Showing papers on "Stressor published in 2015"

Work Stress as a Risk Factor for Cardiovascular Disease

Abstract: The role of psychosocial work stress as a risk factor for chronic disease has been the subject of considerable debate. Many researchers argue in support of a causal connection while others remain skeptical and have argued that the effect on specific health conditions is either negligible or confounded. This review of evidence from over 600,000 men and women from 27 cohort studies in Europe, the USA and Japan suggests that work stressors, such as job strain and long working hours, are associated with a moderately elevated risk of incident coronary heart disease and stroke. The excess risk for exposed individuals is 10–40 % compared with those free of such stressors. Differences between men and women, younger versus older employees and workers from different socioeconomic backgrounds appear to be small, indicating that the association is robust. Meta-analyses of a wider range of health outcomes show additionally an association between work stress and type 2 diabetes, though not with common cancers or chronic obstructive pulmonary disease, suggesting outcome specificity. Few studies have addressed whether mitigation of work stressors would reduce the risk of cardiovascular disease. In view of the limited interventional evidence on benefits, harms and cost-effectiveness, definitive recommendations have not been made (e.g. by the US Preventive Services Taskforce) for the primary prevention of cardiovascular disease via workplace stress reduction. Nevertheless, governments are already launching healthy workplace campaigns, and preventing excessive work stress is a legal obligation in several countries. Promoting awareness of the link between stress and health among both employers and workers is an important component of workplace health promotion.

Minority Stress and Stress Proliferation among Same-Sex and Other Marginalized Couples

Abstract: Drawing from 2 largely isolated approaches to the study of social stress-stress proliferation and minority stress-the authors theorize about stress and mental health among same-sex couples. With this integrated stress framework, they hypothesized that couple-level minority stressors may be experienced by individual partners and jointly by couples as a result of the stigmatized status of their same-sex relationship-a novel concept. They also consider dyadic minority stress processes, which result from the relational experience of individual-level minority stressors between partners. Because this framework includes stressors emanating from both status- (e.g., sexual minority) and role-based (e.g., partner) stress domains, it facilitates the study of stress proliferation linking minority stress (e.g., discrimination), more commonly experienced relational stress (e.g., conflict), and mental health. This framework can be applied to the study of stress and health among other marginalized couples, such as interracial/ethnic, interfaith, and age-discrepant couples.

Stress and Type 2 Diabetes: A Review of How Stress Contributes to the Development of Type 2 Diabetes

Abstract: Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention pro...

Greater amygdala activity and dorsomedial prefrontal-amygdala coupling are associated with enhanced inflammatory responses to stress

Abstract: Psychological stress is implicated in the etiology of many common chronic diseases and mental health disorders. Recent research suggests that inflammation may be a key biological mediator linking stress and health. Nevertheless, the neurocognitive pathways underlying stress-related increases in inflammatory activity are largely unknown. The present study thus examined associations between neural and inflammatory responses to an acute laboratory-based social stressor. Healthy female participants (n=31) were exposed to a brief episode of stress while they underwent an fMRI scan. Blood samples were taken before and after the stressor, and plasma was assayed for markers of inflammatory activity. Exposure to the stressor was associated with significant increases in feelings of social evaluation and rejection, and with increases in levels of inflammation. Analyses linking the neural and inflammatory data revealed that heightened neural activity in the amygdala in response to the stressor was associated with greater increases in inflammation. Functional connectivity analyses indicated that individuals who showed stronger coupling between the amygdala and the dorsomedial prefrontal cortex (DMPFC) also showed a heightened inflammatory response to the stressor. Interestingly, activity in a different set of neural regions was related to increases in feelings of social rejection. These data show that greater amygdala activity in response to a stressor, as well as tighter coupling between the amygdala and the DMPFC, are associated with greater increases in inflammatory activity. Results from this study begin to identify neural mechanisms that might link stress with increased risk for inflammation-related disorders such as cardiovascular disease and depression.

Parent support is less effective in buffering cortisol stress reactivity for adolescents compared to children

Abstract: The goal of the present study was to investigate developmental differences in the effectiveness of parent support to alleviate hypothalamic-pituitary-adrenal (HPA) axis stress responses of children (ages 9-10, N = 40) and adolescents (ages 15-16, N = 41). We experimentally manipulated the provision of parent support during the speech preparation period before a modified Trier Social Stress Test (TSST) and examined its effect on levels of salivary cortisol secreted in response to this laboratory stressor. Analyses revealed a significant interaction of condition and age group such that social support from the parent (versus a stranger) significantly eliminated the cortisol stress response in children, but had no effect on the response among adolescents.

