Family dysfunction, stressful life events, and mental health problems across development in the offspring of parents with an affective disorder.

BACKGROUND: Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well-known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. METHODS: As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self-Report, Family Assessment Device, and an in-house measure, respectively. RESULTS: Multi-group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. CONCLUSIONS: OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high-risk youth.

Towards the correlates of stressful life events as precipitants of obsessive-compulsive disorder: a systematic review and metanalysis.

Obsessive-compulsive disorder (OCD) is a prevalent condition with multifactorial etiology involving genetic and environmental factors. The present study aims to summarize the correlates of stressful life events (SLEs) in OCD by reviewing studies comparing OCD associated or not with SLEs before its onset. To do so, a systematic review was performed by searching PubMed, Web of Science, Scopus, and PsycINFO databases for studies published between the database's inception and November 27, 2023. Studies including individuals whose OCD was precipitated or not by SLEs (SLEs OCD and NSLEs OCD, respectively) were assessed. Effect sizes or odds ratios were then calculated to identify the strength of association between SLEs and clinical characteristics, such as gender, age of onset, family history of OCD, severity of OCD symptoms, depressive symptoms, and mood comorbidities among patients with OCD. Out of the 4083 records initially identified, 5 studies met the inclusion criteria and 3 were comparable through a meta-analysis. Notably, the analyses were limited by the small number of studies available in the literature. The meta-analysis demonstrated SLEs OCD to be associated with female gender, later OCD onset, and increased comorbidity rates with mood disorders. Despite the cross-sectional nature of the reviewed studies, women may be more vulnerable to develop a later onset of OCD following SLEs, which may also lead to mood disorders. Caution is needed to avoid prematurely classifying this presentation as a distinct subtype of OCD.

Association of Stressful Life Events With Oral Health Among Japanese Workers.

BACKGROUND: Psychological stress can cause various mental and physical health problems. The previous results on stress and oral health are inconsistent, possibly because of the narrow stress measurements. We aimed to examine the association between a broader range of stressful life events and oral health among workers. METHODS: This cross-sectional study analyzed anonymous individual data from a national survey in Japan. Data on stressful life events, oral health problems which are one or more of tooth pain, gum swelling/bleeding, and difficulty chewing, and covariates were obtained using a self-reported questionnaire. Covariates used included gender, age group, and disease under treatment. Logistic regression analysis was used to estimate the association between stressful life events and oral health problems. We then estimated the causal treatment effects of stress using the augmented inverse-probability weighting (AIPW) method. RESULTS: Among the 274,881 subjects, 152,850 men (55.6%) and 122,031 women (44.4%) with a mean age of 47.0 (standard deviation, 14.4) years, 4.0% reported oral health problems, with a prevalence of 2.1% among those without any stress. The prevalence increased with stress score, reaching 15.4% for those with the maximum stress score. The adjusted odds ratio of this group compared to those without any stress was 9.2 (95% confidence interval [CI], 8.2-10.3). The estimated prevalence of oral health problems by the AIPW analysis was 2.2% (95% CI, 2.1-2.3%) for those without any stress and 14.4% (95% CI, 12.1-16.7%) for those with the maximum stress scores. CONCLUSION: There was a clear dose-response association between stressful life events and oral health problems.

Genetic and Environmental Influences on Perceived Stress in South Korean Twins.

