Unpacking Psychological Vulnerabilities in Deaths of Despair.

Recent demographic findings show increased rates of death due to suicide, drug addictions, and alcoholism among midlife white adults of lower socioeconomic status (SES). These have been described as "deaths of despair" though little research has directly assessed psychological vulnerabilities. This study used longitudinal data from the Midlife in the U.S. (MIDUS) study to investigate whether low levels of eudaimonic and hedonic well-being predict increased risk of deaths of despair compared to other leading causes of death (cancer, heart disease). The investigation focused on 695 reported deaths with cause of death information obtained from 2004 to 2022 via NDI Plus. Key questions were whether risk for deaths due to despair (suicide, drug addiction, alcoholism) compared to deaths due to cancer or heart disease were differentially predicted by deficiencies in well-being, after adjusting for sociodemographic variables. Low levels of purpose in life, positive relations with others, personal growth and positive affect predicted significantly greater likelihood of deaths of despair compared to deaths due to heart disease, with such patterns prominent among better-educated adults. The findings bring attention to ongoing intervention efforts to improve psychological well-being.

Racial and Educational Disparities in Cumulative Exposure to Hardships of the 2008 Great Recession and Inflammation.

OBJECTIVE: This cross-sectional analysis examined self-reported economic hardships of the 2008 Great Recession, race/ethnicity, educational attainment, and psychological well-being (PWB) as predictors of systemic inflammatory physiology at midlife. We also tested for differential vulnerability in the relationship between recession hardship and inflammatory physiology by race/ethnicity, education, and PWB. METHODS: Adults from the Midlife in the United States Refresher sample completed a survey and biomedical assessments after the recession ( n = 592 non-Hispanic White respondents, n = 158 Black/African American respondents, n = 108 respondents with other race/ethnicity). Cumulative recession hardship was the sum of financial, housing, and employment-related events. Outcomes included circulating levels of interleukin 6 and C-reactive protein. General linear regression models tested main effects interactions between primary predictor variables. RESULTS: Educational attainment was inversely associated with recession hardships ( b = -0.18, 95% confidence interval = -0.26 to -0.11, p < .001). Black/African American respondents reported more recession hardships than White respondents ( b = 1.17, 95% confidence interval = 0.67 to 1.68, p < .001). More recession hardships predicted higher levels of interleukin 6 ( b = 0.06, p < .001) and C-reactive protein ( b = 0.04, p = .004). Analyses did not support race/ethnicity, education, and PWB as moderators of the association between recession hardship and inflammatory markers. CONCLUSIONS: Race/ethnicity and education independently predicted disparities in cumulative recession hardship exposure. Recession hardship predicted higher blood levels of inflammatory proteins associated with long-term health. The lack of findings for differential vulnerability in the relationship between recession hardship and inflammatory markers by race/ethnicity, education, or PWB was possibly due to the limited sample size.

Mediterranean Lifestyle to Promote Physical, Mental, and Environmental Health: The Case of Chile.

Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21-37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country.

Conscientiousness and Smoking: Do Cultural Context and Gender Matter?

Prior studies have found that conscientiousness has a protective effect against smoking, but evidence for this relationship mostly comes from Western contexts. In societies where smoking is pervasive and less stigmatized, the protective effect of conscientiousness on smoking may be less evident. Moreover, whether smoking is viewed as normal or deviant also may vary by gender norms attached to smoking. Using surveys of Midlife Development in the United States (MIDUS) and Japan (MIDJA), we examined patterns in the association between conscientiousness and smoking status (never, former, current) for men and women. We found that in the United States, where the social unacceptability of smoking has dramatically increased, there is an inverse association between conscientiousness and smoking status for both genders. In Japan, where the stigma attached to smoking operates for women but not men, the association between conscientiousness and smoking status varies by gender. For Japanese men, levels of conscientiousness do not differ across smoking statuses. For Japanese women, those who formerly smoked show lower levels of conscientiousness than those who never smoked and those who currently smoke. We interpret these findings in light of differing cultural and historical backgrounds of smoking for men and women.

