Mary C. Davis

Depression and cortisol responses to psychological stress: A meta-analysis

The purpose of this meta-analysis is to examine the association between depression and cortisol responses to psychological stressors. A total of seven studies comparing plasma or cortisol responses to psychological stressors in clinically depressed (MDD) and non-depressed (ND) individuals (N = 196: 98 MDD, 98 ND; 83 men, 113 women; mean age = 40 years) were included. Sample size-adjusted effect sizes (Cohens d statistic) were calculated and averaged across baseline (before stressor onset), stress (stressor onset up to 25 min after stressor offset), and recovery (more than 25 min after stressor offset) periods. Overall, MDD and ND individuals exhibited similar baseline and stress cortisol levels, but MDD patients had much higher cortisol levels during the recovery period than their ND counterparts. There was also a significant time of day effect in which afternoon studies were more likely to reveal higher baseline cortisol levels, blunted stress reactivity, and impaired recovery in MDD patients. This blunted reactivity-impaired recovery pattern observed among the afternoon studies was most pronounced in studies with older and more severely depressed patients.

Positive affect as a source of resilience for women in chronic pain

A sample of 124 women with osteoarthritis or fibromyalgia, or both, completed initial assessments for demographic data, health status, and personality traits and 10-12 weekly interviews regarding pain, stress, negative affect, and positive affect. Multilevel modeling analyses indicated that weekly elevations of pain and stress predicted increases in negative affect. Both higher weekly positive affect as well as greater positive affect on average resulted in lower negative affect both directly and in interaction with pain and stress. Finally, increases in weekly negative affect and higher average negative affect related to greater levels of pain in subsequent weeks. In contrast, higher levels of overall positive affect predicted lower levels of pain in subsequent weeks.

Vulnerability to stress among women in chronic pain from fibromyalgia and osteoarthritis davis et al. stress vulnerability

In two investigations, we studied vulnerability to the negative effects of stress among women in chronic pain from 2 types of musculoskeletal illnesses, fibromyalgia syndrome (FMS) and osteoarthritis (OA). In Study 1, there were 101 female participants 50 to 78 years old: 50 had FMS, 29 had OA knee pain and were scheduled for knee surgery, and 22 had OA but were not planning surgery. Cross-sectional analyses showed that the three groups were comparable on demographic variables, personality attributes, negative affect, active coping, and perceived social support. As expected, FMS and OA surgery women reported similar levels of bodily pain, and both groups scored higher than OA nonsurgery women. However, women with FMS reported poorer emotional and physical health, lower positive affect, a poorer quality social milieu, and more frequent use of avoidant coping with pain than did both groups of women with OA. Moreover, the perception and use of social support were closely tied to perceived social stress only among the FMS group. In Study 2, we experimentally manipulated negative mood and stress in 41 women 37 to 74 years old: 20 women had FMS, and 21 women had OA. Participants from each group were randomly assigned to either a negative mood induction or a neutral mood (control) condition, and then all participants discussed a stressful interpersonal event for 30 min. Stress-related increases in pain were exacerbated by negative mood induction among women with FMS but not women with OA, and pain during stress was associated with decreases in positive affect in women with FMS but not women with OA. These findings suggest that among women with chronic pain, those with FMS may be particularly vulnerable to the negative effects of social stress. They have fewer positive affective resources, use less effective pain-coping strategies, and have more constrained social networks than their counterparts with OA, particularly those who experience similar levels of pain. They also seem to experience more prolonged stress-related increases in pain under certain circumstances, all of which may contribute to a lowering of positive affect and increased stress reactivity over time.

Dimensions of Affect Relationships: Models and Their Integrative Implications

This article presents data from a number of areas of psychology that have dealt with the issue of whether positive and negative affects are independent—the bivariate view— or whether they operate inversely from each other—the unidimensional, bipolar view. Both models have extensive empirical support. A more integrative view, the Dynamic Model of Affect (DMA), specifies conditions under which both bivariate and bipolar models are valid. It is tailored to analyzing both affect systems functioning concurrently. The DMA is reviewed and then extended to show how 3 major areas of research can begin to incorporate the more integrative framework of analyzing co-occurring types of affect.

