Salivary inflammatory biomarkers as a predictor of post-traumatic stress disorder and depressive symptom severity in trauma patients: A prospective study.

BACKGROUND: Although post-traumatic stress disorder (PTSD) and depression screening are recommended for traumatic injury patients, routine screening is still uncommon. Salivary inflammatory biomarkers have biological plausibility and potential feasibility and acceptability for screening. This study tested prospective associations between several salivary inflammatory biomarkers (proinflammatory cytokines interleukin-1ß, interleukin-6, tumor necrosis factor-α; and C-reactive protein), collected during hospitalization and PTSD and depressive symptoms at 5-month follow-up. METHODS: Adult traumatic injury patients (N = 696) at a major urban Level 1 trauma center provided salivary samples and completed PTSD and depressive symptom measures during days 0-13 of inpatient hospitalization. At 5-month follow-up, 368 patients (77 % male, 23 % female) completed the Clinician-Administered PTSD Scale for DSM-IV and the Self-rated Inventory of Depressive Symptomatology. Analyses focused on a latent inflammatory cytokine factor and C-reactive protein at baseline predicting 5-month PTSD and depression symptom outcomes and included baseline symptom levels as covariates. RESULTS: A latent factor representing proinflammatory cytokines was not related to 5-month PTSD or depressive symptom severity. Higher salivary CRP was related to greater PTSD symptom severity (ß = .10, p = .03) at 5-month follow-up and more severity in the following depressive symptoms: changes in weight and appetite, bodily complaints, and constipation/diarrhea (ß's from .14 to .16, p's from .004 -.03). CONCLUSION: In a primarily Latine and Black trauma patient sample, salivary CRP measured after traumatic injury was related to greater PTSD symptom severity and severity in several depressive symptom clusters. Our preliminary findings suggest that salivary or systemic CRP may be useful to include in models predicting post-trauma psychopathology.

Ozone Pollution, Perceived Support at Home, and Asthma Symptom Severity in the Adolescent Sample of the California Health Interview Survey.

BACKGROUND: Outdoor air pollution, including ozone (O3) pollution, and childhood family environments may interact and impact asthma exacerbations in children. Previous epidemiology studies have primarily focused on stress in the home, rather than support, and whether psychosocial factors modify the association between pollution and health outcomes, rather than whether pollution exposure modifies associations between psychosocial factors and health outcomes. METHODS: Data from the cross-sectional 2003 representative, population-based California Health Interview Survey were linked with air quality monitoring data on O3 pollution from the California Air Resources Board. Adolescents (N = 209) ages 12-17 who reported an asthma diagnosis and lived within 5 mi of the nearest air monitoring station had linked O3 data for a 12-month period preceding the survey interview date. Adolescents reported perceived available support from an adult at home and frequency of asthma symptoms. RESULTS: In unadjusted models, for adolescents living in high O3 pollution regions, greater perceived support was related to lower asthma symptom frequency. Follow-up analyses suggested that the most plausible interpretation of the interaction was that O3 exposure modified the association between perceived support and symptom frequency. O3 × perceived support interactions were not statistically significant after adjusting for covariates. CONCLUSIONS: These data provide preliminary evidence that the association between the lack of support in the home environment and worse asthma symptoms may be stronger in areas with higher O3 exposure. Future work may benefit from incorporating personal pollution exposure assessments, comprehensive family environment assessments, and longitudinal follow-up of asthma exacerbations over time.

Annual Research Review: Social relationships and the immune system during development.

A child's social relationships serve critical functions during development. The interface between a child's social world and their immune system, particularly innate immunity, which helped children survive in the face of infections, nutritional scarcity, and violence throughout human history, is the focus of this Annual Research Review. This article reviews the state of research on social relationships and innate immune inflammation during childhood. Warmth and rejection in childhood social relationships, as well as physical trauma and unpredictable social environments, were not consistently related to circulating inflammatory markers such as interleukin-6 and C-reactive protein during childhood. Instead, links between social environments and inflammation were observed in studies that focus on children with greater background risk factors, such as low family socioeconomic status, family history of mood disorders, or presence of chronic interpersonal stressors combined with acute episodic stressors. In addition, studies on worse childhood social environments and greater inflammation in adulthood were more consistent. Warmth and rejection in the social environment may be related to sensitivity of immune cells to the anti-inflammatory actions of glucocorticoids, though this is primarily observed in adolescent women at risk for depression. Additional mechanistic evidence suggests that greater warmth and less rejection are related to processes that regulate inflammation, including greater expression of the glucocorticoid receptor gene and lower expression of genes that are responsive to the pro-inflammatory transcription factor NF-kappa B. The article concludes by discussing implications of the interface between a child's social relationships and inflammation for mental health and other recent (on evolutionary timescales) health threats, as well as recommendations for future research, and recommendations for researchers interested in integrating inflammatory measures in developmental research.

