Stress resilience and cancer risk: a nationwide cohort study

Kennedy, Beatrice; Fang, Fang; Valdimarsdóttir, Unnur; Udumyan, Ruzan; Montgomery, Scott; Fall, Katja

doi:10.1136/jech-2016-208706

Cited by 29 publications

(24 citation statements)

References 36 publications

(21 reference statements)

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“…Further adjustment for adult education level and occupation type as well as for the conscription variables cognitive ability, cardiovascular fitness and BMI attenuated the study results only modestly. The latter is in concordance with earlier findings on lung cancer incidence (a cancer type largely attributable to cigarette smoking), where low stress resilience was associated with increased risk for lung cancer even in employed men with qualified professions 11. Furthermore, these additional variables may partly represent mediating factors in a potential causal pathway between stress resilience and addictive health behaviours, and including them may lead to overadjustment, and consequently to underestimation of the magnitude of the underlying associations.…”

Section: Discussionsupporting

confidence: 91%

“…Large longitudinal register-based studies have linked low stress resilience in late adolescence with subsequent increased risk of coronary heart disease,6 ischaemic and haemorrhagic stroke,7 hypertension,8 heart failure9 and diabetes mellitus type 210 as well as with liver cancer and lung cancer 11. Stress-induced unfavourable health behaviours have been proposed as a main pathway in these associations, and evidence from cross-sectional studies have indicated that higher stress resilience may mitigate tendencies for smoking, nicotine dependence, life-time alcohol consumption and illicit drug use 12–15.…”

Section: Introductionmentioning

confidence: 99%

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Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

Kennedy

Chen

Fang

et al. 2019

J Epidemiol Community Health

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BackgroundWhile compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.MethodsIn this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.ResultsWe found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.ConclusionLow stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

Kennedy

Chen

Fang

et al. 2019

J Epidemiol Community Health

Self Cite

View full text Add to dashboard Cite

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“…Several potential mechanisms for stress-related cancer induction have been proposed, usually linking stress- and depression related CNS activity to immune responses and HPA-axis regulated hormonal secretion ( Soung and Kim, 2015 ; Shin et al, 2016 ). In support of the proposed links between psychological stress and cancer, a recently published prospective cohort study found that adolescent psychological stress resilience was associated with adult cancer occurrence, even after adjusting for socioeconomic circumstances in childhood, and cognitive and physical fitness ( Kennedy et al, 2017 ). Vagal tone is thought to reflect individual stress resilience ( Segerstrom and Nes, 2007 ; McCraty and Shaffer, 2015 ) and several of the characteristics Kennedy et al (2017) used to estimate psychological stress resilience are associated with vagal tone, including persistence ( Segerstrom and Nes, 2007 ; Reynard et al, 2011 ), emotional stability ( Koval et al, 2013 ), social coherence ( McCraty, 2017 ), and adolescent antisocial behavior ( Mezzacappa et al, 1997 ).…”

Section: Applying the Model: Neurodegenerative Disease And Cancermentioning

confidence: 99%

“…In support of the proposed links between psychological stress and cancer, a recently published prospective cohort study found that adolescent psychological stress resilience was associated with adult cancer occurrence, even after adjusting for socioeconomic circumstances in childhood, and cognitive and physical fitness ( Kennedy et al, 2017 ). Vagal tone is thought to reflect individual stress resilience ( Segerstrom and Nes, 2007 ; McCraty and Shaffer, 2015 ) and several of the characteristics Kennedy et al (2017) used to estimate psychological stress resilience are associated with vagal tone, including persistence ( Segerstrom and Nes, 2007 ; Reynard et al, 2011 ), emotional stability ( Koval et al, 2013 ), social coherence ( McCraty, 2017 ), and adolescent antisocial behavior ( Mezzacappa et al, 1997 ). Moreover, vagal tone indicated by vagally mediated HRV predicts capability of regulating arousal during prolonged stressors ( Hildebrandt et al, 2016 ) which links stress regulation capacity to cancer occurrence in adulthood.…”

Section: Applying the Model: Neurodegenerative Disease And Cancermentioning

confidence: 99%

The Neuro-Immuno-Senescence Integrative Model (NISIM) on the Negative Association Between Parasympathetic Activity and Cellular Senescence

