Physiologic Markers of Chronic Stress in Premenopausal, Middle-Aged Women

Objective The purpose of this study was to identify physiological markers of chronic stress in middle-aged women that can be assessed simply and are thus feasible for introduction into large-scale, epidemiologic studies of aging. Methods Subjects were 40 nonsmoking, premenopausal women between the ages of 42 and 52 years, 20 of whom were chronically stressed because of undergoing a divorce or separation and 20 of whom were nonstressed because of being in stable marriages. Stressed and nonstressed women were matched for age, ethnicity, and education. Hypotheses focused on morning and evening salivary cortisol, overnight urinary catecholamines, cortisol, and testosterone, and platelet catecholamines. Results Relative to the nonstressed control subjects, the stressed women had elevated evening (9 PM) salivary cortisols, a finding that was observed on both days (mixed effects model: effect = 0.44; se = 0.14, p = .003). Support for the importance of the HPA axis was provided by the observation that the stressed women had less suppression of salivary cortisol in response to low-dose dexamethasone. Contrary to our hypothesis that stressed women would have lower overnight urinary testosterone, they had higher testosterone on day 2 (stressed = 0.76 ng/mg, nonstressed = 0.55 ng/mg;p = .04). Post hoc repeated measures analysis revealed a significant group effect over all time periods of observation (F = 5.48, p = .03, df = 1,18). Stressed women had a nonsignificant trend toward elevated platelet catecholamines. No association was found for overnight urinary catecholamines or cortisol. Conclusions Promising markers of marital upheaval in middle-aged women are evening salivary cortisol and urinary testosterone from a first morning void. Replication of these findings with the same and different chronic stressors and with women of older ages is needed. The low cost and minimal burden of these potential markers makes it feasible to introduce them into large-scale epidemiologic studies of health in aging women.

[1]  Frank M. Andrews,et al.  Social Indicators of Well-Being: Americans' Perceptions of Life Quality , 1976 .

[2]  T Akerstedt,et al.  Changes in job strain in relation to changes in physiological state. A longitudinal study. , 1988, Scandinavian journal of work, environment & health.

[3]  R. Rubin,et al.  Psychological and physiological assessments on American hostages freed from captivity in Iran. , 1990, Psychosomatic medicine.

[4]  Rhonda Milun,et al.  Exploring the Mind of Testosterone: A Beeper Study☆☆☆★ , 1997 .

[5]  A. Baum,et al.  Urinary Catecholamines and Cortisol in Recent-Onset Posttraumatic Stress Disorder After Motor Vehicle Accidents , 2000, Psychosomatic medicine.

[6]  A Steptoe,et al.  Job Strain and Anger Expression Predict Early Morning Elevations in Salivary Cortisol , 2000, Psychosomatic medicine.

[7]  M. Keshavan,et al.  A.E. Bennett Research Award. Developmental traumatology. Part I: Biological stress systems. , 1999, Biological psychiatry.

[8]  A. Booth,et al.  Testosterone and Men's Marriages , 1993 .

[9]  G. Margolin,et al.  Analysis of the association between marital relationships and health problems: an interactional perspective. , 1992, Psychological bulletin.

[10]  R B Williams,et al.  The Cook‐Medley hostility scale: item content and ability to predict survival. , 1989, Psychosomatic medicine.

[11]  Frank M. Andrews,et al.  Social Indi-cators of Well-Being: American''s Perceptions of Life Quality , 1978 .

[12]  Michael Ross,et al.  Recounting the past: Gender differences in the recall of events in the history of a close relationship. , 1990 .

[13]  M. van Eck,et al.  The Effects of Perceived Stress, Traits, Mood States, and Stressful Daily Events on Salivary Cortisol , 1996, Psychosomatic medicine.

[14]  C. Kirschbaum,et al.  Consistent sex differences in cortisol responses to psychological stress. , 1992, Psychosomatic medicine.

[15]  S. Southwick,et al.  Low Urinary Cortisol Excretion in Patients with Posttraumatic Stress Disorder , 1990, The Journal of nervous and mental disease.

[16]  J. Smyth,et al.  Effect of Chronic Stress Associated With Unemployment on Salivary Cortisol: Overall Cortisol Levels, Diurnal Rhythm, and Acute Stress Reactivity , 1995, Psychosomatic medicine.

[17]  Ronald C. Kessler,et al.  Strategies for measuring stress in studies of psychiatric and physical disorders. , 1995 .

