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Stenfors C.U.D.,Karolinska Institutet | Stenfors C.U.D.,University of Chicago | Jonsdottir I.H.,The Institute of Stress Medicine | Magnusson Hanson L.L.,University of Stockholm | And 2 more authors.
Journal of Psychosomatic Research | Year: 2017

Background The knowledge is limited regarding the relation between systemic inflammatory biomarkers and subjective and objective cognitive functioning in population-based samples of healthy adults across the adult age-span. Thus, the aim of this study was to study a selection of four pro-inflammatory biomarkers (IL-6, MCP-1, TNF-α, CRP) in relation to executive cognitive functioning, episodic memory and subjective cognitive complaints (SCC) in a population-based sample of 215 working adults (age 25–67). Results Higher levels of MCP-1 were associated with poorer executive cognitive functioning, even after adjustments for demographical factors, health status/conditions, SCC and depressive symptoms. IL-6 and CRP were associated with poorer executive cognitive functioning, but these associations covaried with age especially and were not present after adjustment for demographical factors. MCP-1 was associated with poorer episodic memory, but this association also covaried with age especially and was not present after adjustment for demographical factors, and CRP was associated with episodic memory only among participants without reported health conditions. Higher MCP-1 levels were also associated with more SCC and this association covaried with depressive symptoms, while higher levels of TNF-α were associated with less SCC. Conclusion Low grade inflammatory processes in terms of higher systemic levels of pro-inflammatory biomarkers (MCP-1, IL-6 & CRP) were associated with poorer executive functioning in this sample of working adults, and MCP-1 was so after extensive adjustments. Support for associations between these biomarkers and episodic memory and SCC were more limited. Future research should address the causality of associations between low grade inflammatory processes and cognitive functioning. © 2017


Grimby G.,Gothenburg University | Borjesson M.,The Swedish School of Sport and Health Sciences | Jonsdottir I.H.,The Institute of Stress Medicine | Schnohr P.,The Copenhagen City Heart Study | And 3 more authors.
Scandinavian Journal of Medicine and Science in Sports | Year: 2015

The use of a four-level questionnaire to assess leisure time physical activity (PA) and its validation is reviewed in this paper. This questionnaire was first published in 1968 and has then been used by more than 600 000 subjects, especially in different population studies in the Nordic countries. A number of modifications to the questionnaire have been published. These are mostly minor changes, such as adding practical examples of activities to illustrate the levels of PA. Some authors have also added duration requirements that were not included for all levels of PA in the original version. The concurrent validity, with respect to aerobic capacity and movement analysis using objective measurements has been shown to be good, as has the predictive validity with respect to various risk factors for health conditions and for morbidity and mortality. © 2015 John Wiley & Sons A/S.


Lennartsson A.-K.,The Institute of Stress Medicine | Lennartsson A.-K.,Gothenburg University | Theorell T.,University of Stockholm | Kushnir M.M.,Uppsala University | And 6 more authors.
Psychoneuroendocrinology | Year: 2013

Background: Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) have been suggested to play a protective role during acute psychosocial stress, because they act as antagonists to the effects of the stress hormone cortisol. This study aims to investigate whether prolonged psychosocial stress, measured as perceived stress at work during the past week, is related to the capacity to produce DHEA and DHEA-S during acute psychosocial stress. It also aims to investigate whether prolonged perceived stress affects the balance between production of cortisol and DHEA-S during acute psychosocial stress. Method: Thirty-six healthy subjects (19 men and 17 women, mean age 37 years, SD 5 years), were included. Perceived stress at work during the past week was measured by using the Stress-Energy (SE) Questionnaire. The participants were divided into three groups based on their mean scores; Low stress, Medium stress and High stress. The participants underwent the Trier Social Stress Test (TSST) and blood samples were collected before, directly after the stress test, and after 30. min of recovery. General Linear Models were used to investigate if the Medium stress group and the High stress group differ regarding stress response compared to the Low stress group. Results: Higher perceived stress at work was associated with attenuated DHEA-S response during acute psychosocial stress. Furthermore, the ratio between the cortisol production and the DHEA-S production during the acute stress test were higher in individuals reporting higher perceived stress at work compared to individuals reporting low perceived stress at work. There was no statistical difference in DHEA response between the groups. Conclusions: This study shows that prolonged stress, measured as perceived stress at work during the past week, seems to negatively affect the capacity to produce DHEA-S during acute stress. Given the protective functions of DHEA-S, attenuated DHEA-S production during acute stress may lead to higher risk for adverse effects on psychological and physiological health, particularly if stress exposure continues. © 2013 Elsevier Ltd.


