prevention strategies not only in soldiers but also in civilians who are exposed to trauma. We investigated the role of the serotonin transporter linked polymorphic region (5‐HTTLPR) genotype in predicting the emergence of post‐traumatic stress disorder (PTSD), depressive and anxiety symptoms as a function of war zone stressors. A prospective cohort of 133 U.S. Army soldiers with no prior history of deployment to a war zone, who were scheduled to deploy to Iraq, was recruited. Multilevel regression models were used to investigate associations between 5‐HTTLPR genotype, level of war zone stressors, and reported symptoms of PTSD, depression and anxiety while deployed to Iraq. Level of war zone stressors was associated with symptoms of PTSD, depression and anxiety. Consistent with its effects on stress responsiveness, 5‐HTTLPR genotype moderated the relationship between level of war zone stressors and symptoms of emotional disturbance. Specifically, soldiers carrying one or two low functioning alleles (S or L_G) reported heightened symptoms of PTSD, depression and anxiety in response to increased levels of exposure to war zone stressors, relative to soldiers homozygous for the high functioning allele (L_A). These data suggest that 5‐HTTLPR genotype moderates individual sensitivity to war zone stressors and the expression of emotional disturbance including PTSD symptoms. Replication of this association along with identification of other genetic moderators of risk can inform the development of biomarkers that can predict relative resilience vs. vulnerability to stress.     

Genome‐wide variation in DNA methylation is associated with stress resilience and plumage brightness in a wild bird

Individuals often differ in their ability to cope with challenging environmental and social conditions. Evidence from model systems suggests that patterns of DNA methylation are associated with variation in coping ability. These associations could arise directly if methylation plays a role in controlling the physiological response to stressors by, among other things, regulating the release of glucocorticoids in response to challenges. Alternatively, the association could arise indirectly if methylation and resilience have a common cause, such as early‐life conditions. In either case, methylation might act as a biomarker for coping ability. At present, however, relatively little is known about whether variation in methylation is associated with organismal performance and resilience under natural conditions. We studied genome‐wide patterns of DNA methylation in free‐living female tree swallows (Tachycineta bicolor) using methylated DNA immunoprecipitation (MeDIP) and a tree swallow genome that was assembled for this study. We identified areas of the genome that were differentially methylated with respect to social signal expression (breast brightness) and physiological traits (ability to terminate the glucocorticoid stress response through negative feedback). We also asked whether methylation predicted resilience to a subsequent experimentally imposed challenge. Individuals with brighter breast plumage and higher stress resilience had lower methylation at differentially methylated regions across the genome. Thus, widespread differences in methylation predicted both social signal expression and the response to future challenges under natural conditions. These results have implications for predicting individual differences in resilience, and for understanding the mechanistic basis of resilience and its environmental and social mediators.     

Prevalence of and Factors Associated with Human Cysticercosis in 60 Villages in Three Provinces of Burkina Faso

Background

Taenia solium, a zoonotic infection transmitted between humans and pigs, is considered an emerging infection in Sub-Saharan Africa, yet individual and community-level factors associated with the human infection with the larval stages (cysticercosis) are not well understood. This study aims to estimate the magnitude of association of individual-level and village-level factors with current human cysticercosis in 60 villages located in three Provinces of Burkina Faso.

Methodology/Principal Findings

Baseline cross-sectional data collected between February 2011 and January 2012 from a large community randomized-control trial were used. A total of 3609 individuals provided serum samples to assess current infection with cysticercosis. The association between individual and village-level factors and the prevalence of current infection with cysticercosis was estimated using Bayesian hierarchical logistic models. Diffuse priors were used for all regression coefficients. The prevalence of current cysticercosis varied across provinces and villages ranging from 0% to 11.5%. The results obtained suggest that increased age, being male and consuming pork as well as a larger proportion of roaming pigs and percentage of sand in the soil measured at the village level were associated with higher prevalences of infection. Furthermore, consuming pork at another village market had the highest increased prevalence odds of current infection. Having access to a latrine, living in a household with higher wealth quintiles and a higher soil pH measured at the village level decreased the prevalence odds of cysticercosis.

Conclusions/Significance

This is the first large-scale study to examine the association between variables measured at the individual-, household-, and village-level and the prevalence odds of cysticercosis in humans. Factors linked to people, pigs, and the environment were of importance, which further supports the need for a One Health approach to control cysticercosis infection.     