[18]  A. Sherwood,et al.  Blood Pressure Reactivity and Marital Distress in Employed Women , 1998, Psychosomatic medicine.

[19]  Matcheri S Keshavan,et al.  Developmental traumatology part I: biological stress systems∗ ∗ See accompanying Editorial, in this issue. , 1999, Biological Psychiatry.

[20]  A. Baum,et al.  Psychological and Endocrinological Correlates of Chronic Stress at Three Mile Island , 1985 .

[21]  E. Werle,et al.  Syntheses of the sulfoconjugated isomers of norepinephrine and dopamine, controlled by HPLC with ultraviolet detection. , 1988, European journal of biochemistry.

[22]  Tommy Hansson,et al.  Psychological and physiological stress responses during repetitive work at an assembly line , 1989 .

[23]  K. Matthews,et al.  Sex differences in lipid, lipoprotein, cardiovascular, and neuroendocrine responses to acute stress. , 1988, Psychophysiology.

[24]  M. Horowitz,et al.  Impact of Event Scale: A Measure of Subjective Stress , 1979, Psychosomatic medicine.

[25]  P. Bernhardt,et al.  Testosterone changes during vicarious experiences of winning and losing among fans at sporting events , 1998, Physiology & Behavior.

[26]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[27]  C. Koopman,et al.  Social Support and Salivary Cortisol in Women With Metastatic Breast Cancer , 2000, Psychosomatic medicine.

[28]  U. Lundberg,et al.  The total workload of male and female white collar workers as related to age, occupational level, and number of children. , 1994, Scandinavian journal of psychology.

[29]  William R. Lovallo,et al.  Stress hormones in psychophysiological research: Emotional, behavioral, and cognitive implications. , 2000 .

[30]  Julie A. Fielden,et al.  Trial Lawyers and Testosterone: Blue-Collar Talent in a White-Collar World1 , 1998 .

[31]  E. Adam,et al.  Relationship functioning and home and work demands predict individual differences in diurnal cortisol patterns in women , 2001, Psychoneuroendocrinology.

[32]  J. Michalek,et al.  Marriage, Divorce, and Male Testosterone , 1998 .

[33]  C. Kirschbaum,et al.  Synthesis of a cortisol-biotin conjugate and evaluation as a tracer in an immunoassay for salivary cortisol measurement , 1992, The Journal of Steroid Biochemistry and Molecular Biology.

[34]  K. Matthews,et al.  Is life more difficult on mars or venus? A meta-analytic review of sex differences in major and minor life events , 1999, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[35]  S. Yen,et al.  Endocrine function of the postmenopausal ovary: concentration of androgens and estrogens in ovarian and peripheral vein blood. , 1974, The Journal of clinical endocrinology and metabolism.

[36]  C. Kirschbaum,et al.  Salivary cortisol in psychobiological research: an overview. , 1989, Neuropsychobiology.

[37]  J. Blumenthal,et al.  Stress in Employed Women: Impact of Marital Status and Children at Home on Neurohormone Output and Home Strain , 1997, Psychosomatic medicine.

[38]  J. Jennings,et al.  Suppression of plasma testosterone levels and psychological stress. A longitudinal study of young men in Officer Candidate School. , 1972, Archives of general psychiatry.

[39]  L. Radloff.  The CES-D Scale , 1977 .

[40]  T. Tsuchiya,et al.  Different effects of acute and chronic immobilization stress on plasma testosterone levels in male Syrian hamsters , 1995, Psychoneuroendocrinology.

[41]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[42]  R. Pestell,et al.  Platelet catecholamine contents are cumulative indexes of sympathoadrenal activity. , 1990, The American journal of physiology.

[43]  R. Fuller,et al.  Endocrine stress responses of drivers in a ‘real-life’ heavy-goods vehicle driving task , 1979, Psychoneuroendocrinology.

[44]  A. Ostfeld,et al.  Urinary free cortisol and separation anxiety early in the course of bereavement and threatened loss , 1987, Biological Psychiatry.

[45]  B. Zumoff,et al.  Subnormal serum testosterone levels in male internal medicine residents , 1992, Steroids.

[46]  K. Vedhara,et al.  Chronic stress in elderly carers of dementia patients and antibody response to influenza vaccination , 1999, The Lancet.

[47]  ACTH and cortisol levels during residency training. , 1991, The New England journal of medicine.