Lennartsson A.-K.,The Institute of Stress Medicine | Sjors A.,The Institute of Stress Medicine | Jonsdottir I.H.,The Institute of Stress Medicine
Journal of Psychosomatic Research | Year: 2015

Dehydroepiandrosterone sulphate (DHEA-s) is an anabolic protective hormone. We have previously reported that DHEA-s production capacity is attenuated in stressed individuals. The aim of the present study was to investigate the DHEA-s response during acute psychosocial stress in patients with clinical burnout. Methods: Seventeen patients with clinical burnout were compared to 13 non-chronically stressed healthy controls, aged 31-50years (mean age 41years, SD 6years), as they underwent the Trier Social Stress Test (TSST). All patients fulfilled diagnostic criteria for stress-related exhaustion disorder, which is a criteria-based diagnosis that has been used in Sweden since 2005 to define patients seeking health-care for clinical burnout. Blood samples were collected before, directly after the stress test, and after 30min of recovery. DHEA-s levels were measured and delta values (peak levels minus baseline levels) plus area under the curve with respect to increase (AUCI) were calculated. Results: The patients had 43% smaller AUCI DHEA-s (p=0.041) during the stress test. The delta DHEA-s was 34% lower in the patients, however, this difference was not statistically significant (p=0.054). Conclusion: The study indicates that DHEA-s production capacity during acute stress may be attenuated in patients with clinical burnout. Reduced DHEA-s production may constitute one of the links between stress, burnout and the associated adverse health. © 2015 Elsevier Inc.


Lennartsson A.-K.,The Institute of Stress Medicine | Sjors A.,The Institute of Stress Medicine | Wahrborg P.,Gothenburg University | Ljung T.,Mid Sweden University | And 2 more authors.
Frontiers in Psychiatry | Year: 2015

Background: Common consequences of long-term psychosocial stress are fatigue and burnout. It has been suggested that burnout could be associated with hypocortisolism, thus, inability to produce sufficient amounts of cortisol. This study aimed to investigate whether patients with clinical burnout exhibit aberrant ACTH and cortisol responses under acute psychosocial stress compared with healthy individuals. Methods: Nineteen patients (9 men and 10 women) and 37 healthy subjects (20 men and 17 women), underwent the Trier Social Stress Test. Blood samples and saliva samples were collected before, after, and during the stress test for measurements of plasma ACTH, serum cortisol, and salivary cortisol. Several statistical analyses were conducted to compare the responses between patients and controls. In addition, in order to investigate the possibility that burnout patients with more severe symptoms would respond differently, sub-groups of patients reporting higher and lower burnout scores were compared. Results: In both patients and healthy controls, we observed elevated levels of ACTH and cortisol after exposure to the stressor. There were no differences in responses of ACTH, serum cortisol, or salivary cortisol between patients and controls. Patients reporting higher burnout scores had lower salivary cortisol responses than controls, indicating that patients with more severe burnout symptoms may be suffering from hypocortisolism. In addition, patients with more severe burnout symptoms tended to have smaller ACTH responses than the other patients. However, there was no corresponding difference in serum cortisol. Conclusion: This study indicates that hypocortisolism is not present in a clinical burnout patient group as a whole but may be present in the patients with more severe burnout symptoms. © 2015 Lennartsson, Sjörs, Währborg, Ljung and Jonsdottir.


