Chronic Psychosocial Stress and Cardiometabolic Health: Variations in Measurement and Structural Determinants
Kalesnikava, Viktoryia
2022
Abstract
There is growing recognition that chronic psychosocial stress may accelerate aging, increase risk of diseases, and contribute to health disparities. Variability across findings and methodological challenges limit our ability to examine chronic stress as a key mechanism driving health disparities at the population scale. In an effort to clarify some of these dimensions and methodological challenges, this dissertation (1) explored definitional and measurement-related issues around the construct of stress, and by employing uniquely positioned epidemiologic sources of data and life course analytical methods, (2) examined the impact of psychosocial stress on cardiometabolic health across structural and socioeconomic differences. Aim 1 relied on quasi-experimental design features of the Richmond Stress and Sugar study (RSASS) to examine whether two common self-report measures of psychosocial stress reflect neurobiological stress response assessed by changes in salivary cortisol before and after an acute stress challenge. Adjusted linear spline mixed-effects models revealed that both perceived stress and domain-specific stress measures were inversely associated with neurobiological stress reactivity. Neighborhood SES, but not race/ethnicity, modified these associations. In Aim 2, we applied a novel stress framework to examine associations between stress-related cognitive tendencies (i.e., vigilance and avoidant/adaptive stress coping) and metabolic risk in a prospective cohort from the Healthy Aging in Neighborhoods of Diversity across the Lifespan Study (HANDLS). Contrary to our expectations, vigilance was not associated with metabolic risk in any of our mixed-effects linear models, while both types of stress coping were negatively associated with metabolic risk. Findings suggest that a higher level of engagement in any form of stress coping may be beneficial and help temper stress impact on metabolic health. Evidence for stress coping varied by race and lifecourse SES, suggesting that activation of a particular coping style may be context-specific and depend on the availability of psychosocial resources. Aim 3 sought to clarify the role of stress as a contributor to type 2 diabetes incidence, with attention to inequities in diabetes risk. Two separate time-to-event analyses using data from RSASS and HANDLS showed that stress was not associated with incident diabetes, but the estimates of association were in the hypothesized direction and comparable across the studies. This was consistent across two distinct measures of stress: perceived stress and acute stress reactivity. Subgroup analyses in HANDLS revealed that compared to White adults with low levels of perceived stress, White adults with high stress and Black adults (both high and low stress) had higher diabetes incidence. Convergent results from two longitudinal samples underscored the importance of replicating evidence across studies with shared features and design, an effort that provides a more robust understanding of the substantive question than what could be obtained from a single cohort. In sum, collective evidence generated from this work contributes toward efforts aimed at improving stress measures in population research and considering stress as a potentially modifiable factor of social health disparities.Deep Blue DOI
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Chronic Psychosocial Stress and Cardiometabolic Health: Variations in Measurement and Structural Determinants
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