Feeling needed: Effects of a randomized generativity intervention on well-being and inflammation in older women.

Generativity, or concern for and contribution to the well-being of younger generations, plays an important role in successful aging. The purpose of this study was to develop a novel, writing-based intervention to increase feelings of generativity and test the effect of this intervention on well-being and inflammation in a sample of older women. Participants in this study (n = 73; mean age = 70.9 years, range 60-86 years) were randomly assigned to a 6-week generativity writing condition (writing about life experiences and sharing advice with others) or a control writing condition (neutral, descriptive writing). Self-reported measures of social well-being, mental health, and physical health, as well as objective measures of systemic and cellular levels of inflammation (plasma pro-inflammatory cytokines interleukin-6 and tumor necrosis factor-α; genome-wide RNA transcriptional profiling), were assessed pre- and post-intervention. The generativity intervention led to significant improvements across multiple domains, including increases in participation in social activities, decreases in psychological distress, more positive expectations regarding aging in the physical health domain, and decreases in pro-inflammatory gene expression. Thus, this study provides preliminary evidence for the ability of a novel, low-cost, low-effort intervention to favorably impact inflammation and well-being in older women.

Early life stress sensitizes individuals to the psychological correlates of mild fluctuations in inflammation.

BACKGROUND: Early life stress (ELS) has been linked to health disparities across the human lifespan, particularly increased risk for depression and its recurrence. In this study we explore two plausible and competing pathways through which ELS may lead to depression via inflammation. METHODS: Participants (ages 18-22; n = 41) completed the Early Trauma Inventory as a measure of ELS. Participants then completed consecutive daily diaries of mood and other sickness behavior for the 7 days prior to and 7 days after receiving the annual influenza vaccine. Circulating concentrations of plasma interleukin-6 (IL-6) were measured immediately before and 24 hr after vaccination. RESULTS: ELS was not associated with the magnitude of change in IL-6 from pre- to post-vaccine, however, exposure to ELS moderated the association between change in IL-6 from pre- to post-vaccine and changes in both cognitive difficulty and depressed mood. Individuals exposed to greater ELS showed greater psychological sensitivity to increases in IL-6. CONCLUSIONS: Exposure to ELS may increase sensitivity to peripheral inflammation in the central nervous system. Future studies elaborating on the impact of ELS on the sensitivity of specific neural circuits and cells to inflammation are needed.

Within-subject associations between inflammation and features of depression: Using the flu vaccine as a mild inflammatory stimulus.

BACKGROUND: Inflammation plays a role in mood and behavior that may be relevant to identifying risk factors and treatment for depression and other stress-related illnesses. The purpose of this study was to examine whether fluctuations in inflammation following a mild immune stimulus were associated with changes in daily reported features of depression for up to a week in a healthy sample of young adults. METHODS: Forty-one undergraduate students completed daily diaries of mood, feelings of social disconnection, sleep, and physical symptoms for one week before and after receiving the seasonal influenza vaccine. Circulating plasma interleukin-6 (IL-6) was measured via blood samples taken immediately before and one day after vaccination. RESULTS: There was a significant increase in circulating IL-6 from pre- to post-intervention (p = .008), and there was significant variability in the magnitude of IL-6 change. Greater increases in IL-6 were associated with greater mood disturbance on post-vaccine days, specifically depressed mood and cognitive symptoms. CONCLUSIONS: Minor increases in inflammation were associated with corresponding increases in features of depression, and these associations occurred in the absence of any physical symptoms. The influenza vaccine could be used to probe causal relationships with a high degree of ecological validity, even in high-risk and vulnerable populations, to better understand the role of inflammation in the pathogenesis of depression.

Family environments and leukocyte transcriptome indicators of a proinflammatory phenotype in children and parents.

