This meta-analysis reviews 208 laboratory studies of acute psychological stressors and tests a theoretical model delineating conditions capable of eliciting cortisol responses. Psychological stressors increased cortisol levels; however, effects varied widely across tasks. Consistent with the theoretical model, motivated performance tasks elicited cortisol responses if they were uncontrollable or characterized by social-evaluative threat (task performance could be negatively judged by others), when methodological factors and other stressor characteristics were controlled for. Tasks containing both uncontrollable and social-evaluative elements were associated with the largest cortisol and adrenocorticotropin hormone changes and the longest times to recovery. These findings are consistent with the animal literature on the physiological effects of uncontrollable social threat and contradict the belief that cortisol is responsive to all types of stressors.

http://anthro.vancouver.wsu.edu/media/Course_files/anth-260-edward-h-hagen/acute-stressors-and-cortisol-responses-a-theoretical-integration-and-synthesis-of-laboratory-research-1.pdf

Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research.

Background and Purpose— Although depression is an important sequelae of stroke, there is uncertainty regarding its frequency and outcome Methods— We undertook a systematic review of all published nonexperimental studies (to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke Results— Data were available from 51 studies (reported in 96 publications) conducted between 1977 and 2002 Although frequencies varied considerably across studies, the pooled estimate was 33% (95% confidence interval, 29% to 36%) of all stroke survivors experiencing depression Differences in case mix and method of mood assessment could explain some of the variation in estimates across studies The data also suggest that depression resolves spontaneously within several months of onset in the majority of stroke survivors, with few receiving any specific antidepressant therapy or active management Conclusions— Depression is common among stroke patients, with the 

Predictors of Depression after Stroke: A Systematic Review of Observational Studies

Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory.

From W.B. Cannon's identification of adrenaline with "fight or flight" to modern views of stress, negative views of peripheral physiological arousal predominate. Sympathetic nervous system (SNS) arousal is associated with anxiety, neuroticism, the Type A personality, cardiovascular disease, and immune system suppression; illness susceptibility is associated with life events requiring adjustments. "Stress control" has become almost synonymous with arousal reduction. A contrary positive view of peripheral arousal follows from studies of subjects exposed to intermittent stressors. Such exposure leads to low SNS arousal base rates, but to strong and responsive challenge- or stress-induced SNS-adrenal-medullary arousal, with resistance to brain catecholamine depletion and with suppression of pituitary adrenal-cortical responses. That pattern of arousal defines physiological toughness and, in interaction with psychological coping, corresponds with positive performance in even complex tasks, with emotional stability, and with immune system enhancement. The toughness concept suggests an opposition between effective short- and long-term coping, with implications for effective therapies and stress-inoculating life-styles.

/pdf/arousal-and-physiological-toughness-implications-for-mental-22b8eztja8.pdf

Arousal and physiological toughness: Implications for mental and physical health.

Baseline resting electroencephalogram activity was recorded with 3 different reference montages from 15 clinically depressed and 13 control subjects. Power in all frequency bands was extracted by fast Fourier transformation. There was a significant Group X Hemisphere interaction in the mid-frontal region, for the alpha band power only. Depressed subjects had less left-sided activation (i.e., more alpha activity) than did normal control subjects. This pattern of diminished left-sided frontal activation is interpreted as indicating a deficit in approach mechanisms in depressed subjects.

Left frontal hypoactivation in depression.

This study examined the phenomenon of post-stroke depression and evaluated its impact on rehabilitation outcome. Sixty-four patients presenting to a rehabilitation program within weeks of first stroke were evaluated for depression through self-report measures and staff ratings. Patients also rated the particular coping strategies which they used in dealing with their illness and hospital stay. Physical and occupational therapists provided measures of functional impairment at admission and discharge. A high (47%) prevalence of depression was found in this population, with no overall differences observed between patients with right or left hemisphere lesions. Depressed patients, in comparison to non-depressed, evidenced greater functional impairment at both admission and discharge. However, both groups showed similar gains over the course of rehabilitation. Coping strategies employed by depressed patients appeared to reflect a lower level of participation in the rehabilitation process. A subgroup of patients evaluated 6 weeks after discharge revealed that depression was associated with a worsening on one measure of functional status. These findings indicate that depression is a frequent companion of stroke, that it is associated with degree of functional impairment, and that it may exert a negative impact on the rehabilitation process and outcome.