Cultural and life style practices associated with low inflammatory physiology in Japanese adults.

Japan is an exceptionally healthy East Asian country with extended longevity. In addition, the typical levels of several proinflammatory proteins, including both C-reactive protein (CRP) and interleukin-6 (IL-6), are often reported to be low when compared to American and European populations. This analysis determined if blood levels of CRP and IL-6 were associated with 4 cultural practices reflective of Japanese behavior and customs -- drinking tea, eating seafood, consuming vegetables, and partaking in relaxing baths regularly - among 382 adults living in Tokyo. Regression models controlled for demographic factors, adiposity (BMI), physical exercise, smoking, alcohol use, and chronic illness (e.g., diabetes). Consuming a Japanese diet was associated with significantly lower CRP and IL-6 levels. More frequent bathing was associated with lower IL-6, but not specifically predictive of low CRP. This study has confirmed prior evidence for low inflammatory activity in Japanese adults and its association with several behavioral practices common in Japan.

Psychological resources and glucoregulation in Japanese adults: Findings from MIDJA.

OBJECTIVE: To examine associations between glucoregulation and 3 categories of psychological resources: hedonic well-being (i.e., life satisfaction, positive affect), eudaimonic well-being (i.e., personal growth, purpose in life, ikigai), and interdependent well-being (i.e., gratitude, peaceful disengagement, adjustment) among Japanese adults. The question is important given increases in rates of type 2 diabetes in Japan in recent years, combined with the fact that most prior studies linking psychological resources to better physical health have utilized Western samples. METHOD: Data came from the Midlife in Japan Study involving randomly selected participants from the Tokyo metropolitan area, a subsample of whom completed biological data collection (N = 382; 56.0% female; M(SD)age = 55.5(14.0) years). Glycosylated hemoglobin (HbA1c) was the outcome. Models adjusted for age, gender, educational attainment, smoking, alcohol, chronic conditions, body mass index (BMI), use of antidiabetic medication, and negative affect. RESULTS: Purpose in life (ß = -.104, p = .021) was associated with lower HbA1c, and peaceful disengagement (ß = .129, p = .003) was associated with higher HbA1c in fully adjusted models. Comparable to the effects of BMI, a 1 standard deviation change in well-being was associated with a .1% change in HbA1c. CONCLUSIONS: Associations among psychological resources and glucoregulation were mixed. Healthy glucoregulation was evident among Japanese adults with higher levels of purpose in life and lower levels of peaceful disengagement, thereby extending prior research from the United States. The results emphasize the need for considering sociocultural contexts in which psychological resources are experienced in order to understand linkages to physical health. (PsycINFO Database Record

Racial disparities in sleep: the role of neighborhood disadvantage.

OBJECTIVE: Disparities in sleep duration and efficiency between Black/African American (AA) and White/European American (EA) adults are well-documented. The objective of this study was to examine neighborhood disadvantage as an explanation for race differences in objectively measured sleep. METHODS: Data were from 133 AA and 293 EA adults who participated in the sleep assessment protocol of the Midlife in the United States (MIDUS) study (57% female; Mean Age = 56.8 years, SD = 11.4). Sleep minutes, onset latency, and waking after sleep onset (WASO) were assessed over seven nights using wrist actigraphy. Neighborhood characteristics were assessed by linking home addresses to tract-level socioeconomic data from the 2000 US Census. Multilevel models estimated associations between neighborhood disadvantage and sleep, and the degree to which neighborhood disadvantage mediated race differences in sleep controlling for family socioeconomic position and demographic variables. RESULTS: AAs had shorter sleep duration, greater onset latency, and higher WASO than EAs (ps < 0.001). Neighborhood disadvantage was significantly associated with WASO (B = 3.54, p = 0.028), but not sleep minutes (B = -2.21, p = 0.60) or latency (B = 1.55, p = 0.38). Furthermore, race was indirectly associated with WASO via neighborhood disadvantage (B = 4.63, p = 0.035), which explained 24% of the race difference. When measures of depression, health behaviors, and obesity were added to the model, the association between neighborhood disadvantage and WASO was attenuated by 11% but remained significant. CONCLUSION: Findings suggest that neighborhood disadvantage mediates a portion of race differences in WASO, an important indicator of sleep efficiency.