High conflict and low warmth in families may contribute to immune cells developing a tendency to respond to threats with exaggerated inflammation that is insensitive to inhibitory signaling. We tested associations between family environments and expression of genes bearing response elements for transcription factors that regulate inflammation: nuclear factor kappa B (NF-κB) and glucocorticoid receptor. The overall sample (47 families) completed interviews, questionnaires, and 8-week daily diary assessments of conflict and warmth, which were used to create composite family conflict and warmth scores. The diaries assessed upper respiratory infection (URI) symptoms, and URI episodes were clinically verified. Leukocyte RNA was extracted from whole blood samples provided by a subsample of 42 children (8-13 years of age) and 73 parents. In children, higher conflict and lower warmth were related to greater expression of genes bearing response elements for the proinflammatory transcription factor NF-κB, and more severe URI symptoms. In parents, higher conflict and lower warmth were also related to greater NF-κB-associated gene expression. Monocytes and dendritic cells were implicated as primary cellular sources of differential gene expression in the sample. Consistent with existing conceptual frameworks, stressful family environments were related to a proinflammatory phenotype at the level of the circulating leukocyte transcriptome.

Screening for childhood adversity: the what and when of identifying individuals at risk for lifespan health disparities.

Existing research on childhood adversity and health risk across the lifespan lacks specificity regarding which types of exposures to assess and when. The purpose of this study was to contribute to an empirically-supported framework to guide practitioners interested in identifying youth who may be at greatest risk for a lifelong trajectory of health disparities. We also sought to identify the point in childhood at which screening for adversity exposure would capture the largest group of at risk individuals for triage to prevention and intervention services. Participants (n = 4036) collected as part of the Midlife in the United States study reported their medical status and history including physical (cardiovascular disease, hypertension, obesity, diabetes, cancer) and mental health (depression, substance use problems, sleep problems). Participants indicated whether they were exposed to 7 adversities at any point in childhood and their age of exposure to 19 additional lifetime adversities before the age of 18. Parent drug abuse, dropping out or failing out of school, being fired from a job, and sexual assault during childhood exhibited the largest effect sizes on health in adulthood, which were comparable to the effects of childhood maltreatment. Childhood adversity screening in early adolescence may identify the largest proportion of youth at risk for negative health trajectories. The results of this descriptive analysis provide an empirical framework to guide screening for childhood adversity in pediatric populations. We discuss the implications of these observations in the context of prevention science and practice.

The attachment system and physiology in adulthood: normative processes, individual differences, and implications for health.

Attachment theory provides a conceptual framework for understanding intersections between personality and close relationships in adulthood. Moreover, attachment has implications for stress-related physiology and physical health. We review work on normative processes and individual differences in the attachment behavioral system, as well as their associations with biological mechanisms related to health outcomes. We highlight the need for more basic research on normative processes and physiology and discuss our own research on individual differences in attachment and links with physiology. We then describe a novel perspective on attachment and physiology, wherein stress-related physiological changes may also be viewed as supporting the social-cognitive and emotion regulatory functions of the attachment system through providing additional energy to the brain, which has implications for eating behavior and health. We close by discussing our work on individual differences in attachment and restorative processes, including sleep and skin repair, and by stressing the importance of developing biologically plausible models for describing how attachment may impact chronic illness.

Perceived social support and treatment adherence in Chileans with Type 2 diabetes.

This study aimed to determine if greater perceived social support was directly associated with better Type 2 diabetes (T2D) treatment adherence and if better T2D treatment adherence was related to lower HbA1c levels in Chilean adults with T2D. For this purpose, 200 adults were recruited from the Chilean Diabetic Association. Participants were asked to complete self-report instruments and provide a capillary blood sample to measure HbA1c. Structural equation model analyses were performed to determine direct associations. The study's results indicate that greater perceived social support was associated with healthier dietary habits, regular foot care, more frequent physical activity, and lower medication intake. Likewise, blood sugar testing and physical activity were related to HbA1c. These findings provide evidence of how perceived social support relates to T2D treatment adherence behaviors in Latino patients from South America and could be used for interventions to enhance social support from patients' families, partners, and friends.

Saliva sampling method affects performance of a salivary α-amylase biosensor.