2018

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There is evidence that accumulated senescent cells drive age-related pathologies, but the antecedents to the cellular stressors that induce senescence remain poorly understood. Previous research suggests that there is a relationship between shorter telomere length, an antecedent to cellular senescence, and psychological stress. Existing models do not sufficiently account for the specific pathways from which psychological stress regulation is converted into production of reactive oxygen species. We propose the neuro-immuno-senescence integrative model (NISIM) suggesting how vagally mediated heart rate variability (HRV) might be related to cellular senescence. Prefrontally modulated, and vagally mediated cortical influences on the autonomic nervous system, expressed as HRV, affects the immune system by adrenergic stimulation and cholinergic inhibition of cytokine production in macrophages and neutrophils. Previous findings indicate that low HRV is associated with increased production of the pro-inflammatory cytokines IL-6 and TNF-α. IL-6 and TNF-α can activate the NFκB pathway, increasing production of reactive oxygen species that can cause DNA damage. Vagally mediated HRV has been related to an individual’s ability to regulate stress, and is lower in people with shorter telomeres. Based on these previous findings, the NISIM suggest that the main pathway from psychological stress to individual differences in oxidative telomere damage originates in the neuroanatomical components that modulate HRV, and culminates in the cytokine-induced activation of NFκB. Accumulated senescent cells in the brain is hypothesized to promote age-related neurodegenerative disease, and previous reports suggest an association between low HRV and onset of Alzheimer’s and Parkinson’s disease. Accumulating senescent cells in peripheral tissues secreting senescence-associated secretory phenotype factors can alter tissue structure and function which can induce cancer and promote tumor growth and metastasis in old age, and previous research suggested that ability to regulate psychological stress has a negative association with cancer onset. We therefore conclude that the NISIM can account for a large proportion of the individual differences in the psychological stress-related antecedents to cellular senescence, and suggest that it can be useful in providing a dynamic framework for understanding the pathways by which psychological stress induce pathologies in old age.

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“…Several physiological pathways have been proposed that implicate stress hormones in carcinogenesis through effects on immune surveillance . However, clinical evidence for such association is limited by small sample sizes, potential recall bias associated with self‐report, and heterogeneous stress definitions . Aside from stress, recent studies suggest that having a partner can enhance early detection of melanoma .…”

mentioning

confidence: 99%

The association between partner bereavement and melanoma: cohort studies in the U.K. and Denmark

et al. 2020

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Background Psychological stress is commonly cited as a risk factor for melanoma, but clinical evidence is limited. Objectives This study aimed to evaluate the association between partner bereavement and (i) first-time melanoma diagnosis and (ii) mortality in patients with melanoma. Methods We conducted two cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). In study 1, we compared the risk of first melanoma diagnosis in bereaved vs. matched nonbereaved people using stratified Cox regression. In study 2 we estimated hazard ratios (HRs) for death from melanoma in bereaved compared with nonbereaved individuals with melanoma using Cox regression. We estimated HRs separately for the U.K. and for Denmark, and then pooled the data to perform a random-effects meta-analysis. Results In study 1, the pooled adjusted HR for the association between partner bereavement and melanoma diagnosis was 0Á88 [95% confidence interval (CI) 0Á84-0Á92] across the entire follow-up period. In study 2, we observed increased melanoma-specific mortality in people experiencing partner bereavement across the entire follow-up period (HR 1Á17, 95% CI 1Á06-1Á30), with the peak occurring during the first year of follow-up (HR 1Á31, 95% CI 1Á07-1Á60). Conclusions We found decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement. These findings may be partly explained by delayed detection resulting from the loss of a partner who could notice skin changes. Stress may play a role in melanoma progression. Our findings indicate the need for a low threshold for skin examination in individuals whose partners have died. What is already known about this topic? • Psychological stress has been proposed as a risk factor for the development and progression of cancer, including melanoma, but evidence is conflicting. • Clinical evidence is limited by small sample sizes, potential recall bias associated with self-report, and heterogeneous stress definitions. What does this study add? • We found a decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement.

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Stress resilience and cancer risk: a nationwide cohort study

Cited by 29 publications

References 36 publications

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

The Neuro-Immuno-Senescence Integrative Model (NISIM) on the Negative Association Between Parasympathetic Activity and Cellular Senescence

The association between partner bereavement and melanoma: cohort studies in the U.K. and Denmark

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