Early parenthood as a link between childhood disadvantage and adult heart problems: A gender-based approach.

Drawing on conceptual models of critical periods, major life transitions, and life pathways, we proposed that the life-course features of parenthood are important, but understudied, mechanisms for explaining possibly gendered heart-health outcomes. Using three waves from the Midlife in the U.S. Study (MIDUS), we investigated (a) gender differences in the timing of the transition to parenthood as a pathway linking childhood SES disadvantage to onset of heart problems and (b) life-course factors (which vary by gender) that link the timing of the transition to parenthood to adult heart problems. We found that individuals who were disadvantaged in childhood were more likely to have their first child as teenagers or in early young adulthood. For women only, an early transition to parenthood partially explained the association between childhood disadvantage and onset of heart problems. Furthermore, women who had their first child at younger ages, particularly in their teens, had lower rates of college graduation, more financial difficulties, higher levels of depressive symptoms, and greater risk of smoking and obesity in midlife. These factors partially accounted for the association between early parenthood and onset of heart problems in later life. Our findings underscore the significance of the timing of the transition to parenthood in specifying the associations between childhood disadvantage and adult heart problems. Various factors are involved, including low adult SES, psychological distress, and unhealthy lifestyles.

Aging and low-grade inflammation reduce renal function in middle-aged and older adults in Japan and the USA.

The objective of this study was to investigate the effects of low-grade inflammation on age-related changes in glomerular filtration rate (GFR) in middle-aged and older white Americans, African-Americans, and Japanese adults. Serum creatinine, C-reactive protein (CRP), and interleukin-6 (IL-6) levels were determined for 1570 adult participants in two surveys of aging in the USA and Japan (N = 1188 and 382, respectively). Kidney function declined with age in both countries and was associated with IL-6 and CRP. IL-6 and CRP also influenced the extent of the arithmetic bias when calculating the GFR using the chronic kidney disease epidemiology (CKD-EPI) formula with just serum creatinine. Younger African-Americans initially had the highest GFR but showed a steep age-related decrement that was associated with elevated inflammation. Japanese adults had the lowest average GFR but evinced a large effect of increased inflammatory activity when over 70 years of age. Importantly, our results also indicate that low-grade inflammation is important to consider when evaluating kidney function solely from serum creatinine.

Genetic and environmental determinants of population variation in interleukin-6, its soluble receptor and C-reactive protein: insights from identical and fraternal twins.

Interleukin-6 and C-reactive protein are commonly assessed biomarkers linked to illness, obesity, and stressful life events. However, relatively little is known about their heritability. By comparing Caucasian twins from the Midlife in the US project (MIDUS), we estimated the heritability of IL-6, its soluble receptor, and CRP. Based on the hypothesis that adiposity might contribute more to IL-6 than to sIL-6r, we fit heritability models quantifying the extent to which each reflected genetic and environmental factors shared with obesity. Genetic influences on IL-6 and its receptor proved to be distinct. Further, the appearance of a heritable basis for IL-6 was mediated largely via shared paths with obesity. Supporting this conclusion, we confirmed that when unrelated adult controls are carefully matched to twin participants on BMI, age, gender and socioeconomic indices, their IL-6 is similar to the corresponding twins. In contrast, the effect of BMI on CRP was split between shared genetics and environmental influences. In conclusion, IL-6 is strongly affected by factors associated with obesity accounting for its lability and responsiveness to diet, life style and contemporaneous events.

