Immigration stress and maternal sensitivity in a Mexican immigrant sample: The role of parasympathetic activity and familism value.

OBJECTIVES: The present study examined whether immigration stress was related to decreased capacities for psychophysiological stress regulation (as indexed by respiratory sinus arrhythmia [RSA]) and whether lower RSA, in turn, was related to decreased maternal sensitivity. The buffering effect of familism values was also evaluated, such that familism values were expected to minimize associations between immigration stress, RSA, and sensitivity. METHOD: Data were drawn from a longitudinal study of Mexican immigrant mothers (N = 277; Mage = 28 years). Mothers self-reported immigration stress and familism values, and mothers' resting RSA and sensitivity were assessed during laboratory visits. RESULTS: Higher immigration stress was associated with higher RSA (B = .15, SE = .07, p = .04) but was unrelated to maternal sensitivity. Moreover, links between more immigration stress and higher RSA were more pronounced among mothers who reported stronger familism values (B = .20, SE = .07, p = .003). CONCLUSIONS: The present study contributes to our understanding of the sequelae of immigration stress in Mexican immigrant mothers and the cultural resiliency factors that may alter its effects. In contrast to hypotheses, findings suggested that mothers who endorse more immigration stress may also exhibit higher RSA, and links may be more pronounced among those with strong familism values. Further research is needed to advance understanding of resiliency processes that promote family functioning in vulnerable populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Intergenerational Consequences of Maternal Childhood Maltreatment on Infant Health Concerns.

INTRODUCTION: Childhood maltreatment is a well-established risk factor for health problems in adulthood and may also have intergenerational consequences for infant health. Childhood maltreatment may confer risk for infant health by undermining caregiver capacities for sensitive and responsive caregiving. However, associations among childhood maltreatment, maternal sensitivity, and infant health are not well understood. These processes may be of particular importance among low-income and ethnic minority populations for whom disparities in maltreatment exposure and poorer health outcomes are well-established. METHOD: The current study drew data from a sample of low-income, Mexican American families to examine whether maternal childhood maltreatment would be associated with more infant health concerns, and whether lower maternal sensitivity would explain their associations. Data were collected from 322 mother-infant dyads during home visits completed during pregnancy and when infants were 12, 18, and 24 weeks old. RESULTS: Maternal childhood maltreatment exposure and lower maternal sensitivity were both associated with more infant health concerns. Maternal childhood maltreatment was not associated with maternal sensitivity. DISCUSSION: These findings highlight potential intergenerational consequences of maternal childhood maltreatment for infant health and underscore a need for evaluating pre- and postnatal mechanisms through which these effects may be perpetuated. Furthermore, results indicate that maternal sensitivity may represent a promising target for interventions seeking to counteract intergenerational transmission processes. Clarification about underlying risk processes and potentiating resiliency characteristics may elucidate ways to better support mothers and infants across the lifespan.

Childhood maltreatment is associated with a variety of health outcomes across an individual's lifespan and may have intergenerational consequences as well. The present study is among the first to investigate maternal co-regulatory behaviors (i.e., sensitivity) as a potential mechanism through which maternal exposure to childhood maltreatment may influence infant health concerns. Results suggest that both maternal childhood maltreatment history and sensitivity may shape infant outcomes before 24 weeks of age. Increasing understanding of the mechanisms through which maternal childhood maltreatment may exert cascades of influence on infant health may help to inform the development of early intervention services.

Youth Temperament Moderates Associations Between Parental Involvement and Pediatric Type 1 Diabetes Treatment Outcome.