Researchers have proposed that culture significantly influences perceived stress (PS). To date, however, twin studies on PS have been conducted mostly in western, individualistic cultures, which demonstrate that PS due to controllable (personal) life events is more heritable than PS due to uncontrollable (network) life events. This study aimed to investigate genetic and environmental influences on PS in South Korean twins. South Korea practices a dominant collectivist culture. In total, 1372 twin individuals (mean age = 22.4 ± 2.5 years) completed an online survey on PS, which consisted of the scales, Friendship, Academic Stress, Future Career, Family Conflicts, and Family Financial Difficulties (FFD). Friendship, Academic Stress, and Future Career can be considered PS due to personal life events, and Family Conflict and FFD, PS due to network life events. The general sex-limitation model-fitting analysis revealed the absence of qualitative or quantitative sex differences in genetic and environmental influences. Specifically, additive genetic influences were predominant for Friendship (63%), Academic Stress (67%), and Future Career (57%) for both sexes, with the remaining variance attributable to nonshared environmental influences. In contrast, shared environmental influences were largest for Family Conflict (47% for both genders) and FFD (64% for males, 63% for females) with no significant genetic effects. Despite known cultural differences in the means and variances of PS, South Korean twins exhibited significant genetic effects in PS due to personal life events and large shared environmental effects in PS due to network life events, which is similar to western samples.

Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study.

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child's symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7-8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p < 0.001). Social anxiety, attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with new-onset UI, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.

How do stressful life events affect medical students' academic adjustment? Parallel mediating mechanisms of anxiety and depression.

BACKGROUND: Medical students frequently face challenges in academic adjustment, necessitating effective support and intervention. This study aimed to investigate the impact of stressful life events on medical students' academic adjustment, focusing on the mediating roles of depression and anxiety. It also differentiated the impacts between at-risk students (those with academic failures) and their peers respectively. METHODS: This case-control study involved 320 at-risk medical students and 800 other students from a university in western China. Participants anonymously completed the scales of stressful life events, depression, anxiety, and academic adjustment. T-tests, ANOVA, Pearson correlation, and structural equation modeling were employed for statistical analysis. RESULTS: Depression and anxiety were significantly more prevalent in at-risk students (46.8% and 46.1%, respectively) than in controls (34.0% and 40.3%, respectively). Notably, at-risk students had poorer academic adjustment (t = 5.43, p < 0.001). The structural equation modeling had good fit indices and the results indicated that depression and anxiety fully mediated the effects of stressful life events on academic adjustment. For at-risk students, stressful life events significantly decreased academic adjustment through increased depression and anxiety (p < 0.001). Conversely, anxiety had a positive effect on academic adjustment in other students. CONCLUSION: Targeted interventions focusing on depression and anxiety could reduce the negative impact of stressful life events on medical students' academic adjustment. However, educators have to distinguish the differences between at-risk students and others.

Black Adolescent Self-Perceptions: The Roles of Ethnic Identity and Stress Exposure.

Ethnic identity is associated with various positive outcomes for Black adolescents, but more information is needed about its potential to protect adolescents exposed to stress. Stressful life events predict a range of health outcomes, yet few studies have examined their association with adolescent self-perception. Ethnic identity may serve as protection from stress. This study examines longitudinal data to understand relationships between ethnic identity, stressful life events, and self-perception (i.e., social competence, behavioral conduct, and global self-worth). The sample included 140 adolescents (65% female; 93% Black) with an average age of 12.55 (SD = 0.85). Results indicate stressful life events are associated with behavioral conduct self-perception, and ethnic identity is associated with global self-worth. Ethnic identity behavior and other group orientation are associated with self-perception. Ethnic identity and ethnic identity behavior moderate the relationship between stressful life events and behavioral conduct self-perception. Understanding the connections between adolescent stressors and strengths provides insight into research, practice, and policy directions to promote positive outcomes.

Life Stress and Unmarried, Black Fathers' Attitudes Toward Attachment: The Moderating Role of Shift-and-Persist.