Communicating Social Support in Computer-mediated Contexts: A Meta-analytic Review of Content Analyses Examining Support Messages Shared Online among Individuals Coping with Illness

Abstract: Research on social support during the past two decades has been marked by a growth in scholarship examining supportive communication in computer-mediated contexts among individuals coping with illness. In an effort to summarize and advance this body of research, a meta-analytic review of content analyses was conducted. Across the 41 content analyses examining social support messages shared in health-related contexts online, informational and emotional support messages were most prevalent. Additionally, the prevalence of particular types of support messages varied based on several stressor dimensions relevant to illness. Nurturant forms of support were more common among content analyses examining health conditions likely to threaten personal relationships as well as among content analyses focusing on health conditions with a greater potential for loss in the form of death. Action-facilitating types of support were more common among content analyses examining more chronic conditions. The findings from this ...

Gender roles and traits in stress and health

Abstract: Women have a life-expectancy advantage over men, but a marked disadvantage with regards to morbidity. This is known as the female–male health-survival paradox in disciplines such as medicine, medical sociology, and epidemiology. Individual differences in physical and mental health are further notably explained by the degree of stress individuals endure, with women being more affected by stressors than men. Here, we briefly examine the literature on women’s disadvantage in health and stress. Beyond biological considerations, we follow with socio-cognitive explanations of gender differences in health and stress. We show that gender roles and traits (masculinity in particular) explain part of the gender differences in stress, notably cognitive appraisal and coping. Stress in turn degrades health. Implications are discussed. In conclusion, traditional socialization is advantageous for men in terms of health.

Stress, arousal, and sleep

Abstract: Stress is considered to be an important cause of disrupted sleep and insomnia. However, controlled and experimental studies in rodents indicate that effects of stress on sleep-wake regulation are complex and may strongly depend on the nature of the stressor. While most stressors are associated with at least a brief period of arousal and wakefulness, the subsequent amount and architecture of recovery sleep can vary dramatically across conditions even though classical markers of acute stress such as corticosterone are virtually the same. Sleep after stress appears to be highly influenced by situational variables including whether the stressor was controllable and/or predictable, whether the individual had the possibility to learn and adapt, and by the relative resilience and vulnerability of the individual experiencing stress. There are multiple brain regions and neurochemical systems linking stress and sleep, and the specific balance and interactions between these systems may ultimately determine the alterations in sleep-wake architecture. Factors that appear to play an important role in stress-induced wakefulness and sleep changes include various monominergic neurotransmitters, hypocretins, corticotropin releasing factor, and prolactin. In addition to the brain regions directly involved in stress responses such as the hypothalamus, the locus coeruleus, and the amygdala, differential effects of stressor controllability on behavior and sleep may be mediated by the medial prefrontal cortex. These various brain regions interact and influence each other and in turn affect the activity of sleep-wake controlling centers in the brain. Also, these regions likely play significant roles in memory processes and participate in the way stressful memories may affect arousal and sleep. Finally, stress-induced changes in sleep-architecture may affect sleep-related neuronal plasticity processes and thereby contribute to cognitive dysfunction and psychiatric disorders.

Occupational stress, anxiety and coping strategies in police officers

Abstract: BACKGROUND Studies on occupational stress have shown that police officers are exposed to stressful events more often than other workers and this can result in impaired psychosocial well-being and physical health. AIMS To measure the level of stress experienced, the consequences in terms of anxiety and the coping strategies adopted in a sample of police officers working in a large city in northern Italy. METHODS We used the Police Stress Questionnaire and the Distress Thermometer to measure occupational stress, the State-Trait Anxiety Inventory to measure anxiety and the Brief COPE questionnaire to measure coping strategies. RESULTS Six hundred seventeen police officers completed the questionnaire, a response rate of 34%. Differences between genders, sectors and roles emerged, but overall the study population generally demonstrated good use of positive coping strategies. Women in all operational service roles were more vulnerable to both organizational and operational stressors than men (P < 0.001), while in the interior department, men were more vulnerable to organizational stressors (P < 0.05). CONCLUSIONS Our results suggest that for Italian police officers, training courses and support in dealing with occupational stress should take into account gender, role and type of work. Tailored training courses and support programmes could be useful and effective tools for preventing stress before it becomes chronic.

