Brian Lovell

The psychosocial, endocrine and immune consequences of caring for a child with autism or ADHD

Research that has assessed the psychophysiological consequences of caregiver stress in young and middle aged caregivers, that is, in populations not contending with age associated decline of the endocrine and immune systems, has been scarce and yielded inconsistent findings. To extend work in this area, this study assessed the psychosocial, endocrine and immune consequences of caregiver stress in a cross sectional sample of young and middle aged caregivers of children with autism and attention deficit hyperactivity disorder (ADHD) compared against parents of typically developing children. Caregivers (n=56) and parent controls (n=22) completed measures of psychological distress (perceived stress, anxiety/depression), social support and physical health complaints. To capture important indices of the diurnal cortisol pattern, cortisol was measured at waking, 30 min post waking, 1200 h and 2200 h on two consecutive weekdays. Venous blood was taken to assess systemic concentrations of proinflammatory biomarkers, interleukin-6 (IL-6) and C-reactive protein (CRP). Caregivers scored markedly higher on all measures of psychological distress; scores on social support subscales, however, were significantly lower in this group. Diurnal patterns of cortisol secretion did not differentiate between the groups; however, caregivers displayed elevated systemic concentrations of the proinflammatory biomarker, CRP and reported more frequent episodes of physical ill health. The stress of caregiving exacts a significant psychophysiological toll, that is, even in the absence of HPA dysregulation, caregivers demonstrated elevated concentrations of proinflammatory biomarkers and, therefore, might be at greater risk for diseases fostered by disinhibition of the inflammatory response.

The cost of caregiving: Endocrine and immune implications in elderly and non elderly caregivers

This review will provide an overview of literature that has linked caregiver stress with development and progression of disease, via interactions between the hypothalamic-pituitary-adrenal (HPA) axis and immune systems. The link between caregiver stress and dysregulation of key physiologic mediators has, in the main, focussed on elderly caregivers of spouses with degenerative illness, i.e., dementia. In these populations, aberrations of both endocrinological and immunologic mediators have been demonstrated. However, as a function of their advancing age, elderly populations experience natural dysregulation of the HPA axis and decline of immunologic efficacy. More recently, research has begun to assess whether caregiver stress exacts a similar physiologic toll on non elderly caregivers, i.e., parents of medically fragile children. Dysregulation of endocrinological and immunologic mediators have been observed in both populations, however, more consistently so in the elderly. The authors suggest that, by considering specific characteristics of the care recipient, i.e., type of impairment, and concomitant changes in the caregiving experience, i.e., caregiving intensity, as well as the role of dyadic support, researchers might be better poised to explain discrepant physiologic findings between elderly and non elderly caregivers and reconcile similar physiologic inconsistencies between different, non elderly populations.

Perceived stress, common health complaints and diurnal patterns of cortisol secretion in young, otherwise healthy individuals

Research has frequently linked perceived stress with changes in subjective and objective measures of ill health; however, additional assessment should consider the physiological mechanisms mediating these effects. This study investigated whether differential patterns of cortisol secretion might partially mediate perceived stress related disparities in common health complaints in young, otherwise healthy individuals. To capture the kinds of health complaints commonly reported in this population, the Pennebaker Inventory of Limbic Languidness (PILL) was selected. To capture important parameters of the diurnal profile, cortisol was sampled at waking, 30 minutes post waking, 1200 h and 2200 h on three consecutive weekdays. Results revealed flatter diurnal cortisol slopes and elevated mean diurnal output (characterised by HPA hyperactivity in the evening) for participants in the higher stress group. Participants that reported higher perceived levels of stress also reported experiencing common health complaints with markedly greater frequency; however, these disparities were abolished when mean diurnal output of cortisol was statistically controlled. While dysregulation of basal HPA activity has been implicated in the aetiologies of chronic illness, findings reported here implicated hypersecretion of cortisol as one physiological pathway, partially mediating perceived stress related disparities in the kinds of common health complaints that typically affect young, otherwise healthy individuals.

The effects of an anticipated challenge on diurnal cortisol secretion

Abstract In healthy, non-challenged individuals, the secretion of cortisol typically follows a diurnal profile characterized by a peak in the period following waking (cortisol awakening response) and a gradual decline throughout the day. In addition, cortisol secretion is increased in response to acutely stressful stimuli, particularly stressors involving social evaluation. The current study is the first to assess the impact of an anticipated acute laboratory stressor upon the typical diurnal pattern of HPA activation and relationship to acute cortisol secretion. A sample of 23 healthy young adults provided salivary cortisol samples at four time points (immediately upon awakening, 30-min post-awakening, 1200 h and before bed) on 2 consecutive days. On the second day, participants attended the laboratory and undertook an anticipated acute socially evaluative stressor immediately following provision of their 1200 h saliva sample. Heart rate, blood pressure and mood were recorded immediately before and after the stressor and at 10 and 20 min post-stressor along with additional salivary cortisol samples. Typical patterns of cortisol secretion were observed on both days and exposure to the laboratory stressor was associated with the expected increases in cortisol, heart rate, blood pressure and negative mood. However, significant differences in diurnal cortisol secretion were observed between the two days with greater secretion, in particular, during the period following awakening, evident on the day of the anticipated laboratory stressor. Furthermore, secretion of cortisol during the period following awakening was positively related to secretion during the acute reactivity periods. This is the first study to integrate a laboratory stressor into a typical day and assess its impact on indices of diurnal cortisol secretion in an ambulatory setting. The current findings support the notion that the cortisol awakening response is associated with anticipation of the upcoming day and the subsequent demands required of the individual.

The role of social–cognitive and emotional factors on testicular self‐examination

This study determined the role of social–cognitive and affective factors in promoting testicular self‐examination.

The role of social-cognitive and emotional factors on exclusive breastfeeding duration

Background: Previous research has suggested that exclusive breastfeeding is likely to be predicted by social-cognitive variables and fear. However, there is little research assessing the role of regret and self-conscious emotions (e.g., pride and guilt) in promoting exclusive breastfeeding. Research aim: The primary aim of this research was to determine whether social-cognitive variables, fear, regret, and self-conscious emotions predict exclusive breastfeeding duration. The secondary aim of this research was to assess whether these factors predict infant-feeding choice (i.e., exclusively breastfed, combination fed, or generally formula fed). Methods: In this nonexperimental one-group self-report survey, 375 mothers rated social-cognitive variables toward breastfeeding (attitude, subjective norm, perceived control, and self-efficacy), their fear toward inadequate nutrition from breastfeeding and breastfeeding damaging their physical appearance, and the extent to which mothers may feel pride toward breastfeeding and negative self-conscious emotions (guilt and shame) and regret for not breastfeeding their infant. Results: Exclusive breastfeeding duration was positively predicted by self-efficacy, pride, and regret but negatively predicted by the fear toward inadequate nutrition. We also found that in contrast with exclusive breastfeeding, generally formula feeding an infant was associated with lower self-efficacy, pride, and regret but higher subjective norm and fear toward inadequate nutrition through breastfeeding. Conclusion: The authors argue that it is important to consider the role of self-conscious emotions and regret on exclusive breastfeeding.

Assessing the effectiveness of a knowledge‐based intervention to tackle barriers to cervical screening: A pilot study

Key Points • Knowledge and fear may act as barriers to cervical screening • Women (N = 402) received no information about screening, statistical information or barrier-tackling information • Statistical and barrier-tackling information improved knowledge of how frequently women should be screened • Barrier-tackling information reduced the false belief that screening tests for cancer • Screening intention did not vary between the conditions