Reading: Crosswell & Lockwood, 2020 - Best practices for stress measurement

Question 1

What is the main idea of the text

Answer 1

 Stress despite being linked to impaired health is often excluded from health models, likely due to the difficulty in defining and measuring stress

Question 2

 A greater number or real or perceived stress is linked to

Answer 2

poorer mental and physical health and mortality. Research has evidenced the type of stressors that attribute this, the health outcomes they attribute to and the mechanistic pathway for this. Yet, stress is not included in health models

Question 3

• Stress

Answer 3

= an umbrella term representing experiences in which the environmental demands of a situation outweigh the individual’s perceived psychological and physiological ability to cope with it effectively.

Question 4

• Stressors

Answer 4

= stressful events aka discrete events that can be objectively rates as having the potential to alter or disrupt typical psychological functioning, (eg. Job loss etc)

Question 5

• Stress response

Answer 5

= the cognitive, emotional and biological reactions that these stressful events evoke

Question 6

• Stressor exposures can be measured by;

Answer 6

o Self-report measures/questionnaires (eg. Life event checklist)
o By an interviewer
o Or objectively by proximity to an event (eg. Near 9/11)
o Structured interview
 The LEDS (life events difficult schedule) by Brown and Harris, 1978 is a structured interview that’s the gold standard to assessing stressor exposure
* It is intensive in both data collection and data processing
* Requires a trained interviewer
 A subsequent computer-assisted version has been developed called the Stress and Adversity Inventory (STRAIN) by Slavich and Shields, 2018.
* Can be completed by the interviewer or participants themselves
* Is quicker than LEDS
 Both of these measures ask whether participants have experienced crtain events in their life and given follow up questions for additional context

Question 7

 The LEDS (life events difficult schedule) by Brown and Harris, 1978

Answer 7

is a structured interview that’s the gold standard to assessing stressor exposure
* It is intensive in both data collection and data processing
* Requires a trained interviewer

Question 8

Stress and Adversity Inventory (STRAIN) by Slavich and Shields, 2018.

Answer 8

Produced as a subsequent computer-assisted version of LEDS
* Can be completed by the interviewer or participants themselves
* Is quicker than LEDS

Question 9

What do both LEDS and STRAIN assess

Answer 9

 Both of these measures ask whether participants have experienced crtain events in their life and given follow up questions for additional context

Question 10

• Individual Differences in Stress response to a Stressor

Answer 10

o Evidence shows that caring for a family member/friend eg. An Alzheimers patient is a chronic ongoing stressor and has been linked to worse mental and physical health compared to age-matched non-caregivers. But not every caregiver experiences these harms – maybe due to their subjective response to caregiving

Question 11

 Stress responses can be

Answer 11

emotional, cognitive, behavioural of physiological instigated by stressful stimuli

Question 12

Perceived Stress Scale

Answer 12

• A 10 item self-report measure to capture an individual’s perception of how overwhelmed they are by their current life circumstances

Question 13

o Behavioural Coding as a stress measure

Answer 13

Looks at facial reactions, body language etc

Question 14

o Trier Social Stress Test (TSST)

Answer 14

 Standard lab test
 Participants are given a speech task and perform mental arithmetic in front of judges
 This reliably evokes an acute stress response for the majority of participants

Question 15

o Selecting stress measures

Answer 15

 Common types of psychological stress measured using self-report questionnaire in adult samples are ;
* Major life events
* Traumatic events
* Early life stress exposure
* Current chronic or perceived stress in various domains
 The choice of which type of stressor exposure to measure depends on the most relevant stressor to measure for the study population, the specific research question and the hypothesised mechanisms linking that stress type to the outcome of interest

Question 16

o Timescale of the Stressor
 Generally take place in the following time scale

Answer 16

• Chronic
• Life events
• Daily events/hassles
• Acute stress
   Naturalistic stresses tend not to fall discretely into one category

Question 17

o Types of stress response

Answer 17

 Responses to stress can occur before during or after the exposure
 Behavioural responses include
* Coping – eg. Smoking, seeking social support
 Cognitive responses – eg. Appraisals of the exposure as a threat versus challenge and perseverative cognitions
 Physiological responses include
* Immune
* Autonomic
* Neuroendocrine
* Neural changes