OBJECTIVE: Both youth self-regulation and quality of parental involvement have been associated with blood glucose levels (HbA1c) of youth with type 1 diabetes mellitus (T1DM). However, it is unclear whether and how youth and parental factors interact in their relation to youth HbA1c. The differential susceptibility hypothesis proposes that youth with high negative affectivity (NA) and low effortful control (EC) may be more susceptible to the deleterious impact of lower quality parenting behaviors but also reap greater benefit from higher quality parenting behaviors. This study investigated whether youth temperament would moderate the link between diabetes-specific parental assistance (e.g., checking blood sugar) or support (e.g., encouraging, praising) and HbA1c among youth with T1DM. METHODS: Primary caregivers of youth with T1DM (N = 101; M age = 12.02, SD = 2.43) completed surveys on diabetes-specific parental involvement and youth temperament. Medical information (i.e., HbA1c) was obtained from chart review. RESULTS: Multiple regression analyses indicated that youth NA and EC significantly interacted with parental assistance, but not support. Specifically, higher parental assistance was associated with higher HbA1c among youth with high NA or high EC. High assistance was only linked to lower HbA1c for youth with low NA. CONCLUSIONS: Results suggest that optimal levels of parental involvement related to better T1DM outcomes depend on youth's NA or EC. Consistent with the goodness-of-fit framework, when parenting approaches match youth's temperament, youth with T1DM may be better able to maintain lower HbA1c. Family interventions for pediatric T1DM management may take into consideration youth temperament.

Discrimination and depressive symptoms among Black and Asian American college students: Shared and group-specific processes of self-concept.

OBJECTIVES: Black and Asian American emerging adults are at higher risk of experiencing racial/ethnic discrimination and related distress. Racial/ethnic discrimination may increase vulnerability for depressive symptoms by diminishing individuals' positive self-concept. While low global self-esteem has been noted as a crucial process linking discrimination and depressive symptoms, it is unclear if it plays a unique role beyond other relevant aspects of one's self-concept: racial/ethnic private regard and centrality. Moreover, although different racial/ethnic groups are known to experience discrimination in distinctive ways, little is known about how relative processes of self-esteem and racial/ethnic identity may differ across these groups. We investigated the generalizability and specificity of discrimination to distress linkages across Asian and Black Americans. METHOD: Undergraduate Black (N = 109) and Asian American (N = 90) students self-reported racial/ethnic discrimination, depressive symptoms, and self-concept. RESULTS: Global self-esteem indirectly linked the association between discrimination and depressive symptoms among Black Americans beyond the effects of racial/ethnic identity. Only among Black Americans, discrimination was associated with lower private regard. CONCLUSIONS: Finding highlight group-specific processes underlying Black and Asian Americans' experiences of discrimination and depressive symptoms. Findings also demonstrate shared processes of discrimination-depressive symptoms linkage across groups and underscore the need to address the pervasive issues of racism and discrimination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The psychophysiological salience of past experiences of discrimination.

OBJECTIVES: This study sought to test whether a discrimination recall task would elicit a significant parasympathetic response in multiracial undergraduate women. The study also investigated whether parasympathetic responsivity to the discrimination recall would be similar or different from that elicited by a widely used stress paradigm-the Trier Social Stress Test (TSST), and whether responses would differ for Black and White women. METHOD: Multiracial undergraduate women (n = 67; Mage = 19.4 years; 32% White, 22% Black) completed the TSST and a discrimination recall task. Parasympathetic activity was assessed using high-frequency heart rate variability (HF-HRV). RESULTS: Women exhibited significant HF-HRV responsivity to the discrimination recall and showed smaller average decreases in HF-HRV to the discrimination recall than the TSST. However, whereas White women exhibited decreased HF-HRV in response to both tasks, Black women showed increased HF-HRV for the discrimination recall but decreased HF-HRV for the TSST. CONCLUSIONS: Findings complement a growing body of research suggestive that experiences of discrimination are psychophysiologically salient. Additionally, discriminatory experiences may elicit distinctive patterns of HF-HRV responsivity compared to generic social stressors. Efforts to elucidate the unique role of discrimination-specific HF-HRV responsivity may be critical for delineating discrimination-health linkages. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Infant Temperament Profiles, Cultural Orientation, and Toddler Behavioral and Physiological Regulation in Mexican-American Families.

This study sought to (a) replicate infant temperament profiles from predominantly White samples in a sample of low-income, predominantly first-generation Mexican-American families, (b) investigate associations between infant temperament profiles and toddler behavioral and physiological regulation, and (c) explore whether mothers' cultural orientation would moderate those associations. Mothers and infants (n = 322; 46% male) were assessed during pregnancy and at infant ages 9, 12, and 24 months. Latent profile analysis yielded three temperament profiles that were consistent with those from extant research. Compared to the high positive affect, well-regulated profile, the negative reactive, low regulated profile was associated with poorer behavioral and parasympathetic (i.e., respiratory sinus arrhythmia) regulation, but associations depended on mothers' Mexican and Anglo cultural orientation.