Unmarried, Black fathers' positive engagement contributes to children's health and development beginning in early infancy. For many men, preparations for parenthood begin before birth as expectant fathers formulate parenting attitudes that can promote secure infant-father attachment relationships. This study examined aspects of life stress as predictors of prenatal attitudes toward attachment -- the extent to which expectant fathers endorsed promoting attachment security in their infants. Further, we considered whether shift-and-persist cognitive strategies -- a psychological resilience factor focused on shifting to positive focus and future-orientation -- moderated these associations. A sample of 121 unmarried, Black men expecting the birth of a child were recruited during the 2nd or 3rd trimester of their partner's pregnancy. Expectant fathers reported on childhood trauma, recent negative life experiences, and depressive symptomology. Fathers also completed a survey assessment of shift-and-persist strategies, as well as a newly developed scale assessing attitudes toward attachment. Depressive symptoms and negative life events were directly, positively related to attitudes toward attachment. The association between positive attitudes toward attachment and both negative life events and depressive symptomology was moderated by fathers' ability to shift-and-persist. Specifically, aspects of life stress were generally unrelated to attitudes toward attachment when shift-and-persist was low, but related to more positive attitudes toward attachment when shift-and-persist was high. Preliminary findings point to the potential steeling effects of shift-and-persist strategies for expectant fathers facing moderate levels of life stress.

Stressful life events and depressive symptoms during COVID-19: A gender comparison.

The COVID-19 pandemic precipitated a wide range of public health, economic, social, and political shocks, setting in motion life events that reverberated to affect individuals' mental health. Moving beyond a checklist approach, this study drew on individuals' own words to identify both conventional and novel sources of stress during COVID-19 and examine the role of stressful life events in producing gender disparities in depressive symptoms. Drawing on a 2021 U.S. nationally representative survey, we coded text responses to an open-ended question on stressful life events and conducted descriptive and regression analyses (n = 1733). The analyses revealed three key findings. First, men were more likely to report having experienced no stressful life events or else mention politics as a source of stress. Women, by comparison, were more likely to report the following as stressful-inability to socialize, paid work, care work, health, or the death of loved ones. Second, for both women and men, respondents reporting no stressful life events had the lowest, and those reporting finances as the most stressful life event had the highest, depressive symptoms. Third, women had higher depressive symptoms than men, and mediation analysis showed that stressful life events explained approximately a third of the gender gap in depressive symptoms. The findings indicate that policies attending to people's financial stress are important for mitigating mental health risks in turbulent times. Interventions that reduce women's exposure to stressful life events are also crucial to bridging gender disparities in mental health.

Associations between experience of stressful life events and cancer prevalence in China: results from the China Kadoorie Biobank study.

BACKGROUND: Studies examining the relationships of stressful life events and cancer yielded inconsistent findings, while relevant evidence in mainland China is scarce. The current study sought to determine whether experience of stressful life events was associated with cancer prevalence in Chinese population. METHODS: We used cross-sectional data from the China Kadoorie Biobank study which that recruited 0.5 million Chinese adults aged 30 to 79 from 2004 to 2008. Logistic regression models were used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for cancer associated with stressful life events reported at baseline. RESULTS: Among the 461,696 participants included in this analysis, 2,122 (0.46%) had self-reported cancer with the mean (SD) age was 57.12 (9.71) years. Compared to those without any stressful life event, participants who experienced 1 and 2 or more events had significantly higher odds of cancer, with the ORs of 1.80 (95% CI: 1.58-2.05) and 3.05 (2.18-4.28). For categories of work-, family-, and personal-related events, the OR of cancer was 1.48 (1.07-2.05), 2.06 (1.80-2.35), and 1.65 (1.17-2.33), respectively. Regarding the specific stressful life events, loss of income/living on debt, major conflict within family, death/major illness of other close family member, and major injury/traffic accident were significantly associated with increased odds of cancer, with the ORs of 2.64 (1.81-3.86), 1.73 (1.20-2.50), 2.36 (2.05-2.72), and 2.11 (1.43-3.13). CONCLUSION: Our findings suggested that experiences of cumulative and specific stressful life events were significantly associated with increased cancer prevalence in Chinese population.

Polygenic liability, stressful life events and risk for secondary-treated depression in early life: a nationwide register-based case-cohort study.