Educational Status, Anger, and Inflammation in the MIDUS National Sample: Does Race Matter?

BACKGROUND: Racial differences in anger frequency and expression styles have been found. Further, African Americans receive fewer health benefits from higher education than Whites. PURPOSE: This study seeks to investigate racial differences in how anger moderates the association between education and inflammation. METHODS: Midlife in the US participants (n = 1,200; 43.0 % male; 18.5 % African American) provided education and anger data via survey assessments. Interleukin-6 (IL-6) and fibrinogen were determined from a fasting blood sample following an overnight clinic visit. RESULTS: African Americans reported higher anger-out, IL-6, and fibrinogen and lower anger-control than Whites. Anger-out predicted higher IL-6 and fibrinogen among African Americans with higher education; whereas, trait anger and anger-out predicted lower fibrinogen among Whites with higher education. Anger-out marginally predicted higher IL-6 in less educated Whites. CONCLUSIONS: Findings underscore racial differences in the benefits and consequences of educational attainment, and how social inequities and anger are manifested in inflammatory physiology.

Self Realization and Meaning Making in the Face of Adversity: A Eudaimonic Approach to Human Resilience.

This article considers a eudaimonic approach to psychological well-being built on the integration of developmental, existential and humanistic formulations as well as distant writings of Aristotle. Eudaimonia emphasizes meaning-making, self realization and growth, quality connections to others, self-knowledge, managing life, and marching to one's own drummer. These qualities may be of particular importance in the confrontation with significant life challenges. Prior formulations of resilience are reviewed to underscore the unique features of a eudaimonic approach. Empirical findings on meaning making and self realization are then reviewed to document the capacity of some to maintain high well-being in the face of socioeconomic inequality, the challenges of aging, and in dealing with specific challenges (child abuse, cancer, loss of spouse). Moreover, those who sustain or deepen their well-being as they deal with adversity, show better health profiles, thereby underscoring broader benefits of eudaimonia. How meaning is made and personal capacities realized in the confrontation with challenge is revealed by narrative accounts. Thus, the latter half of the article illustrates human resilience in action via the personal stories of three individuals (Mark Mathabane, Ben Mattlin, Victor Frankl) who endured unimaginable hardship, but prevailed and grew in the face of it. The essential roles of strong social ties and the capacity to derive meaning and realize personal growth in grappling with adversity are unmistakable in all three cases.

Purpose in life and use of preventive health care services.

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

Negative emotions predict elevated interleukin-6 in the United States but not in Japan.

Previous studies conducted in Western cultures have shown that negative emotions predict higher levels of pro-inflammatory biomarkers, specifically interleukin-6 (IL-6). This link between negative emotions and IL-6 may be specific to Western cultures where negative emotions are perceived to be problematic and thus may not extend to Eastern cultures where negative emotions are seen as acceptable and normal. Using samples of 1044 American and 382 Japanese middle-aged and older adults, we investigated whether the relationship between negative emotions and IL-6 varies by cultural context. Negative emotions predicted higher IL-6 among American adults, whereas no association was evident among Japanese adults. Furthermore, the interaction between culture and negative emotions remained even after controlling for demographic variables, psychological factors (positive emotions, neuroticism, extraversion), health behaviors (smoking status, alcohol consumption), and health status (chronic conditions, BMI). These findings highlight the role of cultural context in shaping how negative emotions affect inflammatory physiology and underscore the importance of cultural ideas and practices relevant to negative emotions for understanding of the interplay between psychology, physiology, and health.

Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States.

