Psychosocial Stress and Hypothalamic-Pituitary-Adrenal Axis Stress Reactivity: Variations by Race and Socioeconomic Status Among Adults at Risk of Diabetes

Abstract

ObjectiveAlthough stress is posited to play a key role in health disparities, the extent to which commonly used self-report psychosocial stress measures are related to neurobiological stress processes, especially across diverse populations, is unresolved. This study examined how two measures of psychosocial stress, perceived stress and domain-specific stress, covary with the acute neurobiological stress response.MethodsThe Richmond Stress and Sugar Study includes a racially and socioeconomically diverse cohort of adults at risk for type 2 diabetes (n = 125; mean age = 57 years, 48% Black, and 61% high neighborhood socioeconomic status [SES]). Hypothalamic-pituitary-adrenal axis reactivity was assessed by salivary cortisol response to the Trier Social Stress Test (TSST), a laboratory stressor.ResultsHigher perceived stress was associated with a lower cortisol response to the TSST (−7.5%; 95% confidence interval [CI] = −13.1% to −1.5%) but was not associated with cortisol recovery after the TSST (3%; 95% CI = −0.6% to 6.8%). In contrast, domain-specific stress was not associated with cortisol response (−2.1%; 95% CI = −20.7% to 20.9%) but was inversely associated with cortisol recovery (3.7%; 95% CI = 0.6% to 7.0%). SES modified these associations: both perceived stress and domain-specific stress were associated with TSST cortisol response only among participants from high-SES neighborhoods. There was minimal evidence of effect modification by race.ConclusionsBoth self-report measures of psychosocial stress were associated with hypothalamic-pituitary-adrenal axis reactivity to an acute stressor. These associations varied by perceived versus domain-specific measurement scales and by neighborhood SES. Further efforts to refine stress measures and clarify biological linkages between social status and health are needed.

Leveraging a genetically-informative study design to explore depression as a risk factor for type 2 diabetes: Rationale and participant characteristics of the Mood and Immune Regulation in Twins Study

“…Instead, it emphasizes the importance of psychological and social factors as salient to etiopathology. In terms of how psychological factors may influence risk of type 2 diabetes, prior work has shown that depressive symptoms are correlated with biological factors such as inflammation (13)(14)(15) and hypothalamic-pituitary-adrenal (HPA) axis dysregulation (16)(17)(18), which are in turn associated with diabetes risk (19). In addition, these psychological factors are also associated with health behaviors (e.g., poor diet, physical inactivity, sleep disturbances), which are established causes of diabetes.…”