Lennartsson A.-K.,The Institute of Stress Medicine | Lennartsson A.-K.,Gothenburg University | Kushnir M.M.,Uppsala University | Kushnir M.M.,Arup | And 6 more authors.
International Journal of Psychophysiology | Year: 2012

It is well known that acute psychosocial stress activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). However, the effect of acute psychosocial stress on the hypothalamic-pituitary-gonadal (HPG) axis and levels of sex steroids are less known. The aim of this study was to investigate the effect of acute psychosocial stress on serum concentrations of sex steroids in healthy men and women. Twenty men and 19 women (age 30-50. years) underwent Trier Social Stress Test (TSST), a tool for investigating psychobiological stress responses in a laboratory setting. Blood samples were collected before, directly after the stress test, and after 30. min of recovery. Concentrations of androgens were measured with high specificity LC-MS/MS method; concentrations of cortisol, estradiol and sex hormone-binding globulin were determined using immunoassays. In both men and women we observed significantly elevated levels of testosterone, estradiol, androstenedione and sex hormone binding globulin along with significantly increased adrenocorticotropic hormone (ACTH), serum cortisol, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) as a response to the stressor. Thus, even though the HPG axis and the production of sex steroids may be inhibited during prolonged periods of stress, the sex steroid levels may increase in the initial phase of acute psychosocial stress. © 2012 Elsevier B.V.


Sjors A.,The Institute of Stress Medicine | Sjors A.,Linköping University | Ljung T.,Mid Sweden University | Jonsdottir I.H.,The Institute of Stress Medicine | Jonsdottir I.H.,Gothenburg University
Biological Psychology | Year: 2014

This study investigated the association between diurnal salivary cortisol profile and perceived stress at work and at home. Healthy participants (N= 180, 52% women) collected saliva cortisol samples immediately after waking up, 15. min later, 30. min later, and at 9:00, 12:00, 15:00, 18:00 and 21:00. The area under the cortisol awakening curve with respect to ground (AUCgCAR) and increase (AUCiCAR), and diurnal slope between 9:00 and 21:00 were analyzed. Perceived stress at work and at home was measured with the Stress-Energy Questionnaire.Participants reporting stress at home had significantly lower AUCgCAR and a flatter diurnal slope. When performing separate analyses for men and women, this association was only significant among women. Perceived stress at work was not associated with any cortisol measure.This study highlights the importance of stress outside the workplace. The sex differences may indicate an increased vulnerability to non-work stress in women. © 2014 Elsevier B.V.


Lennartsson A.-K.,The Institute of Stress Medicine | Lennartsson A.-K.,Gothenburg University | Jonsdottir I.H.,The Institute of Stress Medicine | Jonsdottir I.H.,Gothenburg University
Psychoneuroendocrinology | Year: 2011

Background: Serum levels of the anterior pituitary hormone prolactin have been reported to increase in response to different types of psychological stressors in humans. However, experimental laboratory stress studies investigating the acute response of prolactin to psychological stress show inconsistent results as increased, as well as decreased or unchanged levels of prolactin have been reported. Objective: The aim of this study was to investigate the effect of acute psychosocial stress on serum concentrations of prolactin in healthy men and women and possible sex differences. Method: Thirty men and 15 women (age 30-50 years) underwent Trier Social Stress Test (TSST), a tool for investigating psychobiological stress responses in a laboratory setting. Blood samples were collected before and directly after the stress test and after 30. min of recovery. Results: We observed significantly elevated prolactin levels - along with significantly increased plasma adrenocorticotropic hormone (ACTH), serum cortisol, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) - in response to the stressor. The prolactin response pattern did not differ between men and women, but there was some indication that women might have higher magnitude of response. Large individual differences regarding the magnitude of response were seen in general. The magnitude of the prolactin response was significantly related to the magnitude of the response of the hypothalamic-pituitary-adrenal (HPA) axis and, to some extent, the cardiovascular responses, indicating that individual differences in prolactin response in healthy men and women are dependent on the general physiological stress activation. In women, the magnitude of response was also related to estradiol level. Conclusion: Prolactin does increase in response to psychosocial stress, however, with large individual variation in magnitude of response. The pattern of prolactin response does not differ between men and women. However, there was some indication that women might have higher magnitude of increase than men, and that the magnitude of response in women was dependent on estradiol levels, and this needs to be further studied. © 2011 Elsevier Ltd.