Effects of maternal and paternal postnatal depressive symptoms on infants' parasympathetic regulation in low-income, Mexican American families.

Mothers and fathers are at elevated risk for developing depression during the first postnatal year, especially among families from marginalized communities. Although a number of studies demonstrate that exposure to maternal depressive symptoms can undermine infants' regulatory development, less is known about the extent to which paternal depressive symptoms may also contribute. The current study investigated whether maternal and paternal depressive symptoms were uniquely associated with infants' physiological regulation, and whether associations varied depending on infant sex. Participants included 90 low-income Mexican American families. Fathers and mothers self-reported their depressive symptoms when infants were 15 weeks old, and infants' resting parasympathetic activity (i.e., respiratory sinus arrhythmia [RSA]) was assessed at 6 and 24 weeks. Results indicated that, after controlling for infant 6-week RSA and depressive symptoms in the other parent, paternal depressive symptoms were associated with lower 24-week RSA for both girls and boys, but maternal depressive symptoms were only associated with lower 24-week RSA for boys. Findings highlight a potential mechanism through which the consequences of parent depressive symptoms may reverberate across generations, and suggest that considerations of both infants' and parents' sex may lend insight into how best to intervene.

Profiles of autonomic stress responsivity in a sample of justice-involved youth: Associations with childhood trauma exposure and emotional and behavioral functioning.

A limited number of studies have begun to investigate how the coordinated actions of distinct physiological systems may be related to the development of psychopathology. However, the form taken by these patterns of coordination as well as their antecedents and developmental implications remain to be clarified. The Adaptive Calibration Model (ACM) proposes four prototypical patterns of physiological stress responsivity and corresponding behavioral patterns, which are further tied to varying levels of childhood adversity. The current study is among the first to investigate whether patterns of sympathetic and parasympathetic stress responsivity predicted by the ACM generalize to a sample of justice-involved youth with disproportionately high rates of childhood trauma exposure. Psychophysiological and self-report data were collected from 822 justice-involved youth (182 girls) ages 12-19 years. Latent profile analyses yielded five profiles of physiological responsivity that largely corresponded to the patterns proposed by the ACM. Further, these profiles demonstrated predicted associations with self-reported emotionality and adjustment. Trauma exposure was associated with a lower likelihood of membership in one of the profiles showing blunted physiological responsivity. Our discussion highlights ways in which insights from the ACM may inform understanding about linkages between physiology and adjustment.

Influences of adversity across the lifespan on respiratory sinus arrhythmia during pregnancy.

There is limited understanding of factors across the lifespan that influence pregnant women's respiratory sinus arrhythmia (RSA), which could have implications for their health and offspring development. We examined associations among 162 English- and Spanish-speaking pregnant women's childhood maltreatment history, emotion dysregulation, recent life stress, and resting RSA during the third trimester. Moderated mediation analyses indicated that more severe childhood maltreatment history (95% confidence interval (CI) [0.26, 0.63]) and higher emotion dysregulation (95% CI [0.001, 0.006]) predicted more stress during pregnancy, and childhood maltreatment history interacted with emotion dysregulation to predict resting RSA (95% CI [-0.04, -0.0003]). Exploratory analyses revealed that women's health-related stress during pregnancy mediated the relation between emotion dysregulation and RSA regardless of childhood maltreatment severity (95% CI [-0.007, -0.002]). These findings suggest that women's resting RSA during pregnancy may reflect physical and emotional stress accumulation across the lifespan and that relations between early life adversity and prenatal psychophysiology may be buffered by protective factors, such as emotion regulation. In addition, these findings underscore the importance of distinguishing between types of prenatal stress. Given the implications for women's health and offspring development, we urge researchers to continue exploring factors associated with pregnant women's psychophysiology.

Intergenerational transmission of emotion dysregulation: Part I. Psychopathology, self-injury, and parasympathetic responsivity among pregnant women.

The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation-a multilevel, transdiagnostic risk factor for psychopathology-and its associations with stress, distress, and SITBs in a sample of pregnant women (26-40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.