Post-stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome.

Recent evidence suggests that poststroke depression is associated with the location of the brain infarct, proximity to the frontal pole being associated with greater depression following left hemisphere injury, and an opposite relationship being seen with injury to the right hemisphere. This study was designed to replicate and extend previous investigation of this issue. Depression was assessed following recent stroke in patients with localized right (n = 16) or left (n = 19) hemisphere lesions. No overall differences between these groups were found on several measures of depression. Although there appeared to be a negative linear relationship between severity of depression and distance of the lesion from the frontal pole in left hemisphere patients, this association failed to attain statistical significance. A curvilinear relationship was evident in right hemisphere patients, with anterior and posterior lesions associated with high depression scores. These data support the notion that lesion location is associated with the severity of poststroke depression, although the nature of this association may be more complex than has previously been suggested.

Poststroke depression and lesion location. An attempted replication.

Aerobic fitness is associated with numerous physiological adaptations which permit physical stress to be coped with more efficiently. The present experiment examined whether aerobic fitness influences emotional response. Heart rate, biochemical measures (catecholamines, cortisol, prolactin, lactic acid), and self-reported arousal and anxiety were monitored in 15 highly trained and 15 untrained subjects at various points before, during and following exposure to a series of psychosocial stressors. Heart rate and subjective arousal level increased markedly during the stressors in both groups. Trained subjects showed higher levels of norepinephrine and prolactin early in the stress period, more rapid heart rate recovery following the stressors, and lower levels of anxiety at the conclusion of the session. This more rapid heart rate and subjective recovery from psychosocial stress, suggests that aerobically trained individuals may be capable of faster recovery in both physiological and subjective dimensions of emotionality. The differences in reactivity profiles between the aerobically trained and untrained were discussed in light of models that have dealt with the adaptiveness of emotional response.

Aerobic fitness level and reactivity to psychosocial stress: Physiological, biochemical, and subjective measures

SUMMARY. Alcoholics who participated in a lithess program had improved rates o] abstinence. Although alcoholism is viewed as a multifaceted disorder, there has been little systematic analysis of the role of physical rehabilitation in alcoholism treatment (1). The past decade has witnessed great concern, in the public as a whole, over aerobic or endurance fitness. Programs which emphasize aerobic fitness require participation for at least 30 min three times a week, with an intensity of effort of from 60 to 80 % of maximum. Physiological adaptations take place following several weeks of regular participation in such a graded exercise program: reduced basal and working heart rate, lowered blood pressure, increase in muscle tone, increase in maximum oxygen uptake, and delayed onset of fatigue (2, 3). Numerous psychological adjustments have also been noted from such activity: e.g., lowered anxiety, improved self-esteem and greater selfconfidence (4, 5). In previous research on exercise programs with alcoholics, Gary and Guthrie (6) found little correlation between fitness improvement and changes in self-concept. Frankel and Murphy (7), administering the Minnesota Multiphasic Personality Inventory in conjunction with a 12week fitness program, found positive changes on the depression and psychasthenia subscales which were associated with fitness improvement. Pursch a suggested that running daily aids in the rehabilitation of

David Sinyor

Papers

Post-stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome.

Poststroke depression and lesion location. An attempted replication.

Aerobic fitness level and reactivity to psychosocial stress: Physiological, biochemical, and subjective measures

The role of a physical fitness program in the treatment of alcoholism.

An aversive naloxone-morphine interaction in rats.