BACKGROUND: In this study, we examined the relationship between polygenic liability for depression and number of stressful life events (SLEs) as risk factors for early-onset depression treated in inpatient, outpatient or emergency room settings at psychiatric hospitals in Denmark. METHODS: Data were drawn from the iPSYCH2012 case-cohort sample, a population-based sample of individuals born in Denmark between 1981 and 2005. The sample included 18 532 individuals who were diagnosed with depression by a psychiatrist by age 31 years, and a comparison group of 20 184 individuals. Information on SLEs was obtained from nationwide registers and operationalized as a time-varying count variable. Hazard ratios and cumulative incidence rates were estimated using Cox regressions. RESULTS: Risk for depression increased by 35% with each standard deviation increase in polygenic liability (p < 0.0001), and 36% (p < 0.0001) with each additional SLE. There was a small interaction between polygenic liability and SLEs (ß = -0.04, p = 0.0009). The probability of being diagnosed with depression in a hospital-based setting between ages 15 and 31 years ranged from 1.5% among males in the lowest quartile of polygenic liability with 0 events by age 15, to 18.8% among females in the highest quartile of polygenic liability with 4+ events by age 15. CONCLUSIONS: These findings suggest that although there is minimal interaction between polygenic liability and SLEs as risk factors for hospital-treated depression, combining information on these two important risk factors could potentially be useful for identifying high-risk individuals.

Stressful life events increase the risk of major depressive episodes: A population-based twin study.

BACKGROUND: Previous studies have found that stressful life events (SLEs) are associated with an increased risk of adult depression. However, many studies are observational in nature and limited by methodological issues, such as potential confounding by genetic factors. Genetically informative research, such as the co-twin control design, can strengthen causal inference in observational studies. Discrete-time survival analysis has several benefits and multilevel survival analysis can incorporate frailty terms (random effects) to estimate the components of the biometric model. In the current study, we investigated associations between SLEs and depression risk in a population-based twin sample (N = 2299). METHODS: A co-twin control design was used to investigate the influence of the occurrence of SLEs on depression risk. The co-twin control design involves comparing patterns of associations in the full sample and within dizygotic (DZ) and monozygotic twins (MZ). Associations were modelled using discrete-time survival analysis with biometric frailty terms. Data from two time points were used in the analyses. Mean age at Wave 1 was 28 years and mean age at Wave 2 was 38 years. RESULTS: SLE occurrence was associated with increased depression risk. Co-twin control analyses indicated that this association was at least in part due to the causal influence of SLE exposure on depression risk for event occurrence across all SLEs and for violent SLEs. A minor proportion of the total genetic risk of depression reflected genetic effects related to SLEs. CONCLUSIONS: The results support previous research in implicating SLEs as important risk factors with probable causal influence on depression risk.

Death of parent, sibling, spouse, and child in a Swedish national sample and risk of subsequent stress reaction, major depression, alcohol-use disorder, and drug-use disorder.

BACKGROUND: To determine, in a general population, how much rates of stress reactions (SR), major depression (MD), alcohol-use disorder (AUD) and drug-use disorder (DUD) increase after the death of close relatives. METHODS: SR, MD, AUD, and DUD registrations were assessed from national Swedish registries. From the population followed from 2000 to 2018, those exposed to death of a close relative in 2002-2016 were matched to unexposed controls and analyzed in males and females by a controlled pre-post design using a difference-in-difference method. RESULTS: Substantial, brief increases in risk for SR and more modest prolonged increases in MD were observed after death of relatives in both men and women greatest with children, followed by spouses, parents, and siblings. Relatively long-lasting modest increases in AUD but not DUD were also observed following death of relatives. The absolute increases for SR and MD were greater in females than males and for AUD greater in males than females. However, logistic regression analyses showed most effects did not differ significantly by sex. Consistently larger increases in disorder risk were seen with the death of younger v. older parents, siblings, and spouses and with accidental v. non-accidental death in children. CONCLUSIONS: Applying a matched cohort design to Swedish population registries, death of close relatives was associated with, and likely caused, substantial increases in rates of SR, MD, and AUD, consistent with smaller prior clinical investigations. Through such registries, we can, in large representative samples, integrate the impact of exposures to selected environmental adversities into disorder risk pathways.