Is life more difficult on mars or venus? A meta-analytic review of sex differences in major and minor life events

We conducted a meta-analysis of studies examining sex differences in reported levels of stress, considering the impact of: (a) the age and representativeness of sample participants, (b) whether life events were weighted or unweighted by participants for impact or severity, (c) the major versus minor nature of the stress, and (d) the life domain of the stressor. Overall, the meta-analysis of 119 studies including 83,559 participants found that females were exposed to more stress than were males (d=.123, r=.061). However, there was considerable heterogeneity among studies, with greater effect sizes associated with: (a) life events weighted by participants for impact, (b) adolescents compared to both younger and older samples, (c) major life stressors compared to minor stressors, and (d) interpersonal relationship stressors compared to work stressors. In none of the subgroup analyses did males experience considerably more stress than females. Evaluation of a subsample of 39 studies that examined gender differences in psychological symptoms revealed that females reported more symptoms of depression, anxiety, and psychosomatic problems (d=.282, r=.139) and that the sex difference in reports of psychological symptoms accounted for approximately 4% of the variance in the sex differences in reports of stress. Possible explanations for the observed patterning of effects are discussed, as are recommendations for further research.

Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia

Abstract We examined between and within‐person variability, affective correlates, and diagnostic differences in daily fatigue in women with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia syndrome (FMS). Two hundred and fifty‐five female patients recruited from the community served as participants for this project. The patients had a physician‐confirmed diagnosis of RA (n = 89), OA (n = 76), or FMS (n = 90). Individuals completed an initial questionnaire and up to 32 daily diaries assessing illness symptoms and psychosocial variables (i.e., fatigue, pain, sleep problems, depression, and affect). The primary outcome for the current project was variability in fatigue. We examined affective, pain, and sleep correlates of fatigue, and tested whether these relations varied by diagnosis. Results indicated that FMS patients had higher overall levels of and greater daily variability in fatigue compared with the other pain groups. For all patients, fatigue correlated highly with lower positive affect (PA). Moreover, day‐to‐day increases in fatigue were associated with decreases in PA, particularly among FMS patients, and with increases in negative affect (NA). Daily pain was associated with increased fatigue in all groups, although OA patients showed less pain reactivity than either FMS or RA patients. These findings indicate that fatigue is a common feature of rheumatologic conditions. Nonetheless, there are important differences between RA, OA, and FM patients in both the everyday manifestations and the biopsychosocial correlates of fatigue.

Fibromyalgia: Evidence for Deficits in Positive Affect Regulation

Objective: Fibromyalgia (FMS) is characterized by chronic pain, high psychiatric comorbidity, and the absence of observable pathology. Our objective was to examine positive and negative affective indices, both at the trait and contextual levels, in FMS compared with a chronic pain control group, osteoarthritis (OA). Methods: The sample consisted of 126 female FMS (87) and OA (39) patients from the community. Participants answered a self-report questionnaire assessing demographic and personality variables and were interviewed regarding average pain, affect, anxiety, and depression. Participants were then interviewed weekly for up to 12 weeks regarding pain, affect, fatigue, perceived interpersonal stress (IS), and positive interpersonal events (PE). Results: FMS participants reported lower levels of positive affect (p < .01) and extraversion (p < .01) than OA participants. There were no significant differences between groups in negative affect, depression, anxiety, or neuroticism after controlling for age and average pain. At the weekly level, FMS participants reported lower levels of positive affect (p < .01), but not negative affect. Furthermore, during weeks of elevated IS, FMS participants evidenced steeper declines in positive affect than OA participants (p < .01). Conclusions: Despite the predominance of literature focusing on psychologic disturbance in FMS, these analyses identified dysfunctional positive affect regulation as a key feature of FMS. FMS status was uniquely characterized by lower levels of positive affect, especially during stressful weeks. These findings challenge current conceptualizations of FMS and point to new directions for interventions that focus on improving positive affective resources, especially during times of stress. FMS = fibromyalgia syndrome; OA = osteoarthritis; PA = positive affect; NA = negative affect; IS = perceived interpersonal stress; PE = positive interpersonal events.