Community-Level Social Capital and Psychological Distress among the Elderly in Japan: A Population-Based Study

Despite accumulating evidence, previous studies have not clearly separated the contribution of community-level social capital on mental health from that of individual-level social support. We examined the association between community-level social capital and psychological distress in a sample of older Japanese individuals, taking into account the effects of individual-level social capital and social support. We collected data via a cross-sectional survey among all residents aged ≥65 in three rural municipalities in Okayama Prefecture. We measured two components of social capital in the questionnaire: perceptions of trust and reciprocity in the community. Community-level social capital was obtained by aggregating individual responses and calculating the proportion of subjects reporting mistrust and lack of reciprocity. Psychological distress was assessed by the Kessler Psychological Distress scale. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for psychological distress using two-level Poisson regression models (9,761 individuals nested within 35 communities). The prevalence of psychological distress was 39.8%. Low community-level social capital was associated with psychological distress, even after controlling for individual-level social support, age, sex, educational attainment, frequency of alcohol consumption, smoking status, body mass index, marital status, socioeconomic status, and number of cohabiters. The adjusted RRs per 10% increase of the proportion of mistrust and lack of reciprocity in the communities were 1.23 (95% CI: 1.01–1.51) and 1.12 (95% CI: 1.02–1.24), respectively. Lower levels of community-level social capital are associated with psychological distress among the Japanese elderly population, even after adjusting for individual-level perceptions of social capital and social support.     

Biomarker/bioindicator response profiles of organisms can help differentiate between sources of anthropogenic stressors in aquatic ecosystems

Aquatic ecosystems can be chronically stressed by multiple environmental factors which originate from a variety of point and non-point sources. In addition, these stressors may vary both spatially and temporally, and, combined with synergestic and cumulative interactions of these stressors, complicate the interpretation and evaluation of stress responses in organisms. To help identify and differentiate between sources of anthropogenic stressors in aquatic systems, a diagnostic approach based on exposure-response profiles in sentinel organisms was developed from the known effects of various anthropogenic activities on biological systems. To generate these exposure-effects profiles, biomarkers of exposure were plotted against bioindicators of corresponding effects for several major anthropogenic activities including petrochemical, pulp and paper, domestic sewage, mining operations, land-development, and agricultural activities. Biomarkers of exposure to environmental stressors varied widely depending on the type of anthropogenic activity involved. Bioindicator effects, however, including histopathological lesions, bioenergetic status, growth, reproductive impairment, and community-level endpoints were similar among several of the major anthropogenic activities because responses at these higher levels are less specific to stressors than are biomarkers. This approach appears useful for helping to identify and diagnose sources of stress in environments impacted by multiple stressors. By identifying the types and sources of environmental stressors impacting key components of biological systems, aquatic ecosystems can be more effectively protected, regulated, and managed to help improve and maintain environmental quality and ecosystem fitness.     

Posttraumatic growth,posttraumatic stress disorder and resilience of motor vehicle accident survivors

Background  

Although some previous studies have suggested that posttraumatic growth (PTG) is comprised of several factors with different properties, few have examined both the association between PTG and posttraumatic stress disorder (PTSD) and between PTG and resilience, focusing on each of the factors of PTG. This study aimed to examine the hypothesis that some factors of PTG, such as personal strength, relate to resilience, whereas other factors, such as appreciation of life, relate to PTSD symptoms among Japanese motor vehicle accident (MVA) survivors.     

乳腺癌术后患者创伤后成长与心理弹性和生命质量的相关性研究

摘要 目的：探讨乳腺癌术后患者创伤后成长（PTG）的影响因素,并分析其与心理弹性和生命质量的关系。方法：选择2020年1月~2021年8月在山东省立第三医院接受手术治疗的乳腺癌患者80例作为研究对象。采用创伤后成长量表（PTGI）评价乳腺癌术后患者PTG情况。采用乳腺癌患者生命质量测定量表（FACT-B）评价生命质量。采用心理弹性量表（CD-RISC）评价心理弹性。采用单因素及多因素Logistic回归分析乳腺癌术后患者PTG的影响因素,采用Pearson相关性分析PTGI评分与CD-RISC评分和FACT-B评分的关系。结果：乳腺癌术后患者PTGI评分为（50.38±13.39）分,根据PTGI评分将其分为PTG高分组（n=32）和PTG低分组（n=48）。乳腺癌术后患者PTG水平与文化程度、家庭月收入、疾病发现方式、工作状况、手术方式、临床分期、术后并发症、基础疾病有关（P<0.05）。多因素Logistic回归分析结果显示：家庭月收入<3000元、临床分期为II期、文化程度为小学及其以下、手术方式为乳房切除、有术后并发症、有基础疾病均是乳腺癌术后患者PTG的危险因素（P<0.05）。PTG高分组患者的CD-RISC、FACT-B评分高于PTG低分组,组间对比有统计学差异（P<0.05）。Pearson相关性分析结果显示,PTGI评分与CD-RISC评分、FACT-B评分呈正相关（P<0.05）。结论：乳腺癌术后患者PTG水平一般,受到临床分期、文化程度、手术方式等多种因素的影响,临床工作中应对相关因素予以重视并及时干预。同时PTG会影响患者的心理弹性和生命质量,PTG水平越高,心理弹性越好,生命质量亦越高。     

