Uncertainty and psychological distress during COVID-19: What about protective factors?

The present study examined the relationship between perceived uncertainty and depression/ anxiety symptoms during the COVID-19 pandemic and it tested the moderating roles of resilience and perceived social support in this relationship. A cross-sectional study was conducted between March 31st and May 15th, 2020, using an online, multi-language, international survey built within Qualtrics. We collected data on sociodemographic features, perceived uncertainty, perceived social support, depression and anxiety symptoms, and resilience. A moderation model was tested using model 2 of Hayes' PROCESS macro for SPSS. The study included 3786 respondents from 94 different countries, 47.7% of whom reported residence in the United States of America. Results demonstrated that higher perceived uncertainty was associated with more symptoms of depression and anxiety. Higher resilience levels and higher perceived social support were associated with fewer depression and anxiety symptoms. The moderation hypotheses were supported; the relationship between uncertainty and symptoms of depression and anxiety decreased as levels of resilience increased and as perceived social support increased. The results suggest that resilience and social support could be helpful targets to reduce the negative effects of uncertainty on depression and anxiety symptoms. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03244-2.

Blunted opioid regulation of the HPA stress response during nicotine withdrawal: therapeutic implications.

Endogenous opioids regulate pain, drug reward, and stress responses. We have previously shown reduced hypothalamic-pituitary-adrenal (HPA) responses to psychological stress and to opioid blockade among dependent smokers. In this study, we examined the extent to which biologically confirmed nicotine withdrawal alters endogenous opioid regulation of HPA axis functioning during rest and in response to acute stress. Smokers were randomly assigned to one of two conditions; 24 h withdrawal from all nicotine-containing products (n = 62) or smoking ad libitum (n = 44). A nonsmoking comparison group (n = 43) was also included. Participants (85 males and 64 females) completed two acute stress sessions during which a placebo or 50 mg of naltrexone (opioid antagonist) were administered using a double-blind design. Blood and saliva samples (assayed for cortisol and adrenocorticotropic hormone, i.e. ACTH) and mood measures were obtained during a resting absorption period, after acute stress (public speaking, mental arithmetic, and cold pressor tasks), and during an extended recovery period. Results indicated that opioid blockade (naltrexone) was associated with increased ACTH and cortisol responses to stress, and tobacco withdrawal was associated with blunted hormonal responses. A pattern of sex differences also emerged, with women exhibiting reduced ACTH responses to stress and higher ACTH and plasma cortisol responses to opioid blockade. These results indicated that compared to ad libitum smoking, nicotine withdrawal is associated with blunted opioid modulation of the HPA axis. Sex may modulate these effects. Blunted endogenous opioid regulation may underlie an incentive process that reinforces smoking behavior and may warrant therapeutic attention.

Resilience and the Role of Depressed and Anxious Mood in the Relationship Between Perceived Social Isolation and Perceived Sleep Quality During the COVID-19 Pandemic.

BACKGROUND: The aim of the study was to examine the mediating role of depressed and anxious mood in the relationship between perceived social isolation and perceived sleep quality during the COVID-19 pandemic. We also aimed to investigate the moderating role of psychological resilience in this mediation. METHODS: A cross-sectional study of adults (18+ years old) was conducted using an online, multi-language, international survey between March 31 and May 15, 2020. Simple and moderated mediation analyses were performed using the PROCESS macro for SPSS, with perceived social isolation as an independent variable, change in perceived sleep quality (during vs. before the COVID-19 pandemic) as a dependent variable, depressed and anxious mood (Patient Health Questionnaire-4, PHQ-4) as a mediator, and resilience (Brief Resilience Scale, BRS) as a moderator. RESULTS: A convenience sample of 3816 participants (2692 = female) from 94 countries (47.4% USA) met criteria for inclusion in the analyses. Results showed that depressed and anxious mood mediated the relationship between perceived social isolation and change in perceived sleep quality. This mediation was moderated by resilience; the indirect effect of perceived social isolation on change in perceived sleep quality through depressed and anxious mood decreased as the level of resilience increased (index of moderated mediation = 0.008, SE = 0.003, 95%CI [0.001; 0.014]). CONCLUSIONS: The study findings indicate benefits of psychological resilience in buffering negative effects of perceived isolation, suggesting potential benefits of developing targeted strategies to enhance resilience during times of significant crises.

The Impact of Personal Metaphors and Memorable Interpersonal Communication on Body Satisfaction.

Memorable messages about body size can have profound negative psychological and emotional effects on body image and personal health. We found that both men and women recalled more negative than positive memorable messages about their body appearance and size. Participants who reported receiving negative memorable messages also revealed stronger current body dissatisfaction and poorer self-image than participants who reported positive memorable messages. Participants who received negative body comments also described their own body using negative metaphors. Negative memorable messages often occurred in front of third parties who expressed approval for the message, sometimes in the form of laughter. We discuss the mental health consequences of negative messages about body size and the implications for public health campaigns.