The Impact of Internalized Homophobia on HIV Preventive Interventions

A growing body of research implicates internalized homophobia—the internalization of societys antihomosexual sentiments by gay and lesbian people—as a factor contributing to HIV-related sexual risk behavior in gay and bisexual men. Although accumulating evidence links internalized homophobia and sexual risk behavior, no study has explored the impact of internalized homophobia on efforts to prevent these behaviors. This paper examines the effect of internalized homophobia on gay and bisexual mens awareness of, participation in, and perceptions of programs offered by a community-based HIV prevention organization. In Study 1, 595 gay and bisexual men reported their levels of awareness of and participation in HIV prevention programming offered by one community organization. Internalized homophobia was negatively related to mens awareness of the services offered by the organization. However, among the men who were aware of at least one service, internalized homophobia did not further predict service utilization. Study 2 examined 89 gay and bisexual men who participated for a single session in a group-structured, community-based HIV preventive intervention. Pre- to immediate postintervention change in perceptions of condom use self-efficacy was inversely related to internalized homophobia. Internalized homophobia was also a significant negative predictor of the extent to which participants felt similar to and related well with other members of the group. Together, these findings suggest that internalized homophobia may pose multiple barriers to community-based HIV prevention efforts.

The role of stressful events in the relationship between positive and negative affects : Evidence from field and experimental studies

Three studies are presented that examine the effects of stress on the relationship between positive and negative affective states. In the first study, recently bereaved and disabled older adults were compared to matched control groups without these recent stressors. Negative affect was inversely correlated with positive affect to a significantly greater extent for the highly stressed groups compared with controls. In a second study, older adults were exposed to a laboratory stressor, and their positive and negative affective reactions recorded. Immediately following a speech stressor task, the inverse correlation between positive and negative affect was significantly greater than in pre- and postassessments of affects. The third study was an attempt to replicate and extend the findings from Study 2 with a mid-aged sample of women. The speech stressor had the same effects as in Study 2. A second stressor, which induced pain through immersion of an arm into cold water, had no effects on the correlation between affective states. Alternative explanations for these effects and the implications for cognitive interventions are discussed.

Hostile attitudes predict elevated vascular resistance during interpersonal stress in men and women.

Objective: Existing research indicates that hostility is associated with enhanced blood pressure responses during social stress, but little is known about the hemodynamic patterns underlying these blood pressure increases, particularly in women. The present study examined hemodynamic responses to a low-anger interpersonal stressor, testing the hypotheses that hostile individuals show enhanced vascular responses and that low hostile individuals show enhanced myocardial responses. Methods: Eighty undergraduate men and women were categorized as high or low in hostility on the basis of median splits of Cook-Medley Hostility Scale scores. Participants discussed a controversial topic with a confederate who disagreed with them, and hemodynamic responses were assessed with impedance cardiography. Results: High hostile individuals exhibited greater increases in diastolic blood pressure and total peripheral resistance and smaller increases in cardiac output during an interpersonal stressor than did low hostile individuals. Systolic blood pressure and heart rate increases were greater among high hostile relative to low hostile females and comparable among low and high hostile males. Affective responses and task perceptions were generally similar for high and low hostile participants, but the relationship between task perception and hemodynamic responses varied on the basis of hostility level. Conclusions: These findings suggest that hostility in both men and women is associated with heightened vascular and dampened cardiac responsivity to interpersonal stress that is not deliberately anger provoking. Moreover, they indicate that the associations between task perception and hemodynamic responses vary between high and low hostile individuals.