OBJECTIVES: Prompted by the discordance between a standardized salivary alpha-amylase (sAA) biosensor applied in clinical settings and a reference laboratory analyzer, we examined the impact of the saliva sampling method on the analytic performance of the biosensor. METHODS: Direct mouth readings using the biosensor from 31 normal, healthy volunteers were compared to biosensor and conventional assay readings obtained from saliva samples collected concurrently by passive drool and processed in three different ways (unprocessed, thawed, and thawed and centrifuged). RESULTS: The direct readings from the mouth showed consistently lower sAA values (Ps < 0.01) compared to all other combinations of sample processing and quantification platforms (biosensor vs. conventional assay). Readings obtained from passive drool saliva were strongly correlated with one another, and Bland-Altman plots of agreement indicated a smaller discrepancy between conventional and biosensor readings obtained with passive drool when compared to the direct mouth readings. CONCLUSIONS: Our study indicates that the analytical performance of the sAA biosensor is influenced significantly by the saliva sampling method. In contrast to the relatively imprecise direct mouth measurements, biosensor sAA levels established indirectly from passive drool saliva samples provide more accurate estimation of sAA levels, even after intermediary processing steps (e.g., freezing, thawing, centrifugation).

Hugs and Cortisol Awakening Response the Next Day: An Ecological Momentary Assessment Study.

Previous research suggests that affectionate touch such as hugs might downregulate stress systems such as the hypothalamic pituitary adrenal (HPA) axis. However, the current literature lacks in generalizability beyond the laboratory setting and outside the context of romantic relationships. The cortisol awakening response (CAR) is a measure of the HPA axis and is responsive to daily fluctuations in stress and social information. However, associations between affectionate touch and the CAR have never been assessed. This study used ecological momentary assessment (EMA) to measure daily hugging behaviors in 104 first-year college students and salivary cortisol to assess the CAR. Participants who reported more daily hugs in their social interactions had significantly smaller CARs the next morning compared to days they reported fewer hugs. This study contributes to the literature on social interactions and stress responsive systems and emphasizes the importance of assessing affectionate touch behaviors such as hugs that can be exchanged outside the context of romantic relationships.

Correlates of Skin Conductance Reactivity to Stroke-Related Trauma Reminders During Hospitalization for Stroke.

Objective: Although several risk factors for stroke-induced posttraumatic stress disorder (PTSD) have been identified, objective risk measures that can be detected in the acute aftermath of these events are needed. This study is the first to collect an objective measure of psychophysiological arousal-skin conductance (SC) reactivity to a trauma interview-in patients after stroke or transient ischemic attack (TIA) and investigate correlates of SC reactivity. Methods: Mobile SC measurement during a resting baseline and standardized trauma interview was performed in-hospital in 98 individuals following stroke/TIA. We examined associations between several stroke-induced PTSD risk factors (sociodemographic, psychosocial, and medical characteristics) and SC reactivity to a trauma interview involving a free-response recalling of the stroke/TIA event. Results: Of the sociodemographic, psychosocial, medical characteristics examined as correlates to SC reactivity to recalling the stroke/TIA event, 2 factors reflecting aspects of prior and in-hospital experience were significantly associated with this indicator of sympathetic nervous system activation. A greater cumulative trauma burden was significantly associated with greater SC reactivity (r = .23, P = .04). Additionally, individuals administered benzodiazepines in-hospital had significantly greater SC reactivity to recalling the stroke/TIA event (M = 1.51, SD = 1.52) than those who were not (M = 0.76, SD = 1.16; P = .01). Greater cumulative trauma burden remained significantly associated with greater SC reactivity when adjusting for age and in-hospital benzodiazepine administration (ß=0.22, P = .04). Conclusion: This study demonstrated that SC reactivity was related to both behavioral and psychological risk factors for PTSD after a stroke/TIA event. Additionally, we demonstrated the feasibility of a low-cost, mobile measurement of SC that can be conducted in-hospital in a novel patient population: individuals with a medical trauma. With this measure, we were able to identify those individuals with the greatest trauma-related sympathetic nervous system reactivity in the days following a medical trauma. Future research is needed to determine whether SC reactivity may be leveraged in the development of brief, noninvasive screening measures for enhancing PTSD risk prediction.

Utility of a salivary biosensor for objective assessment of surgery-related stress.