Hypothalamic pituitary adrenal and autonomic nervous system biomarkers of stress and tobacco relapse: Review of the research.

Tobacco smoking is a risk factor for countless diseases, and smoking relapse remains a major public health concern. Subjective reports of stress by smokers are a common theme for relapse, however, the role of objective stress-related biomarkers in predicting tobacco relapse risk has been less studied. The aim of this manuscript was to review existing literature on the connection between biomarkers of stress and smoking relapse. Overall, trends indicate that blunted hypothalamic-pituitary-adrenal (HPA) responses to acute stress, larger reductions in HPA biomarkers during the initial days of abstinence during cessation (compared to pre-cessation levels), and exaggerated autonomic responses to stress predict increased risk of relapse. In addition, successful cessation is followed by changes in stress biomarkers (e.g., reductions in cortisol and heart rate, HR). This review also identifies potential modifiers, such as methodological differences, biological sex, and chronic stress, to account for heterogeneity of findings within and across studies. In addition, we identify gaps in the literature and suggest future research directions focusing on the roles of genetics and gene expression as well as the influence of neurobiological mechanisms on stress and relapse risk. Future clinical implications of this research include identifying reliable indicators of relapse risk and the potential of pharmacotherapeutic treatments to target stress response systems to correct dysregulation and potentially reduce stress-related risk of relapse.

Biobehavioral and affective stress responses during nicotine withdrawal: Influence of regular cannabis co-use.

BACKGROUND: Co-use of cannabis is increasing in nicotine users and presents additional challenges in addressing nicotine dependence. This study examined the links between regular co-use of cannabis and nicotine with biobehavioral and affective changes in response to stress during nicotine withdrawal and ad libitum use. METHODS: Participants (N = 79) who regularly used nicotine-only, cannabis-only, both substances, or neither substance were invited to attend two laboratory stress assessment sessions. For nicotine users, one session occurred during ad libitum nicotine use and one occurred after abstinence from nicotine. During the stress sessions, participants provided saliva samples for cortisol assay and completed measures of subjective states. Cardiovascular measures were collected during resting baseline, exposure to acute stressors, and a recovery rest period. RESULTS: Nicotine-only users had higher average cortisol levels in the second lab session (nicotine withdrawal) relative to the first lab session (ad libitum nicotine use). Compared to nicotine non-users, nicotine users reported less positive affect and exhibited attenuated cortisol and systolic blood pressure (BP) stress responses. Cannabis users exhibited exaggerated diastolic BP responses to stress compared to cannabis non-users, and co-users of nicotine and cannabis had higher levels of cannabis craving than cannabis-only users (p < .01). CONCLUSIONS: This study partially replicated earlier findings on the effects of chronic nicotine use and provided novel results regarding the influence of cannabis co-use on physiological and affective responses to stress in nicotine users during nicotine withdrawal.

Impact of Early-Life Adversity on Cannabis Use: Exploring the Mediating and Moderating Effects of Chronic Pain.

Background: Although research suggests that early-life adversity (ELA) and cannabis use are linked, researchers have not established factors that mediate or modify this relationship. Identifying such factors could help in developing targeted interventions. We explored chronic pain as a potential mediator or moderator of this relationship. Methods: Using an online study, we collected cross-sectional data about ELA, cannabis use, and chronic pain to test whether ELA (adverse childhood experiences total score) is associated with cannabis use, and to examine pain as a potential mediator or moderator. Cannabis use was examined two ways: times used per day, and categorized as non-, some, or regular use. Chronic pain was measured as present/absent and as the number of painful body locations (0-8). Analyses used linear and multinomial regression. Results: ELA, chronic pain, and cannabis use were common among respondents. ELA was strongly associated with both measures of cannabis use. The number of painful body locations modestly mediated the association of ELA with cannabis use, reducing the magnitude of regression coefficients by about 1/7. The number of painful body locations modified the association between ELA and cannabis use (p≤0.006), while chronic pain presence/absence (a less-informative measure) had only a nonsignificant modification effect (p≥0.10). When either ELA or pain was high, the other was not associated with cannabis use; when either ELA or pain was low, more painful locations or higher ELA (respectively) was associated with more intense cannabis use. Conclusion: These exploratory findings suggest the importance of ELA and chronic pain as factors contributing to cannabis use, and of accounting for these factors in developing treatment and prevention strategies addressing cannabis use.

Nicotine addiction and the influence of life adversity and acute stress on PYY: Prediction of early smoking relapse.