Question 18

o Measurement assessment window

Answer 18

 The latency between stressor exposure and measurement is crucial, as retrospective autobiographical reports are prone to bias and error, especially when there have been years or decades since the exposure in question.
 In addition to latency, present mental stage and emotional salience of a memory can influence a retrospective report.
 Therefore it can be better to reduce latency eg. In acute stressor experimental studies where latency is controlled for

Question 19

 Evidence for linking stress to physical health

Answer 19

o Acute stress reactivity and early life stress, work or occupational stress and social isolation or longlines are most consistently linked to disease and mortality
o Cardiovascular disease is the leading cause of death in developed countries and is linked to stress.
o Heightened cardiovascular reactivity and delayed recovery to acute stressors are prospectively associated with increased cardiovascular disease risk
 Eg.
o Cortical and inflammatory responses to acute stressors have also been shown to prospectively predict incident hypertension
 Heightened reaction s and prolonged recovery may be associated to perseverative cognitions before (worrying) and after (rumination) stressor exposure
o Additionally a hyporeactive response to stress is linked to worse health – decreased cardiovascular and/or cortisol response is associated with obesity, risk of obesity, depression, anxiety etc and poor self-rates and functional health

Question 20

 Research on early life stress and physical health

Answer 20

o There’s strong evidence linking adult disease risk and mortality to exposure to early life stress
 The Adverse Childhood Experiences (ACE) study looked at this by examining 10k adults who had more ACE than average. This was positively associated with ischemic heart disease, cancer, chronic lung disease, skeletal fractures and liver disease etc
 ACE was associated with 3x the likelihood of heart disease

Question 21

 Job Stress

Answer 21

o Epidemiological studies show a link to high work stress and worse physical and mental health
 Job strain is a well studies model where there is high demands in terms of workload and intensity and little control.
 High job strain is linked to anxiety, depression, high blood pressure, cardiovascular events and metabolic syndrome and event coronary heart disease risk

Question 22

 Isolation and loneliness

Answer 22

o Being socially isolated links to an average of 26-32% increase in mortality
o This risk is comparable to smoking and having a high blood pressure
o Suggesting a meaningful connection with others is important for health and well=being

Question 23

 Biological pathways for stress to disease

Answer 23

o There are numerous plausible pathways linking stress to cardiovascular disease
o The most current evidence suggests stress-related alterations in the immune, autonomic and neuroendocrine systems.
o A widely accepted stress-disease model is the “wear and tear” hypothesis. In this, prolonged or repeated stress prematurely depletes the finite amount of adaptational energy of the organism, decreasing the bodies ability to successfully adapt to the environmental challenges. Therefore, repeated or prolonged exposure to stressful events wears out the stress responses system causing maladaptive patterns to occur.
o Another model suggests stress-related changes in endothelial function, elevated chronic inflammation, metabolic dysfunction, changes in DNA repair, gene expression, telomere shortening

Question 24

 Inflammatory Responses

Answer 24

o Systemic inflammation is linked to cardiovascular disease, cancer and chronic lower respiratory disease.
o A short term inflammatory response is thought to be adaptative as it recruits immune cells to the site of real or potential injury to heal wounds from stressor exposure
o But when there is no wound to heal, these inflammatory responses can cause long-term damage and contribute to disease processes

Question 25

 Objective Stress Measures ?

Answer 25

o There aren’t any specific stress bio-markers
 As raised heart rate, cortisol secretion etc can be caused by more than just stress

 Biomarkers can be a mediator, predictor or outcome of psychological and physiological responses to a traumatic stressor. The characterisation depends on the design of the study, the research design and outcome of interest
 Biomarkers should not replace self-report, behavoiural and cognitive outcomes as primary outcomes in psycho

Question 26

Cumulative life stress

Answer 26

= aggregate number of stressor exposures and/or intensity of stress responses over one’s life course).

Question 27

 Variability in Stress Exposures and Responses

Answer 27

o Despite stress exposure being inevitable not everyone develops stress-related illness
 This may be due to stress exposures not being distributed evenly across social groups
* Eg. Women, youth, members of racial minority groups, divorcees, poor and working class individuals report higher chornic stress and cumulative stress etc
 Inter-individual differences in stress responses
* These differences are influenced by socioeconomics, cultural factors, genetics and developmental factors, historical and current stressors, stable protective factors and health behaviours