Adverse childhood experiences, antenatal stressful life events, and marijuana use during pregnancy: A population-based study.

Cumulative exposure to adverse childhood experiences (ACEs) and antenatal stressful life events (ASLEs) are independently associated with marijuana use during pregnancy. However, research has not explored how both exposures may influence marijuana use jointly. Assessing the joint associations of ACEs and recent ASLEs on marijuana use can identify people who may benefit from early intervention. Data come from the Nevada Pregnancy Risk Assessment Monitoring System, 2017-2020 (N = 2483). We assessed eight measures of ACEs before age 18 and fourteen measures of ASLEs twelve months before giving birth. Generalized estimating equations estimated the direct and joint associations (additive and multiplicative interaction) of ACEs and ASLEs on marijuana use during pregnancy. 9.8% used marijuana during the most recent pregnancy. Compared to people who reported no ACEs, those reporting 1 ACE (adjusted prevalence ratio[aPR] = 1.96, 95% confidence interval [CI] = 1.30-2.94), 3 ACEs (aPR = 3.58, 95%CI = 2.69-4.77), and 4+ ACEs (aPR = 3.67, 95%CI = 2.36-5.72) were more likely to use marijuana. Compared to people reporting no ASLEs, those reporting 4+ ASLEs (aPR = 3.12, 95% CI = 1.64-5.92) were more likely to use marijuana. There was evidence of interaction for high ACE and ASLE exposure on an additive scale. ACEs and ASLEs were independently associated with marijuana use during pregnancy, and there was evidence of additive interaction. Screening for ACEs and ASLEs during pregnancy, referrals to appropriate behavioral health services, and trauma-informed approaches are important to address marijuana use during pregnancy.

What is the impact of stress on the onset and anti-thyroid drug therapy in patients with graves' disease: a systematic review and meta-analysis.

BACKGROUND: The effect of stress on Graves' disease (GD) is controversial. Our purpose was to quantify the impacts of stress on patients with Graves' disease. METHODS: Systematic searches of PubMed, MEDLINE, Embase, Web of Science, Scopus, Cochrane Library and PsycInfo were conducted from inception to 1 January 2023. Studies comparing the incidence of stressful life events (SLEs) that occurred before diagnosis and during drug therapy in cases diagnosed with GD and controls were included in the final analysis. RESULTS: Nine case-control studies and four cohort studies enrolling 2892 participants (1685 [58%] patients) were included. Meta-analysis revealed a high and significant effect-size index in a random effect model (d = 1.81, P = 0.01), indicating that stress is an important factor in the onset of GD. The relationship between SLEs and GD was stronger in studies with higher proportions of female patients (ß = 0.22, P < 0.01) and weaker in studies with older patients with GD (ß =-0.62, P < 0.01). However, stress did not significantly affect the outcome of antithyroid drug therapy for GD (d = 0.32, P = 0.09). CONCLUSIONS: The results of this meta-analysis suggest that stress is one of the environmental triggers for the onset of GD. Therefore, we recommend stress management assistance for individuals genetically susceptible to GD, especially for young females.

The mediating effect of distress tolerance on the relationship between stressful life events and suicide risk in patients with major depressive disorder.