Neighborhood linking social capital as a predictor of lung cancer: A Swedish national cohort study

BackgroundThe aim of this nationwide follow-up study was to examine whether neighborhood linking social capital is associated with lung cancer, including incident and mortality cases, after adjustment for individual- and familial-level factors.MethodsThis follow-up study comprised 2,123,707 men and 2,046,174 women aged 25 years or older in Sweden. The follow-up period started on January 1, 2002 and proceeded until first incident of lung cancer, mortality of lung cancer, death from any other cause, emigration or the end of the study period on December 31, 2010. Multilevel logistic regression models (individual-level factors at the first level and neighborhood-level factors at the second level) were used to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).ResultsWe identified 16,561 lung cancer cases (8422 men and 8139 women) during the follow-up period. Higher ORs of lung cancer, including incident and mortality cases, were observed in individuals who lived in neighborhoods with low social capital (men: OR = 1.37, 95% CI = 1.27–1.47; women: OR = 1.32, 95% CI = 1.23–1.42) than in those living in neighborhoods with high social capital, after adjustment for potential confounding factors.ConclusionThe results of this large national cohort study suggest that neighborhood linking social capital has important independent effects on lung cancer, including incident and mortality cases. These findings indicate that decision-makers must consider the effect of neighborhood-level factors as well as individual- and familial-level factors.     

Metabolomic identification of molecular changes associated with stress resilience in the chronic mild stress rat model of depression

Chronic stressful events are key risk factors for major depressive disorder (MDD), yet some individuals exposed to stressful events do not develop MDD. This disparity suggests the significance of resilience to deleterious stress effects. However, the underlying molecular mechanisms of stress resilience are poorly understood. In the present study, the chronic mild stress (CMS) rat model of depression was used to reveal the individual differences in stress response. Employing a gas chromatography/mass spectrometry metabolomic approach, the molecular changes associated with stress resilience in rat cerebellum were characterized by comparing anhedonic, CMS resilient and control groups. The results showed that four cerebellar metabolites—proline, lysine, glutamine, and dihydroxyacetone phosphate—were identified as the key differential metabolites associated with stress resilience. These metabolites may play a potential role in rendering individuals less vulnerable to CMS exposure. These findings provide insight into the molecular mechanisms underlying stress resilience and shed light on novel therapeutic opportunities to augment stress resiliency.     

Meta-community selection favours reciprocal cooperation but depresses exploitation between competitors

The evolution of cooperation and mutualism has mainly been explored through individual- and group-level processes. However, community-level processes could also impose selection pressure on species interactions. By using a dome-shaped nonmonotonic interaction (DS interaction) with cooperation at low-density and competition at high-density, we studied how cooperation and exploitation are selected at the meta-community level. Our results showed that population densities of species and communities were both significantly associated with the number of DS interactions and the species interaction modes. The more cooperation a species received via DS interactions, the higher its density was. A community with more DS interactions, especially more reciprocal cooperation, showed a higher total population density. Both reciprocal cooperators and exploiters in a local community were more favoured than unidirectional cooperators within a closed community. When facing competition from a community without cooperators (with only competitors), both reciprocal cooperators and exploiters were favoured in a local community, but only reciprocal cooperators were more favoured when facing competition from another community with cooperators. Our results suggest that selection at the meta-community level could be an alternative mechanism for the evolution of cooperation and the depression of exploitation between competitors.     

Local Stressors Reduce Coral Resilience to Bleaching

Coral bleaching, during which corals lose their symbiotic dinoflagellates, typically corresponds with periods of intense heat stress, and appears to be increasing in frequency and geographic extent as the climate warms. A fundamental question in coral reef ecology is whether chronic local stress reduces coral resistance and resilience from episodic stress such as bleaching, or alternatively promotes acclimatization, potentially increasing resistance and resilience. Here we show that following a major bleaching event, Montastraea faveolata coral growth rates at sites with higher local anthropogenic stressors remained suppressed for at least 8 years, while coral growth rates at sites with lower stress recovered in 2–3 years. Instead of promoting acclimatization, our data indicate that background stress reduces coral fitness and resilience to episodic events. We also suggest that reducing chronic stress through local coral reef management efforts may increase coral resilience to global climate change.     

Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg

Background

Research in the field of psychoneuroimmunology (PNI) has revealed that depression is associated with inflammation manifested by increased levels of proinflammatory cytokines.