Early life adversity (ELA) is associated with earlier initiation and maintenance of tobacco smoking and with a greater risk of subsequent relapse. There is growing evidence that appetite hormones, including peptide YY (PYY), which modulates craving and satiety responses, play a role in stress and addiction processes. This study employed a quasi-experimental design to examine the association between ELA and circulating PYY stress responses in smokers and nonsmokers (N = 152, ages 19-73 years) to examine the effects of nicotine addiction. Smokers initiated a quit attempt as part of the study and were classified as either abstinent smokers or relapsed smokers based on their nicotine use during the follow-up period. PYY levels were measured at five timepoints during three lab sessions and compared between nonsmokers and the two smoking groups (abstainers, relapsers): while smokers were using nicotine ad libitum, 24 h after smokers initiated a quit attempt, and 4 weeks after smokers initiated a quit attempt. Multivariate analyses showed the main effects of time on PYY, which decreased over time within each session. The main effects of ELA during the first (ad libitum smoking) and second (24-h post-cessation for smokers) sessions indicated that experiencing ELA was associated with lower PYY. No systematic effect of nicotine addiction or relapse was observed in this study. These findings suggest that adults with higher ELA may experience lower PYY. Additional research is needed to further explore the role of PYY in stress and addiction processes.

Early life adversity and substance use: The mediating role of mood and the moderating role of impulsivity.

INTRODUCTION: Early life adversity (ELA) is a risk factor for substance use and misuse, and multiple factors mediate and moderate this association. We examined whether moods mediate the relationships between ELA and nicotine use, cannabis use, and co-use, and whether these mediation effects varied as a function of delay discounting. METHODS: A total of 2555 adults completed a delay discounting task and responded to questions related to demographics, ELA, mood, and substance use. Data were analyzed using Pearson correlations and moderated mediation using Hayes' PROCESS macro (V3.4, Model 15). RESULTS: ELA was positively associated with cannabis use, nicotine use, co-use of both substances, depressed and stressed moods, and it was negatively associated with positive mood. While cannabis use was associated negatively with stressed and depressed moods and positively with positive mood, nicotine use was associated negatively with positive mood. Moderated mediation analyses indicated that positive mood mediated the relationship between ELA and cannabis use for those with average and above average delay discounting. Positive mood also mediated the relationship between ELA and co-use among those with above average delay discounting. CONCLUSION: The results suggest that ELA's associations with cannabis use and cannabis-nicotine co-use may be partially attributable to ELA's effects on positive mood among those who are predisposed to moderately to highly impulsive decision making.

Stress and COVID-19 related behaviours: The mediating role of delay discounting.

We examined stress as a predictor of behaviours related to Coronavirus Disease-2019 (COVID-19) through its effects on delay discounting. Adults (N = 3686) completed an online survey with a behavioural measure of delay discounting and questions regarding stress, physical distancing, and stockpiling of food and supplies. Stress was weakly, but positively, correlated with delay discounting (p < 0.01). Delay discounting was positively correlated with stockpiling (p < 0.01); and discounting was negatively correlated with physical distancing (p < 0.01). Mediation models indicated that discounting was a significant mediator of the relationship between stress and physical distancing (-0.003) and stockpiling (0.003); bootstrap 95% CIs (-0.006, -0.001) and (0.001, 0.005), respectively. After accounting for its indirect effects through discounting, stress continued to have a direct effect on these outcomes. This study indicates that delay discounting partially mediates the link between stress and behaviours related to COVID-19. Results suggest that interventions reducing stress and/or delay discounting may be profitable for increasing infection prevention and reducing stockpiling.

Effects of regular cannabis and nicotine use on acute stress responses: chronic nicotine, but not cannabis use, is associated with blunted adrenocortical and cardiovascular responses to stress.

RATIONALE: Cannabis is one of the most prevalent substances used by tobacco smokers and, in light of the growing list of states and territories legalizing cannabis, it is expected that co-use of cannabis and nicotine will escalate significantly and will lead to continuing challenges with tobacco use. OBJECTIVES: This study was conducted to examine the interactive effects of chronic cannabis and nicotine use on adrenocortical, cardiovascular, and psychological responses to stress and to explore sex differences in these effects. METHODS: Participants (N = 231) included cannabis-only users, nicotine-only users, co-users of both substances, and a non/light-user comparison group. After attending a medical screening session, participants completed a laboratory stress session during which they completed measures of subjective states, cardiovascular responses, and salivary cortisol during baseline (rest) and after exposure to acute stress challenges. RESULTS: Nicotine use, but not cannabis use, was associated with blunted cortisol and cardiovascular responses to stress across both men and women. Men exhibited larger cortisol responses to stress than women. Co-users had significantly larger stress-related increases in cannabis craving than cannabis-only users. Cannabis users reported smaller increases in anxiety during stress than cannabis non/light-users, and both male nicotine-only users and male cannabis-only users experienced significantly smaller increases in stress than their non/light-user control counterparts. CONCLUSIONS: This study replicates and extends earlier research on the impacts of sex and nicotine use on stress responses, and it provides novel findings suggesting that when co-used with nicotine, cannabis use may not confer additional alterations to physiological nor subjective responses to stress. Co-use, however, was associated with enhanced stress-related craving for cannabis.