BACKGROUND: Despite widespread acknowledgment of the impact of stressful life events on suicide risk, the understanding of the psychological mechanisms underlying the relationship between stressful life events and suicide risk in major depressive disorder (MDD) remain unclear. This study aim to examine whether the distress tolerance mediates the relationship between the stressful life events and suicide risk in patients with MDD. METHODS: A cross-sectional study was carried out among 125 Chinese patients with MDD, mean age was 27.05 (SD=0.68) and 68.8% were females. The 17-item Hamilton Depression Rating scale (HAMD-17), the validated Chinese version of the Mini International Neuropsychiatric Interview (MINI) suicide module, Life Events Scale (LES) and Distress Tolerance Scale (DTS) were utilized to evaluate depressive symptoms, stressful life events, levels of distress tolerance, and suicide risk, respectively. Mediation analyses was used to test the mediation effect of distress tolerance on the relationship between stressful life events and suicide risk. RESULTS: The ratio of suicide risk in patients with MDD was 75.2%. Pearson correlation analysis showed that stressful life events were positively correlated with suicide risk(r=0.182, p<0.05). Stressful life events(r=-0.323, p<0.01) and suicide risk(r=-0.354, p<0.01) were negatively correlated with distress tolerance. Mediation analyses showed that the direct path from stressful life events to suicide risk was not significant (B= 0.012, 95% confidence interval (CI) [-0.017, 0.042]). Stressful life events affected suicide risk indirectly through distress tolerance (B= 0.018, 95% CI [0.007, 0.031]), and the mediating effect accounted for 60.0% of the total effect. CONCLUSION: Distress tolerance completely played a mediating role between stressful life events and suicide risk. Further suicide prevention and intervention strategies should focus on increasing levels of distress tolerance in patients with MDD.

Temperament and adolescent suicide attempts: a case-control study with multi-ethnic Asian adolescents.

BACKGROUND: Suicide is the leading cause of death for adolescents in several parts of Asia, including Singapore. This study examines the relationship between temperament and youth suicide attempts in a sample of multi-ethnic Singaporean adolescents. METHODS: A case-control design compared 60 adolescents (Mage = 16.40, SDage = 2.00) with a recent suicide attempt (i.e., past 6 months) with 58 adolescents (Mage = 16.00, SDage = 1.68) without any history of suicide attempts. Presence of suicide attempts was established using the semi-structured interviewer-administered Columbia Suicide Severity Rating Scale. Participants also completed self-report measures on temperament traits, psychiatric diagnoses, stressful life events, and perceived parental rejection in an interview-based format. RESULTS: Psychiatric comorbidity, recent stressful life events, perceived parental rejection, and all five "difficult temperament" traits, were significantly overrepresented among adolescent cases relative to healthy controls. Adjusted logistic regression models revealed significant associations between suicide attempt, MDD comorbidity (OR: 10.7, 95% Cl: (2.24-51.39)), "negative mood" trait (OR: 1.12-1.18, 95% Cl: (1.00-1.27)), and the interaction term of "positive mood" and "high adaptability" traits (OR: 0.943 - 0.955, 95% Cl: (0.900 - 0.986)). Specifically, "positive mood" predicted lower likelihood of a suicide attempt when "adaptability" was high (OR: 0.335 - 0.342, 95% Cl: (0.186 - 0.500)) but not low (OR: 0.968 - 0.993, 95% Cl: (0.797 - 1.31)). CONCLUSION: Temperament screening may be important to identify adolescents at higher or lower risk of suicide at an early stage. More longitudinal and neurobiological research converging on these temperament findings will be helpful in ascertaining temperament screening as an effective suicide prevention methodology for adolescents.

Post-traumatic stress disorder among heart disease patients: a clinical follow-up of individuals with myocardial infarction in the Tromsø Study.