PURPOSE: Year-to-year decreases in smoking in the US have been observed only sporadically in recent years, which suggest a need for intensified efforts to identify those at risk for persistent smoking. To address this need, we examined the association between a variety of psychosocial stressors and smoking persistence, cessation, and relapse over 9-10 years among adults in the United States (n = 4,938, ages 25-74). METHODS: Using information provided at baseline and follow-up, participants were categorized as non-smokers, persistent smokers, ex-smokers, and relapsed smokers. Stressors related to relationships, finances, work-family conflict, perceived inequality, neighborhood, discrimination, and past-year family problems were assessed at baseline and follow-up. RESULTS: High stress at both assessments was associated with greater odds of persistent smoking for stressors related to relationships, finances, work, perceived inequality, past-year family problems, and a summary score. Among respondents who were smokers at baseline, high stress at both time points for relationship stress, perceived inequality, and past-year family problems was associated with nearly double the odds of failure to quit. CONCLUSIONS: Interventions to address psychosocial stress may be important components within smoking cessation efforts.

Varieties of anger and the inverse link between education and inflammation: toward an integrative framework.

OBJECTIVE: To examine multiple aspects of anger experience and expression (frequency, outward expression, suppression, and control) as moderators of the association of social inequality, as measured by educational status, with inflammation and coagulation markers. METHODS: After survey assessments via telephone and mail, Midlife in the United States respondents (N = 1054) participated in an overnight clinic visit, where they completed anger questionnaires and provided a fasting blood sample to measure interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen. RESULTS: Educational status was linked to higher anger control among men (B = 0.14, p = .001). Significant inverse correlations emerged between education and IL-6, CRP, and fibrinogen (r values ≥ -0.09, p values <.004) and between anger control and IL-6 and CRP (r values = -0.07, p values < .03). Controlling for demographic and health status covariates, anger-in predicted lower fibrinogen (p = .03). Interactions between education and anger measures were significant for education and trait anger as related to fibrinogen (p = .02) and education and anger-out as related to IL-6 (p = .05) and fibrinogen (p = .05). As predicted, the inverse relationships between education and IL-6 and fibrinogen were stronger among individuals reporting high anger. Anger control also moderated the association of education with IL-6 in women (p = .026), such that the link between education and IL-6 was attenuated among women with high anger control. CONCLUSIONS: Varieties of anger moderated educational gradients in inflammation: The inverse relationships between education and inflammation markers were strongest among individuals with high anger and were attenuated among those with high anger control.

Social relationships and inflammatory markers: an analysis of Taiwan and the U.S.

We evaluated the association between two aspects of social relationships and six inflammatory markers in Taiwan and the U.S. These two countries share similar levels of current life expectancy, but exhibit important differences in social structure. The data comprised population based samples from Taiwan (aged 53+; n=962) and the U.S. (aged 35-86; n=990) collected between 2003 and 2009. Circulating levels of interleukin-6 (IL-6), C-reactive protein (CRP), fibrinogen, and soluble forms of intercellular adhesion molecule 1, E-selectin, and IL-6 receptor (sIL-6R) were measured in fasting blood samples. A social integration score was based on marital status, contact with family and friends, church attendance, and other social participation. A perceived social support index was based on questions regarding the availability of care and support from family and friends. Linear regression models tested the association between these two measures and each inflammatory marker controlling for sociodemographic characteristics, obesity, medication use, and baseline health status. After adjusting for potential confounders, social integration had a significant but weak inverse association with CRP in Taiwan. Perceived social support was significant in two of 12 models, and the coefficient was positive (i.e., higher support was associated with higher CRP and sIL-6R in the U.S.). We found no evidence that the coefficients for social relationship measures varied by sex or age. Our results yielded limited evidence of a weak association between two dimensions of social relationships and six inflammatory markers in Taiwan and the U.S. Given that the literature suggests a strong link between social relationships and mortality, and that inflammation plays an important role in the leading causes of death, we had expected to find consistent and moderately strong associations between social relationships and inflammatory markers. The small effect sizes and lack of robustness across markers were surprising.

Living well with medical comorbidities: a biopsychosocial perspective.

