Race, ethnicity, and social class are associated with cardiovascular risk factors and a range of chronic and acute diseases. Four articles and an editorial in this issue of Psychosomatic Medicine contribute to our understanding of the nature and underlying mechanisms driving racial disparities in health and disease. The first article, by DeSantis et al., examines salivary cortisol levels combined with assessments of life events, psychological distress, and depressive symptoms in 152 adults at several points during a 5-year study. The results confirm the deleterious effects of psychosocial stressors on neuroendocrine function and suggest that the effects of stress on cortisol patterning are worse for black and Latino individuals than for white individuals.
Pages 2–5; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.2.aspx
A meta-analysis by Hill et al. indicates that, in comparison to whites, black participants display higher levels of high frequency heart rate variability, a measure of parasympathetic nervous system activity. The authors discuss their findings that higher levels of parasympathetic activity may reflect potential biobehavioral resilience to environmental stressful situations.
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In an editorial, Dr. Elizabeth Brondolo interprets these effects from a biopsychosocial contextual perspective. The psychosocial context includes the type, timing, and frequency of stress exposure, and the levels of background stress. Ultimately, these contextual variables may create race and class differences in the underlying mechanisms that contribute to the development of different risk factors for adverse health outcomes such as cardiovascular disease, diabetes, and cancer.
Pages 16–25; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.4.aspx
In a study by Von Känel et al., black South Africans were found to have markedly shorter telomeres than white South Africans. Telomeres protect the human genome from becoming unstable during cell replication and telomere shortening has been used as an index of biological aging. Telomere length is also inversely associated with the risk of cardiovascular disease. This study also shows that the observed ethnic difference may be primarily explained by genetic factors and less so by biomedical or psychosocial factors.
Pages 26–32; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.5.aspx
The health benefits of educational attainment may be less pronounced for African Americans than for whites because of stresses associated with minority status. Fuller-Powell et al. investigated the prospective effect of educational attainment on age-related inflammation markers among African American and white individuals in a 15-year follow-up study. The beneficial effects of educational attainment on fibrinogen levels were higher for white than for black participants. Similar effects were found for other inflammation-related measures (CRP and IL-6). Income, health behaviors, and early life adversity accounted for only a small part of the observed differences.
Pages 33–40; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.6.aspx
Excessive psychological stress experienced by pregnant women can adversely affect fetal development. La Marca-Ghaemmaghami et al. investigated amniotic fluid from healthy pregnant women undergoing amniocentesis during the second trimester. Cardiac parameters (HRV) were measured continuously throughout the procedure. Amniocentesis induced significant psychological and autonomic alterations, suggesting that the maternal autonomic nervous system (ANS) is involved in the regulation of the fetoplacental barrier to stress as indicated by a positive correlation between the increase in low frequency/high frequency HRV with E/(E+F). Results suggest up-regulated placental 11A-HSD2 in response to acute stress whereas the reverse was found for baseline ANS indices.
Pages 41–49; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.7.aspx
Michels et al. examined the 2-year longitudinal, bidirectional relationship between child-reported stress and adiposity in 316 children, aged 5 to 12 years. Adiposity, as indicated by body mass index (BMI) and percentage of fat, was associated with subsequent increases in stress levels. Stress was also associated with subsequent rises in adiposity (BMI, fat percentage, and waist circumference) but only when taking cortisol levels and life-style factors into account. These results highlight the adverse effect of an unhealthy body composition on children’s psychological well-being and the need for multifactorial obesity prevention programs that target both stress and life-style factors.
Pages 50–58; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.8.aspx
Mindfulness intervention effects on weight loss were examined in a systematic review by Olson et al. Most of the reviewed studies documented weight loss among participants of mindfulness interventions, but the studies did not clarify the degree to which changes in mindfulness were related to the magnitude of weight loss. More careful attention to control conditions and optimizing measurement of mindfulness is needed in future research.
Pages 59–67; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.9.aspx
Beydoun at al. describe associations of dietary antioxidants with cognitive function in a large diverse population in cross-sectional analyses. Higher vitamin E intake was associated with better verbal memory, immediate recall, and verbal fluency. Women with higher vitamin E intake had better performance on a psychomotor speed test, which was not observed in men. The vitamin E–verbal memory association was partially mediated by depressive symptoms.
Pages 68–82; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.10.aspx
Psychiatric disorders are associated with higher rates of physical morbidities, but little attention has been paid to the rates of dental disease. Kisely et al. conducted a systematic review and meta-analysis of severe mental illness(SMI) and dental health. People with SMI were nearly 3 times as likely to have lost all their teeth compared to the general community. Even when teeth were retained, people with SMI had significantly greater decay. Targeting oral health might improve medical and psychosocial outcomes, especially given that dental disease can predispose people to chronic medical illness, including cardiovascular disease.
Pages 83–92; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.11.aspx
The association of perceived stress and depression with short- and long-term incidence of sepsis was examined by Ojard et al. Over 30,000 individuals were evaluated for incident sepsis from 2003 to 2012. A total of 1500 episode of sepsis occurred. Increased stress was associated with a higher 1-year incidence of sepsis, even after accounting for depressive symptoms. The association between stress and 10-year incidence of sepsis was also significant, but this association was reduced when adjusting for depressive symptoms. The authors conclude that reduction of stress may limit short-term sepsis risk.
Pages 93–100; Web:http://journals.lww.com/psychosomaticmedicine/Fulltext/2015/01000/Article.12.aspx