Testing the programming of temperament and psychopathology in two independent samples of children with prenatal substance exposure.

Prenatal programming models have rarely been applied to research on children with prenatal substance exposure, despite evidence suggesting that prenatal drug exposure is a form of stress that impacts neurodevelopmental outcomes and risk for psychopathology. Utilizing data from two longitudinal multisite studies comprising children prenatally exposed to substances as well as a nonexposed comparison group (Maternal Lifestyle Study, n = 1,388; Infant Development, Environment, and Lifestyle study, n = 412), we tested whether early phenotypic indicators of hypothesized programming effects, indexed by growth parameters at birth and infant temperament, served as a link between prenatal substance exposure and internalizing and externalizing behavior at age 5. Latent profile analysis indicated that individual differences in reactivity and regulation for infants prenatally exposed to substances was best characterized by four temperament profiles. These profiles were virtually identical across two independent samples, and demonstrated unique associations with adjustment difficulties nearly 5 years later. Results of path analysis using structural equation modeling also showed that increased prenatal substance exposure was linked to poorer growth parameters at birth, profiles of temperamental reactivity in infancy, and internalizing and externalizing behavior at age 5. This pathway was partially replicated across samples. This study was among the first to link known individual-level correlates of prenatal substance exposure into a specific pathway to childhood problem behavior. Implications for the developmental origins of a child's susceptibility to psychopathology as a result of intrauterine substance exposure are discussed.

The Birth and Beyond (BABY) study: protocol for a birth cohort study investigating the social and environmental determinants of pregnancy-related outcomes in Black American families.

INTRODUCTION: In the USA, Black birthing people and infants experience disproportionately worse pregnancy-related health outcomes. The causes for these disparities are unknown, but evidence suggests that they are likely socially and environmentally based. Efforts to identify the determinants of these racial disparities are urgently needed to elucidate the highest priority targets for intervention. The Birth and Beyond (BABY) study evaluates how micro-level (eg, interpersonal and family) and macro-level (eg, neighbourhood and environmental) risk and resiliency factors transact to shape birth person-infant health, and underlying psychobiological mechanisms. METHODS AND ANALYSIS: The BABY study will follow 350 Black families (birthing parents, non-birthing parents and infants) from pregnancy through the first postpartum year, with research visits during pregnancy and at infant ages 6 and 12 months. Research visits comprise a combination of interview about a range of recent and life course stress and resiliency exposures and supports, psychophysiological (sympathetic, parasympathetic and adrenocortical) assessment and behavioural observations of parent-infant coregulatory behaviours. Spatial analyses are completed by mapping parent current and past residential addresses onto archival public data (eg, about neighbourhood quality and racial segregation). Finally, EMRs are abstracted for information about birthing parent relevant medical history, pregnancy conditions and infant birth outcomes. Analyses will evaluate the risk and resiliency mechanisms that contribute to pregnancy and birth-related outcomes for Black birthing people and their infants, and the protective role of individual, familial, cultural, and community supports. ETHICS AND DISSEMINATION: The BABY study has been approved by the Institutional Review Board at Albany Medical Centre. The study team consulted with local organisations and groups comprised of stakeholders and community leaders and continues to do so throughout the study. Research results will be disseminated with the scientific and local community as appropriate.

Racial differences in sympathetic nervous system indicators: Implications and challenges for research.

Growing evidence indicates the presence of racial differences in sympathetic nervous system (SNS) functioning, yet the nature of these differences is unclear and appears to vary across different indices of SNS activity. Moreover, racial differences among commonly used indices of SNS activity are under-investigated. This systematic review examines racial differences among widely used resting SNS indices, such as electrodermal activity (EDA), pre-ejection period (PEP), and salivary alpha-amylase (sAA). Our review reveals that Black participants have consistently been found to display lower resting EDA compared to White participants. The few studies that have investigated or reported racial differences in PEP and sAA yield mixed findings about whether racial differences exist. We discuss potential reasons for racial differences in SNS activity, such as index-specific factors, lab confounds, psychosocial environmental factors, and their interactions. We outline a framework characterizing possible contributors to racial differences in SNS functioning. Lastly, we highlight the implications of several definitional, analytic, and interpretive issues concerning the treatment of group differences in psychophysiological activity and provide future recommendations.