Discussion

The old paradigm described inflammation as simply one of many risk factors for depression. The new paradigm is based on more recent research that has indicated that physical and psychological stressors increase inflammation. These recent studies constitute an important shift in the depression paradigm: inflammation is not simply a risk factor; it is the risk factor that underlies all the others. Moreover, inflammation explains why psychosocial, behavioral and physical risk factors increase the risk of depression. This is true for depression in general and for postpartum depression in particular. Puerperal women are especially vulnerable to these effects because their levels of proinflammatory cytokines significantly increase during the last trimester of pregnancy – a time when they are also at high risk for depression. Moreover, common experiences of new motherhood, such as sleep disturbance, postpartum pain, and past or current psychological trauma, act as stressors that cause proinflammatory cytokine levels to rise. Breastfeeding has a protective effect on maternal mental health because it attenuates stress and modulates the inflammatory response. However, breastfeeding difficulties, such as nipple pain, can increase the risk of depression and must be addressed promptly.

Conclusion

PNI research suggests two goals for the prevention and treatment of postpartum depression: reducing maternal stress and reducing inflammation. Breastfeeding and exercise reduce maternal stress and are protective of maternal mood. In addition, most current treatments for depression are anti-inflammatory. These include long-chain omega-3 fatty acids, cognitive therapy, St. John's wort, and conventional antidepressants.     

Low self-esteem and psychiatric patients: Part II - The relationship between self-esteem and demographic factors and psychosocial stressors in psychiatric patients

BACKGROUND: The objective of the present study was to identify the effects and relative importance of demographic factors and psychosocial stressors on self-esteem of psychiatric patients. METHOD: The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, patients and controls completed two self-esteem questionnaires, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. In addition, a large amount of demographic and psychosocial data was collected on all patients. RESULTS: Significantly increased self-esteem was observed with an increase in age, educational achievement and income. Employed patients showed significantly higher self-esteem compared to unemployed patients. Female patients had a significantly lower self-esteem compared to male patients. The self-esteem of psychiatric patients did not vary significantly with their marital status. No relationship was detected between acute stressors and the self-esteem of psychiatric patients, although severe enduring stressors were associated with lower self-esteem in psychiatric patients. CONCLUSION: The results of this large study demonstrate that the self-esteem of adult psychiatric patients is affected by a number of demographic and psychosocial factors including age, sex, educational status, income, employment status, and enduring psychosocial stressors.     

Resilience to Stress and Disturbance,and Resistance to Bromus tectorum L. Invasion in Cold Desert Shrublands of Western North America

Alien grass invasions in arid and semi-arid ecosystems are resulting in grass–fire cycles and ecosystem-level transformations that severely diminish ecosystem services. Our capacity to address the rapid and complex changes occurring in these ecosystems can be enhanced by developing an understanding of the environmental factors and ecosystem attributes that determine resilience of native ecosystems to stress and disturbance, and resistance to invasion. Cold desert shrublands occur over strong environmental gradients and exhibit significant differences in resilience and resistance. They provide an excellent opportunity to increase our understanding of these concepts. Herein, we examine a series of linked questions about (a) ecosystem attributes that determine resilience and resistance along environmental gradients, (b) effects of disturbances like livestock grazing and altered fire regimes and of stressors like rapid climate change, rising CO₂, and N deposition on resilience and resistance, and (c) interacting effects of resilience and resistance on ecosystems with different environmental conditions. We conclude by providing strategies for the use of resilience and resistance concepts in a management context. At ecological site scales, state and transition models are used to illustrate how differences in resilience and resistance influence potential alternative vegetation states, transitions among states, and thresholds. At landscape scales management strategies based on resilience and resistance—protection, prevention, restoration, and monitoring and adaptive management—are used to determine priority management areas and appropriate actions.     

High self-perceived stress and many stressors, but normal diurnal cortisol rhythm, in adults with ADHD (attention-deficit/hyperactivity disorder)

Attention-deficit/hyperactivity disorder (ADHD) in adults is associated with significant impairment in many life activities and may thus increase the risk of chronic stress in everyday life. We compared adults with a DSM-IV ADHD diagnosis (n = 28) with healthy controls (n = 28) regarding subjective stress and amounts of stressors in everyday life, diurnal salivary cortisol in the everyday environment and salivary cortisol before and after cognitive stress in a laboratory setting. The association between cortisol concentrations and impulsivity was also investigated. Consistent with assumptions, individuals with ADHD reported significantly more self-perceived stress than controls, and subjective stress correlated with the amount of stressors in everyday life. The two groups were comparable with respect to overall diurnal cortisol levels and rhythm, as well as in pre- and post-stress cortisol concentrations. Post-stress cortisol (but not baseline cortisol) concentration was positively correlated with impulsivity. The group with high post-stress cortisol also reported more symptoms of depression and anxiety, as well as self-perceived stress and stressors in every-day life. The diagnosis of ADHD significantly increased the risk of belonging to the group with high post-stress cortisol levels. The results in this study warrant a focus not only on the primary diagnosis of ADHD, but also calls for a broader assessment of stressors and subjective stress in everyday life, as well as support comprising stress management and coping skills.