OBJECTIVES: We take a biopsychosocial perspective on age-related diseases by examining psychological correlates of having multiple chronic conditions and determining whether positive psychological functioning predicts advantageous profiles of biological risk factors. METHOD: Respondents to the national survey of Midlife in the United States who participated in clinical assessments of health and biological processes (n = 998) provided information on chronic medical conditions and multiple domains of psychological functioning. Serum concentrations of interleukin-6 (IL-6) and C-reactive protein (CRP) were determined from fasting blood samples. RESULTS: Life satisfaction declined with increasing comorbidity while negative affect increased. In contrast, positive affect, purpose in life, and positive relations with others were unrelated to comorbidity status. Significant interactions showed that although IL-6 and CRP increased with increasing number of chronic conditions, respondents with higher levels of purpose in life, positive relations with others, and (in the case of CRP) positive affect had lower levels of inflammation compared with those with lower well-being scores. DISCUSSION: The results suggest that many older adults with medical comorbidities maintain high levels of positive psychological functioning that are in turn linked to better profiles of biological disease risk.

Psychosocial stressors and cigarette smoking among African American adults in midlife.

INTRODUCTION: Psychosocial stress is a significant risk factor for smoking, and Blacks experience higher levels of psychosocial stress relative to other racial/ethnic groups. Limited research has comprehensively examined psychosocial stressors in relation to smoking among Blacks. METHODS: We examined psychosocial stressors in relation to smoking status (current, previous, and never) in middle-aged Blacks (34-85 years, n = 592) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study II (2004-2006). Eleven stressor domains were assessed, including psychological and physical work stress, work-family conflict, perceived inequality, relationship stress, neighborhood stress, discrimination, financial stress, recent problems, stressful events, and childhood adversity. We also calculated a cumulative score. Multinomial models were adjusted for age, gender, education, and income. RESULTS: Seven of the 11 stressors and the cumulative score were associated with higher odds of being a current smoker compared with a never-smoker: neighborhood, financial, relationship, and psychological work stress, perceived inequality, stressful events, childhood adversity (p values <.05; ORs ranged from 1.28 to 1.77). Three stressors and the cumulative score were associated with higher odds of being a previous smoker versus a never-smoker (p < .05). Individuals who scored in the top quartile on 5 or more stressors were 3.74 (95% CI = 2.09-6.71) times as likely to be current smokers, and more than twice as likely to be previous smokers, compared with individuals with no high stressors. CONCLUSIONS: These results demonstrate a strong relationship between stress and smoking among urban middle-aged Blacks and suggest that cessation programs should address modifiable individual and community-level stressors.

Cancer survivors' responses to daily stressors: implications for quality of life.

OBJECTIVE: This study examined cancer survivors' experience of and responses to challenges and stressors associated with everyday living. The impact of daily stressors on quality of life concerns and cortisol patterns was also investigated. METHOD: Participants included 111 cancer survivors who participated in a national telephone diary study of daily experiences (National Study of Daily Experiences). Their responses were compared with those of 111 sociodemographically matched participants with no cancer history using a multilevel modeling approach. Over an 8-day period, participants completed a daily inventory of the occurrence and impact of stressful events, affect, and physical symptoms. Salivary cortisol was sampled four times per day, and indices of awakening response (cortisol awakening response), diurnal slope, and overall output (area under the curve) were examined. RESULTS: Cancer survivors experienced similar numbers and types of stressful events as the comparison group. Although appraisals were largely comparable, cancer survivors showed a modest tendency to perceive stressors as more severe and disruptive, particularly those involving interpersonal tensions. The occurrence of stressors was associated with increased negative affect, decreased positive affect, and increased physical symptoms, but little change in cortisol. Relative to the comparison group, cancer survivors showed less pronounced changes in positive affect and cortisol output when stressors occurred, but a greater increase in negative affect in response to interpersonal conflicts. CONCLUSION: Findings indicate that cancer survivors show a resilient ability to respond to day-to-day stressors and challenges. However, daily stressors can have a significant impact on survivors' mood and physical symptoms and therefore may be an important intervention target.