BACKGROUND: Myocardial infarction is likely to be experienced as a life-threatening and potentially traumatic event. Approximately one-third of patients with myocardial infarction experience clinically significant symptoms of anxiety/depression. However, it is unclear how many of these patients experience these symptoms because of post-traumatic stress disorder (PTSD). We conducted a clinical screening of individuals with a confirmed myocardial infarction diagnosis. Our goal was to examine the prevalence of PTSD in myocardial infarction patients and study how PTSD symptoms were associated with exposure to potentially traumatic events. METHOD: This is epidemiological research with a cross-sectional design following up participants from the Tromsø Study with a confirmed diagnosis of myocardial infarction. We sent invitations to participants in the Tromsø Study with clinically significant self-reported anxiety or depression symptoms following myocardial infarction. A cross-sectional sample of N = 79 participants (61 men and 18 women) was collected. During an interview, participants completed the Stressful Life Events Screening Questionnaire and the PTSD checklist PCL-5. RESULTS: We found nine participants (11.6%) with probable PTSD. This was significantly higher than the postulated population prevalence in Norway (p < 0.015). We found no direct association between myocardial infarction as illness trauma and symptom levels (p = 0.123). However, we found a significant linear trend (p = 0.002), indicating that symptom severity increased proportionately as the number of post-traumatic events increased. CONCLUSION: PTSD prevalence in myocardial infarction patients was related to lifetime exposure to traumatic events, not the myocardial infarction event alone. More research is required to examine the interaction between myocardial infarction and PTSD. Clinicians should be aware that anxiety or depression symptoms after MI could be secondary symptoms of PTSD.

Joint effects of recent stressful life events and adverse childhood experiences on perinatal comorbid anxiety and depression.

BACKGROUND: Stressful life events (SLEs) and adverse childhood experiences (ACEs) have been reported to be associated with perinatal depression (PND) or perinatal anxiety (PNA) alone; however, in most cases, majority of PND and PNA coexist and could lead to more serious health consequences. The independent effect of recent SLEs and their joint effects with ACEs on perinatal comorbid anxiety and depression (CAD) remain inadequately explored. METHODS: Based on a longitudinal study, 1082 participants receiving prenatal care in Ma'anshan, China were included. Women were recruited in the first trimester (T1: ≤14+ 6 weeks) and followed up at 15 ~ 27 weeks (T2), 28 ~ 40 weeks (T3), and postpartum (T4). Depression and anxiety status were assessed at all time points, while recent SLEs and ACEs were measured at T1. Logistic regression was conducted to examine the associations of SLEs with the risks of CAD at different time points, as well as their joint effects with ACEs on CAD. RESULTS: Approximately 38.5% of women experienced at least one SLE, which was significantly associated with higher risks of CAD at all time points (p < 0.05). As the number of SLEs increased, the risk of CAD increased (p for trend < 0.05). Specific types of SLEs were associated with CAD in different periods, while only interpersonal events were consistently associated with risks of CAD throughout the whole perinatal period. The joint effects of SLEs with ACEs on CAD were identified throughout the perinatal period, with the highest observed in the first trimester (aOR = 7.47, 95% CI: 3.73-14.95; p for trend < 0.001). CONCLUSION: Our study demonstrated independent associations of recent SLEs and their joint effects with ACEs with risks of perinatal CAD. SLEs combined with ACEs should be recognized as a major risk factor for perinatal CAD and managed at the earliest time to prevent and control CAD.

Early adversity and depressive symptoms among early adolescent girls: the mediating role of exposure to recent interpersonal acute stress.

Early adversity confers risk for depression in part through its association with recent (i.e., proximal) acute stress. However, it remains unresolved whether: a) early adversity predicts increases in recent acute stress over time; b) all - or only certain types - of recent events mediate the relationship between early adversity and depression; and c) early adversity places individuals at greater risk for depression via greater exposure to independent (i.e., fateful) interpersonal events or via greater generation of dependent (i.e., partially self-initiated) interpersonal events (i.e., stress generation) or both. These questions were examined in a 3-wave longitudinal study of early adolescent girls (N = 125; M = 12.35 years [SD = .77]) with no history of diagnosable depression using contextual life stress and diagnostic interviews. Path analyses indicated that increases in past-year acute interpersonal, but not non-interpersonal, stress mediated the link between early adversity and depressive symptoms. The mediating role of interpersonal events was limited to independent ones, suggesting increases in interpersonal event exposure, not interpersonal stress generation, acted as a mediator. Finally, findings support prior evidence that early adversity may not directly predict future depressive symptoms. Implications for understanding the role of recent stress in the association between early adversity and adolescent depression are discussed.