Meta-analytical assessment of the effects of protocol variations on cortisol responses to the Trier Social Stress Test.

BACKGROUND: The Trier Social Stress Test (TSST) is one of the most widely used laboratory stress tests. Exposure to this psychosocial stressor has been shown to stimulate an acute cortisol stress response in the majority of healthy individuals, while deviations from the typical pattern, i.e., cortisol reactivity dysfunctions have been linked to an ever-increasing number of negative health outcomes. However, significant variability between labs exists in strength of observed cortisol responses in healthy individuals. This variability raises the question of how to distinguish across labs between cortisol stress response patterns that reflect health risk from those that are due to methodological differences. Thus, we propose a systematic review and meta-analysis that aims at quantifying the effects of methodological variation in study and TSST protocol elements on cortisol stress responses in healthy individuals. METHODS: Literature searches were conducted using standard databases for English language with key words including Trier Social Stress Test, TSST, Cortisol, and Laboratory Stressor among others. 186 studies met our inclusion criteria of healthy human participants without systemic immunological or endocrine dysfunction and provided sufficient information to compute a total of 237 sub-sample effect sizes. RESULTS AND DISCUSSION: With regard to study protocol variations that may risk confounding baseline cortisol values and thus influence subsequent reactivity measures, meta-analytical examination revealed that acclimation periods pre-TSST below 30 or perhaps even 15min may suffice, at least as long as no interfering activities, i.e., questionnaires, are taking place during that timeframe. Assessing the effects of TSST protocol variations on cortisol response strength, several observations are noteworthy. First, shortening speech preparation time did not change cortisol responses in any way, nor did including questionnaires during that period show an effect. As such, our findings suggest that speech preparation time is one TSST element that can be used to reduce the burden for participants as well as laboratory logistics. Secondly, having an all female panel and instructing panel members to show negative instead of neutral behavior towards the participants both were associated with considerably reduced cortisol stress response strengths. Thirdly, several variables of interest, such as content of the speech task or gender match between active panel member and participant, were problematic to evaluate due to the large number of studies not reporting those details. This calls for future studies to report more details regarding potentially relevant protocol specifications.

Leisure activities are linked to mental health benefits by providing time structure: comparing employed, unemployed and homemakers.

BACKGROUND: Unemployment has consistently been linked to negative mental health outcomes, emphasising the need to characterise the underlying mechanisms. The current study aimed at testing whether compared with other employment groups, fewer leisure activities observed in unemployment may contribute to elevated risk for negative mental health via loss of time structure. METHODS: Depressive symptoms (Center for Epidemiologic Studies Depression), leisure activities (exercise, self-focused, social), and time structure (Time Structure Questionnaire (TSQ)) were assessed cross-sectionally in 406 participants (unemployed=155, employed=140, homemakers=111) recruited through Amazon Mechanical Turk. RESULTS: Controlling for gender and age, structural equation modelling revealed time structure partially (employed, homemakers) and fully (unemployed) mediated the relationship between leisure activities and depressive symptoms. With the exception of differential effects for structured routines, all other TSQ factors (sense of purpose, present orientation, effective organisation and persistence) contributed significantly to all models. CONCLUSIONS: These findings support the idea that especially for the unemployed, leisure activities impose their mental health benefits through increasing individuals' perception of spending their time effectively. Social leisure activities that provide a sense of daily structure may thereby be a particularly promising low-cost intervention to improve mental health in this population.

Differential Links Between Leisure Activities and Depressive Symptoms in Unemployed Individuals.

OBJECTIVE: Unemployment has consistently been linked to an elevated risk for depression. Exercise, specifically leisure-based physical activities, has received increasing attention as alternative treatment options. However, because leisure activities are pursued during discretionary time, it is unclear if the mental health benefits of physical and leisure activities apply during times of unemployment as well. METHOD: Depressive symptoms and participation in recreational activities were assessed in 142 employed and 158 unemployed participants (age = 34 ± 11 years; male = 150). RESULTS: Independent of employment status, all recreational activities were inversely associated with depressive symptoms. However, social (employed: ηp (2) = .21; unemployed: ηp (2) = .11) and self-focused (employed: ηp (2) = .19; unemployed: ηp (2) = .10) recreational activities were more strongly related to depressive symptoms than exercise (employed: ηp (2) = .12; unemployed: ηp (2) > .05). CONCLUSION: These findings highlight the strong mental health associations of recreational activities and suggest that, particularly for unemployed individuals, promoting recreational activities, rather than exercise, may leverage the stronger negative relationship with risk of depression.