allostatic load? (Chair) Fischer JE, Kudielka BM, Von Kanel R, Fischer JC, Freedland KE. The pathogenesis of atherosclerosis extends over the decades of ...
Symposium abstracts / Journal of Psychosomatic Research 55 (2003) 111–129 empirically supported treatments for stress reduction on diurnal variations in salivary cortisol and other indices of physiological stress.
The long-term impact of chronic stress on health: any help from allostatic load? (Chair) Fischer JE, Kudielka BM, Von Kanel R, Fischer JC, Freedland KE The pathogenesis of atherosclerosis extends over the decades of working life. Longitudinal studies have identified a list of individual genetic, biological, psychosocial, and behavioral risk factors for cardiovascular disease. Work place studies have underscored the clinical relevance of environmental risk factors such as socioeconomic status and work characteristics. The latter have been viewed as a chronic burden on the individual, affecting both health behavior and stress adaptation. The wear and tear attributable to overexertion of the adaptive mechanisms has been conceptualized as the allostatic load. In the elderly, an early operationalization of allostatic load including 10 biological measures predicted health status at the 7.5 years follow-up. The usefulness of the allostatic load construct as an early warning set of biological markers for identification of at-risk individuals within the working population remains unknown. Open questions include the following: Which psychosocial factors should be measured? Which biological variables should be determined? What are the adequate statistical techniques? These questions are discussed from the data of the Augsburg Cohort Project and the St. Louis Depression Study. The Augsburg Cohort Project is a longitudinal study specifically designed to test the conceptualization of allostatic load within a cohort of currently 1170 employees at an airplane manufacturing plant.
Assessing allostatic load in middle-aged populations: Which measures that indicate chronic stress or behavior-related wear and tear should be included? Fischer JE, Fischer JC; Kudielka BM, Von Kanel R Background: Since the operationalization of allostatic load (AL) in the McAthur Studies of Successful Aging, new risk factors for long-term morbidity and cardiovascular disease have been established, leading to the question, which parsimonious set of primary, secondary, and tertiary indicators appropriately captures AL in middle aged populations? New variables should be established risk factors, relate to health behavior or psychosocial stress, and should show limited correlation with the original variables. The issue is discussed for C-reactive protein (CRP) and microalbuminuria using data from the Augsburg Cohort Project. Methods/results: Excluding subjects with missing data or acute inflammation left 1079 datasets. CRP showed week correlation with the original 10 measures of AL (all Pearson’s r < .01). Beyond demographic variables [R2 = .038, F(4,1074) = 10.7, P < .001], health behavior [R2 = .15, F(4,1070) = 49.5, P < .001], exhaustion and adverse working conditions [R2 = .01, F(3,1067) = 3.6, P = .013], and body mass index [R2 = .02, F(1,1066) = 31.6, P < .00l] explained significant proportions of the variance. Likewise, albuminuria showed little correlation with the original variables. After considering demographic characteristics, psychosocial and behavioral factors explained significant proportions of the variance. Conclusion: Recently established risk factors for long-term morbidity and mortality supplements should be considered when assessing AL.
The interrelationship of psychosocial factors relevant to allostatic load in a working population. Do we measure distinct or overlapping psychological concepts? Kudielka BM, Von Kanel R, Gander M, Fischer JE Background: Allostatic Load may be associated with psychological factors, like depression, vital exhaustion (chronic distress), type-D personality, anxiety, lack of social support, functional health and ef-
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fort-reward-imbalance. These concepts share several common features leading to the question whether commonly used psychometric scales reflect distinguishable concepts or are considerably overlapping identities. Methods: Data from the Augsburg Cohort Project (N = 780, mean age 40 yrs., 89% males) were analyzed to investigate the interrelationship between the Hospital Anxiety and Depression Scale (HADS), Type-D Personality (DS14), Maastricht Vital Exhaustion Questionnaire (VE), Social Support, functional health (SF12), and Effort-Reward-Imbalance (ERI). Results: A full Pearson correlation matrix revealed low to medium associations, with HADS-Depression, DS14-Negative Affectivity and Vital Exhaustion (VE) showing the highest intercorrelations. HADS-D correlated more closely with DS14-NA than with VE, and factor analyses virtually regained these three scales. An exploratory factor analysis including all items resulted in distinguishable factors, considerably reflecting the original psychometric scales. Conclusion: Although the correlation matrix suggests some conceptual overlap, factorial analyses strengthened the assumption of conceptually distinguishable entities. Depressive symptoms and negative affectivity versus vital exhaustion appear constituting distinct psychological concepts.
The contribution of psychosocial factors to allostatic load Von Kanel R, Kudielka BM, Fischer JE Background: Allostatic load (AL) has been construed as a cumulative measure of biological burden predicting mortality and health deterioration in the elderly. We investigated the relation of psychosocial variables to the ‘‘original AL score’’ comprising 10 variables as opposed to an ‘‘extended AL score’’ additionally including measures of inflammation, hemostasis, albuminuria, and body mass index. Methods: Study participants were 677 (63% male) employees of a German airplane manufacturing plant (mean age F S.D. 39 F 11 years). For regression analyses, demographic factors (age, gender), health behaviour variables, and a set of psychosocial measures were sequentially forced into the regression equation. Results: Demographic variables explained a significant proportion of the original AL score [R2=.190, F(4,672) = 39, P < .001]; however, health behaviour and psychosocial variables did not add significant variance. On the other hand, while age and gender explained 15% [R 2 =.150, F(4,672) = 30, P < .001] of the variance in the extended AL score, health behaviour accounted for an additional 1% [dR2=.010, dF(4,666) = 2.1, P = .084] and psychosocial factors for an additional 2.3% [dR2=.023, dF(8,660) = 2.3, P = .017]. Conclusions: The findings MII call for an extension or refinement of AL, which might allow more accurate modelling of morbidity and mortality risk with health behaviour and psychosocial factors as mediated by AL.
Beyond correlation and regression: insights gained from structural equation modeling — the example of depression and inflammationrelated risk of cardiovascular disease Freedland KE, Miller GE Background: Longitudinal studies suggest an increased risk of coronary heart disease (CHD) from psychiatric depression. One hypothesis states that depression promotes inflammation, a key process in the pathogenesis of CHD. The present study assessed depression, adiposity, and inflammatory molecules implicated with CHD. The aim of the analysis was to elucidate the interrelationships between psychological and biological variables. Methods: Fifty adults with clinical depression were enrolled, and fifty matched controls with no history of psychiatric illness. Participants were in good health (no acute infectious disease, chronic medical illness, or prescribed medication regimen). Structural equation modeling compared the validity of six models specifying various patterns of relations between depression, adiposity, and inflammation.