PURPOSE: To evaluate the clinical utility of a salivary α-amylase (sAA) biosensor for assessing oral surgery-related stress responses and the differential effect of the personality trait of pain catastrophizing. PATIENTS AND METHODS: A prospective cohort study was conducted in 76 healthy subjects who underwent elective removal of their third molars. Along with subjects' self-reports of anxiety and pain, biosensor-facilitated measurements of sAA levels were obtained at multiple time points during the preoperative consult, surgery, and postsurgical follow-up visits. In addition, subjects completed the Pain Catastrophizing Scale at baseline. Mixed-effect regression models examined changes in sAA levels and self-report ratings within and across visits and the contribution of pain catastrophizing. RESULTS: The sAA levels were lower during surgery and postsurgical follow-up compared with the consult visit (P < .01). The sAA levels decreased during the surgery visit (P < .05) and did not change during the consult or follow-up visits. Individuals who reported greater helplessness to pain manifested higher sAA levels during the surgery visit (P < .05). Self-reported anxiety ratings were highest during the surgery visit, and pain ratings were highest during the follow-up visit. CONCLUSIONS: The sAA levels did not show the predicted increases during the surgery visit compared with the consult and postsurgical follow-up visits or increases during the surgery visit. However, individuals who reported responding to pain with helplessness had higher sAA levels in anticipation of surgery, providing proof of concept for the value of point-of-care assessments of surgery-induced stresses and the differential effect of personality traits.

Achieving Status and Reducing Loneliness during the Transition to College: The Role of Entitlement, Intrasexual Competitiveness, and Dominance.

Although many emerging adults struggle to gain status and develop social relationships, particularly during the college transition, it remains unclear whether certain personality traits facilitate this transition. Using a longitudinal design, we investigated whether status-related traits-namely, entitlement, intrasexual competitiveness, and dominance-related to the development of status in 91 first-year college students (M age=18.15, SD=0.44) transitioning to a novel college environment. We also examined whether personality traits moderated the degree to which status related to loneliness. As hypothesized, only students high in intrasexual competitiveness experienced increases in subjective dorm status across the year. In addition, students exhibiting average or low entitlement experienced decreases in loneliness over time, whereas high entitlement was related to consistently low loneliness. Finally, higher subjective dorm status was related to lower loneliness only for less dominant students, as assessed by both self-ratings of trait dominance and raters' judgments of facial dominance from photographs. Using a real-world context of status development, these results suggest that personality traits may influence students' ability to experience higher status and modulate the relation between subjective status and loneliness.

Allostatic processes in the family.

The concepts of allostatic load and allostatic processes can help psychologists understand how health trajectories are influenced by stressful childhood experiences in the family. This paper describes psychological pathways and two key allostatic mediators, the hypothalamic-pituitary-adrenal axis and the immune system, through which stressful early rearing conditions may influence adult mental and physical health. The action of meshed gears is introduced as a metaphor to illustrate how responses occurring within a brief time frame, for example, immediate reactions to stressors, can influence developmental and health processes unfolding over much longer spans of time. We identify early-developing psychological and biological response patterns that could link chronic stressors in childhood to later health outcomes. Some of these "precursor outcomes" (e.g., heightened vigilance and preparedness for threats; enhanced inflammatory and humoral responses to infectious microorganisms) appear to be aimed at protection from immediate dangers; they may reflect "adaptive trade-offs" that balance short-term survival advantages under harsh rearing conditions against disadvantages manifested later in development. Our analysis also suggests mechanisms that underlie resilience in risky family environments.

Cues of Social Status: Associations Between Attractiveness, Dominance, and Status.

Hierarchies naturally emerge in social species, and judgments of status in these hierarchies have consequences for social relationships and health. Although judgments of social status are shaped by appearance, the physical cues that inform judgments of status remain unclear. The transition to college presents an opportunity to examine judgments of social status in a newly developing social hierarchy. We examined whether appearances-as measured by raters' judgments of photographs and videos-provide information about undergraduate students' social status at their university and in society in Study 1. Exploratory analyses investigated whether associations differed by participants' sex. Eighty-one first-year undergraduate students (Mage = 18.20, SD = 0.50; 64.2% female) provided photographs and videos and reported their social status relative to university peers and relative to other people in society. As hypothesized, when participants were judged to be more attractive and dominant they were also judged to have higher status. These associations were replicated in two additional samples of raters who evaluated smiling and neutral photographs from the Chicago Faces Database in Study 2. Multilevel models also revealed that college students with higher self-reported university social status were judged to have higher status, attractiveness, and dominance, although judgments were not related to self-reported society social status. Findings highlight that there is agreement between self-reports of university status and observer-perceptions of status based solely on photographs and videos, and suggest that appearance may shape newly developing social hierarchies, such as those that emerge during the transition to college.