Social Drivers of Mental Health: A U.S. Study Using Machine Learning.

INTRODUCTION: Social drivers of mental health can be compared on an aggregated level. This study employed a machine learning approach to identify and rank social drivers of mental health across census tracts in the U.S. METHODS: Data for 38,379 census tracts in the U.S. were collected from multiple sources in 2021. Two measures of mental health problems-self-reported depression and self-assessed poor mental health-among adults and three domains of social drivers (behavioral, environmental, and social) were analyzed on the basis of the unit of census tracts using the Extreme Gradient Boosting machine learning approach in 2022. The leading social drivers were found in each domain in the main sample and in the subsamples divided on the basis of poverty and racial segregation. RESULTS: The three domains combined explained more than 90% of the variance of both mental illness indicators. Self-reported depression and self-assessed poor mental health differed in major social drivers. The two outcome indicators had one overlapping correlate from the behavioral domain: smoking. Other than smoking, climate zone and racial composition were the leading correlates from the environmental and social domains, respectively. Census tract characteristics moderated the impacts of social drivers on mental health problems; the major social drivers differed by census tract poverty and racial segregation. CONCLUSIONS: Population mental health is highly contextualized. Better interventions can be developed on the basis of census tract-level analyses of social drivers that characterize the upstream causes of mental health problems.

Glutathione S-transferase Pi expression predicts response to adjuvant chemotherapy for stage C colon cancer: a matched historical control study.

BACKGROUND: This study examined the association between overall survival and Glutathione S-transferase Pi (GST Pi) expression and genetic polymorphism in stage C colon cancer patients after resection alone versus resection plus 5-fluourouracil-based adjuvant chemotherapy. METHODS: Patients were drawn from a hospital registry of colorectal cancer resections. Those receiving chemotherapy after it was introduced in 1992 were compared with an age and sex matched control group from the preceding period. GST Pi expression was assessed by immunohistochemistry. Overall survival was analysed by the Kaplan-Meier method and Cox regression. RESULTS: From an initial 104 patients treated with chemotherapy and 104 matched controls, 26 were excluded because of non-informative immunohistochemistry, leaving 95 in the treated group and 87 controls. Survival did not differ significantly among patients with low GST Pi who did or did not receive chemotherapy and those with high GST Pi who received chemotherapy (lowest pair-wise p = 0.11) whereas patients with high GST Pi who did not receive chemotherapy experienced markedly poorer survival than any of the other three groups (all pair-wise p <0.01). This result was unaffected by GST Pi genotype. CONCLUSION: Stage C colon cancer patients with low GST Pi did not benefit from 5-fluourouracil-based adjuvant chemotherapy whereas those with high GST Pi did.

Developmental Origins of Pregnancy-Related Morbidity and Mortality in Black U.S. Women.

In the US, Black women are at disproportionate risk for pregnancy-related morbidity and mortality (PRMM). Disparities in PRMM have been tied to elevated rates of obstetric cardiometabolic complications for Black women. Research seeking to elucidate the determinants of Black PRMM to date have focused predominantly on risk factors occurring during pregnancy (e.g., health risk behaviors, quantity and quality of prenatal care, provider behaviors, and attitudes). Meanwhile, other research investigating the developmental origins of health and disease (DOHaD) model indicates that the origins of adult cardiometabolic health can be traced back to stress exposures occurring during the intrauterine and early life periods. Despite the relevancy of this work to Black PRMM, the DOHaD model has never been applied to investigate the determinants of Black PRMM. We argue that the DOHaD model represents a compelling theoretical framework from which to conceptualize factors that drive racial disparities PRMM. Research and intervention working from a developmental origins orientation may help address this urgent public health crisis of Black PRMM.

Maternal depression and adverse neighbourhood conditions during pregnancy are associated with gestational epigenetic age deceleration.