Early life adversity and appetite hormones: The effects of smoking status, nicotine withdrawal, and relapse on ghrelin and peptide YY during smoking cessation.

There is evidence suggesting that ghrelin and peptide YY (PYY) modulate stress responses and the rewarding effects of drugs, although no research has examined the impact of exposure to early life stress on these hormones in smokers nor during smoking cessation. This study examined the relationships between early life adversity (ELA) and circulating ghrelin and PYY during ad libitum smoking and early withdrawal in tobacco smokers (N = 98) who were interested in cessation. We also included a comparison group of nonsmokers (N = 36). We prospectively compared levels of hormones between smokers who were successful in quitting within a 2-week period, smokers who relapsed during that period, and nonsmokers. Results showed that ELA was positively associated with elevated ghrelin in nonsmokers. Among those reporting no ELA, successful quitters had higher ghrelin levels than nonsmokers during ad libitum smoking, while relapsers had higher ghrelin levels than nonsmokers during withdrawal. In addition, having no ELA was associated with a decline in ghrelin from the ad libitum to abstinence sessions in successful quitters; this withdrawal-related decline was not found in relapsers. Although effects of ELA, smoking group, and time on PYY were not significant, greater PYY was associated with reduced urges to smoke during withdrawal. These findings suggest the importance of considering changes in appetite-related hormones in individuals who are dependent on tobacco. This research provides additional indications for effects of ELA on appetite-stimulating hormones.

Regular cannabis use is associated with blunted affective, but not cardiovascular, stress responses.

AIMS: To examine the potential impact of regular cannabis use on cardiovascular and subjective responses to acute stress. DESIGN: We used a quasi-experimental design in which subjective states and cardiovascular measures were obtained during rest and in response to acute stress challenges in a sample of regular cannabis users and non-users. PARTICIPANTS: Seventy-nine adults (forty-five cannabis users and thirty-four non-users). MEASUREMENTS: We measured subjective states (positive affect, state stress, state anxiety, cannabis craving) and cardiovascular indicators (blood pressure, heart rate, mean arterial pressure) during baseline rest and in response to public speaking, mental arithmetic, and cold-pressor challenges. Regular cannabis use was established via self-report and was confirmed with a positive urine drug test. FINDINGS: Regular cannabis use was associated with blunted positive affect (F = 5.67, p = .002), state stress (F = 6.05, p = .002), and state anxiety (F = 6.48, p < .001) in response to acute stress challenges. There was no evidence of an association between cannabis use and cardiovascular responses (Fs ≤ 1.54; Ps ≥ 0.21). Contrary to expectations, cannabis craving decreased in response to stress challenges (F = 8.44, p < .001). CONCLUSION: Chronic cannabis use is associated with blunted positive and negative (stress, anxiety) affective responses to acute stress, indicating emotional dysregulation in this population.

Effects of tobacco addiction on links between early life adversities, sleep disturbance, and depression: A moderated mediation approach.

Despite the well-established relationship between early life adversities (ELA) and depression, the underlying mechanisms for this link remain less clear and need to be developed. The aim of this study was to advance our understanding of this link by testing the mediating role of sleep disturbances and the moderating role of tobacco use in this mediation. A total of 579 smokers and non-smokers were recruited in two US communities (Duluth and Minneapolis, MN). Simple and moderated mediation analyses were performed using the PROCESS macro for SPSS, with the number of ELA as an independent variable, depression symptoms assessed by the Patient Health Questionnaire-9 (PHQ-9) as a dependent variable, sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) as a mediator, and smoking status as a moderator variable. The study demonstrated that ELA and depressive symptoms were positively correlated; and sleep quality fully mediated this relationship. This mediation was moderated by tobacco use (index of moderated mediation = 0.10, 95%CI [0.03; 0.19]) and was more pronounced among smokers (b = 0.14, 95%CI [0.07; 0.23]) than non-smokers (b = 0.04, 95%CI [0.0002; 0.10]). Subsequent mediation analyses run separately for each component of the PSQI suggested that individuals who experienced ELA and who were smokers had greater delays in sleep onset and were more likely to sleep for a shorter duration, both of which predicted greater depressive symptoms. Sleep quality is therefore a promising ELA-related target for preventive and therapeutic interventions as well as for further research in depression and tobacco addiction.