Understanding trajectories of underlying dimensions of posttraumatic psychopathology.

BACKGROUND: Research suggests four modal trajectories of psychological symptoms after traumatic injury: Resilient, Chronic, Delayed Onset, Recovery. However, most studies focus on symptoms of psychiatric disorders (e.g., posttraumatic stress disorder, depression), which are limited by heterogeneity and symptom overlap. We examined trajectories of cross-cutting posttraumatic symptom dimensions following traumatic injury and predictors of trajectory membership. METHODS: In this longitudinal study of 427 predominantly Hispanic/Latino traumatic injury survivors, posttraumatic psychopathology symptoms were assessed during hospitalization and approximately one and five months post-trauma. Using latent class growth analysis, we estimated trajectories of several posttraumatic symptom dimensions: re-experiencing, avoidance, anxious arousal, numbing, dysphoric arousal, loss, and threat. We then examined sociodemographic and trauma-related characteristics (measured during hospitalization) as predictors of trajectory membership for each dimension. RESULTS: Four trajectories (Resilient, Chronic, Delayed Onset, Recovery) emerged for all dimensions except loss and threat, which manifested three trajectories (Resilient, Chronic, Delayed Onset). Across dimensions, membership in the Chronic (vs. Resilient) trajectory was consistently predicted by unemployment (7 of 7 dimensions), followed by older age (3/7), female sex (3/7), and assaultive trauma (2/7). For several dimensions, unemployment also distinguished between participants who presented with similar symptom levels days after trauma, but then diverged over time. LIMITATIONS: Measures of posttraumatic symptom dimension constructs differed across assessments. CONCLUSIONS: This study provides evidence of distinct trajectories across transdiagnostic symptom dimensions after traumatic injury. Employment status emerged as the most important predictor of trajectory membership. Research is needed to better understand the etiologies and consequences of these posttraumatic symptom dimension trajectories.

Generativity and Social Well-Being in Older Women: Expectations Regarding Aging Matter.

OBJECTIVES: Beliefs about aging can contribute to health and well-being in older adults. Feeling generative, or that one is caring for and contributing to the well-being of others, can also impact health and well-being. In this study, we hypothesized that those with more positive expectations regarding aging (ERA) in the mental health domain would report greater levels of perceived social support (PSS) and lower levels of loneliness in response to a generativity intervention (vs control condition). METHOD: Participants in this study (n = 73, 100% female) were randomly assigned to a 6-week generativity condition, which involved writing about life experiences and sharing advice with others, or to a control condition, which involved writing about neutral topics. Pre- and postintervention, PSS, and feelings of loneliness were measured. RESULTS: Those in the generativity condition with more positive ERA in the mental health domain reported greater PSS and lower loneliness postintervention. DISCUSSION: These results highlight the importance of psychological factors, such as ERA, in moderating the efficacy of interventions to promote social well-being in older adults.

Momentary work worries, marital disclosure, and salivary cortisol among parents of young children.

OBJECTIVE: To investigate whether worries about work are linked to people's own cortisol levels and their spouses' cortisol levels in everyday life and whether marital factors may moderate these links. Although research has shown that satisfying marriages can buffer the physiological effects of everyday stress, the specific mechanisms through which marriage influences the processing and transmission of stress have not yet been identified. METHODS: Thirty-seven healthy married couples completed baseline measures and then provided saliva samples and indicated their worries about work for six times a day from a Saturday morning through a Monday evening. RESULTS: Wives' cortisol levels were associated positively with their own work worries (p = .008) and with their husbands' work worries (p = .006). Husbands' cortisol levels were associated positively only with their own work worries (p = .015). Wives low in both marital satisfaction and disclosure showed a stronger association between work worries and cortisol compared with wives reporting either high marital satisfaction and/or high marital disclosure. CONCLUSIONS: These results suggest that momentary feelings of stress affect not only one's own cortisol levels but affect close others' cortisol levels as well. Furthermore, they suggest that, for women, the stress-buffering effects of a happy marriage may be partially explained by the extent to which they disclose their thoughts and feelings with their spouses.