Gestational epigenetic age (GEA) acceleration and deceleration can indicate developmental risk and may help elucidate how prenatal exposures lead to offspring outcomes. Depression and neighbourhood conditions during pregnancy are well-established determinants of birth and child outcomes. Emerging research suggests that maternal depression may contribute to GEA deceleration. It is unknown whether prenatal neighbourhood adversity would likewise influence GEA deceleration. This study examined whether maternal depression and neighbourhood conditions independently or jointly contributed to GEA deceleration, and which social and environmental neighbourhood conditions were associated with GEA. Participants were from the Albany Infant and Mother Study (n = 204), a prospective non-probability sampled cohort of higher risk racial/ethnic diverse mother/infant dyads. GEA was estimated from cord blood. Depressive symptoms and census-tract level neighbourhood conditions were assessed during pregnancy. Maternal depression (ß = -0.03, SE = 0.01, p = 0.008) and neighbourhood adversity (ß = -0.32, SE = 0.14, p = 0.02) were independently associated with GEA deceleration, controlling for all covariates including antidepressant use and cell type proportions. Neighbourhood adversity did not modify the association of maternal depression and GEA (ß = 0.003, SE = 0.03, p = 0.92). igher levels of neighbourhood poverty, public assistance, and lack of healthy food access were each associated with GEA deceleration; higher elementary school test scores (an indicator of community tax base) were associated with GEA acceleration (all p < 0.001). The results of this study indicated that maternal depression and neighbourhood conditions were independently and cumulatively associated GEA in this diverse population.

Differential Contributions of Parental Warmth and Mindfulness to Child Executive Function and Pediatric Type 1 Diabetes Management.

OBJECTIVE: Positive parenting (e.g., parental warmth, mindful parenting) has been posited to promote effective pediatric type 1 diabetes mellitus (T1DM) management. This promotive effect may partly be conferred by fostering child self-regulatory development, such as executive function (EF). However, no research has examined whether better child EF serves as a mechanism underlying associations between positive parenting and child blood glucose levels (HbA1c). Moreover, it is unclear whether mindful parenting offers a unique benefit beyond that of parental warmth-a key pillar of effective parental involvement in T1DM management. METHODS: Primary caregivers of children with T1DM (N = 101; Mage = 12.02) reported on parenting behaviors and child EF. Children's medical information was obtained through chart review. Path analysis was used to examine direct and indirect relations in the cross-sectional data. RESULTS: The path analysis indicated that only parental warmth, not mindful parenting, was significantly associated with lower HbA1c. Both parental warmth and mindful parenting were significantly related to better child EF, but child EF did not mediate the associations between parenting and HbA1c. CONCLUSION: Parental warmth may constitute a key parenting behavior promoting effective pediatric T1DM management. Enhancing parental warmth may be an important target of interventions aiming to improve HbA1c. Although child EF was unrelated to HbA1c in this sample, given positive associations between parental warmth and mindfulness and child EF, longitudinal research is warranted to examine whether these positive parenting behaviors may confer long-term benefits for T1DM self-management through improved EF.

Clinicopathological correlates and prognostic significance of glutathione S-transferase Pi expression in 468 patients after potentially curative resection of node-positive colonic cancer.

AIMS: This study investigated the association between glutathione S-transferase Pi (GST Pi) expression, histopathology and overall survival in 468 patients after resection of stage C colonic adenocarcinoma. METHODS AND RESULTS: Data were drawn from a prospective hospital registry of consecutive bowel cancer resections with a minimum follow-up of 5 years. Nuclear and cytoplasmic GST Pi expression, assessed by both intensity of staining and percentage of stained cells at both the central part of the tumour and the invasive tumour front, were evaluated retrospectively by tissue microarray immunohistochemistry on archival specimens. The most effective measure of GST Pi expression was the percentage of immunostained nuclei in central tumour tissue, where >40% stained was associated significantly with high grade, invasion beyond the muscularis propria, involvement of a free serosal surface or apical node, and invasion into an adjacent organ or structure. After adjustment of other predictors, GST Pi expression remained independently prognostic for reduced overall survival (hazard ratio 1.4, P = 0.002). CONCLUSIONS: In patients with clinicopathological stage C colonic cancer, GST Pi expression is associated with features of tumour aggressiveness and with reduced overall survival. Further appropriately designed studies should aim to discover whether GST Pi can predict response to adjuvant chemotherapy.