Hasselberg K.,The Institute of Stress Medicine | Jonsdottir I.H.,The Institute of Stress Medicine | Ellbin S.,The Institute of Stress Medicine | Skagert K.,The Institute of Stress Medicine
BMC Psychiatry | Year: 2014

Background:Several researchers imply that both work-related and non-work-related stress exposure are likely to contribute to stress-related mental illness. Yet empirical studies investigating both domains seem to be limited, particularly in a clinical population. The purpose of this study was to a) explore which stressors (non-work and work-related) are reported as important for the onset of illness by patients seeking medical care for stress-related exhaustion and b) explore the prevalence of each stressor and examine whether the pattern differs between men and women.Methods:This is an exploratory mixed method study, comprising patients at a specialist outpatient stress clinic. Information from medical records of 20 patients was initially used in a first qualitative step to construct the instrument, using a combination of a conventional content analysis and a directed content analysis. In the second phase patient records from 50 men and 50 women were selected and coded in accordance with the coding instrument. Frequency statistics were calculated for all stressors.Results:A total of 24 categories of stressors (11 related to work and 13 related to private life) were identified in the first qualitative step. A median of four stressors, usually both work and non-work-related was reported by the patients. The most common stressors were 1) quantitative demands at work, 2) private relational conflicts and 3) emotional demands at work.Conclusions:Work demands are, by far, the most prevalent stressor, followed by relational problems in private life. The pattern was similar for women and men, with a slight difference in the distribution between work and non-work stressors. Men and women also show similar patterns when comparing the occurrence of each stressor. Slight differences were seen, in particular with regard to managerial responsibility that was reported by 6% of the women compared to 36% of the men. One important practical implication of this study is that patients with stress-related exhaustion often have a long period of impaired ability at work. Successful prevention at the workplace is thus of great importance. However, it is equally important to discuss how society can support individuals such as single parents or couples with relational conflicts. © 2014 Hasselberg et al.; licensee BioMed Central Ltd.


PubMed | Mid Sweden University, Gothenburg University and The Institute of Stress Medicine
Type: | Journal: Frontiers in psychiatry | Year: 2015

Common consequences of long-term psychosocial stress are fatigue and burnout. It has been suggested that burnout could be associated with hypocortisolism, thus, inability to produce sufficient amounts of cortisol. This study aimed to investigate whether patients with clinical burnout exhibit aberrant ACTH and cortisol responses under acute psychosocial stress compared with healthy individuals.Nineteen patients (9 men and 10 women) and 37 healthy subjects (20 men and 17 women), underwent the Trier Social Stress Test. Blood samples and saliva samples were collected before, after, and during the stress test for measurements of plasma ACTH, serum cortisol, and salivary cortisol. Several statistical analyses were conducted to compare the responses between patients and controls. In addition, in order to investigate the possibility that burnout patients with more severe symptoms would respond differently, sub-groups of patients reporting higher and lower burnout scores were compared.In both patients and healthy controls, we observed elevated levels of ACTH and cortisol after exposure to the stressor. There were no differences in responses of ACTH, serum cortisol, or salivary cortisol between patients and controls. Patients reporting higher burnout scores had lower salivary cortisol responses than controls, indicating that patients with more severe burnout symptoms may be suffering from hypocortisolism. In addition, patients with more severe burnout symptoms tended to have smaller ACTH responses than the other patients. However, there was no corresponding difference in serum cortisol.This study indicates that hypocortisolism is not present in a clinical burnout patient group as a whole but may be present in the patients with more severe burnout symptoms.

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