Chronic and acute effects of stress on energy balance: are there appropriate animal models?

Abstract: Stress activates multiple neural and endocrine systems to allow an animal to respond to and survive in a threatening environment. The corticotropin-releasing factor system is a primary initiator of this integrated response, which includes activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. The energetic response to acute stress is determined by the nature and severity of the stressor, but a typical response to an acute stressor is inhibition of food intake, increased heat production, and increased activity with sustained changes in body weight, behavior, and HPA reactivity. The effect of chronic psychological stress is more variable. In humans, chronic stress may cause weight gain in restrained eaters who show increased HPA reactivity to acute stress. This phenotype is difficult to replicate in rodent models where chronic psychological stress is more likely to cause weight loss than weight gain. An exception may be hamsters subjected to repeated bouts of social defeat or foot shock, but the data are limited. Recent reports on the food intake and body composition of subordinate members of group-housed female monkeys indicate that these animals have a similar phenotype to human stress-induced eaters, but there are a limited number of investigators with access to the model. Few stress experiments focus on energy balance, but more information on the phenotype of both humans and animal models during and after exposure to acute or chronic stress may provide novel insight into mechanisms that normally control body weight.

Hindrances are not threats: advancing the multidimensionality of work stress.

Abstract: The challenge-hindrance framework has proved useful for explaining inconsistencies in relationships between work stressors and important outcomes. By introducing the distinction between threat and hindrance to this framework, we capture the potential for personal harm or loss (threat) associated with stressors, as distinct from the potential to block goal attainment (hindrance) or promote gain (challenge). In Study 1, survey data were collected from 609 retail workers, 220 of whom responded 6 months later. The results supported a 3-factor threat-hindrance-challenge stressor structure and showed that threat stressors are associated with increased psychological distress and emotional exhaustion, and reduced dedication, whereas hindrance stressors undermine dedication but may not be related to distress or exhaustion with threats included in the model. Study 2 utilized a diary study design, with data collected from 207 workers over 3 workdays. Findings revealed that the threat, hindrance, and challenge appraisals of individual workers are statistically distinct, and associated with stressors and well-being as anticipated: threats with role conflict and anxiety, hindrances with organizational constraints and fatigue, and challenges with skill demands and enthusiasm. Overall, moving to a 3-dimensional challenge-hindrance-threat framework for stressors and stress appraisals will support a more accurate picture regarding the nature, processes, and effects of stressors on individuals and organizations, and ensure prevention efforts are not misguided.

Stress among Medical Students and Its Association with Substance Use and Academic Performance

Abstract: Background. Chronic stress among medical students affects academic performance of students and leads to depression, substance use, and suicide. There is, however, a shortage of such research evidence in Ethiopia. Objective. We aimed to estimate the prevalence and severity of stress and its association with substance use and academic performance among medical students. Methods. A cross-sectional survey was conducted on a sample of 329 medical students at Jimma University. Data were collected using the General Health Questionnaire (GHQ-12), Medical Students Stress Questionnaire (MSSQ-20), and Drug Abuse Surveillance Test (DAST). Data were analyzed using SPSS version 20.0. Logistic regression analysis and Student’s -test were applied. Results. The mean age of the respondents was 23.02 (SD = 2.074) years. The current prevalence of stress was 52.4%. Academic related stressor domain was the main source of stress among 281 (88.6%) students. Stress was significantly associated with khat chewing [AOR = 3.03, 95% CI (1.17, 7.85)], smoking [AOR = 4.55, 95% CI (1.05, 19.77)], and alcohol intake [AOR = 1.93, 95% CI (1.03, 3.60)]. The prevalence of stress was high during the initial three years of study. Stress was significantly ( ) but negatively ( ) correlated with academic achievement. Conclusion. Stress was a significant problem among medical students and had a negative impact on their academic performance. Year of study, income, and substance use were associated with stress. Counseling and awareness creation are recommended.

Do Stressed Mothers have Heavier Children? A Meta‐Analysis on the Relationship Between Maternal Stress and Child Body Mass Index

Abstract: In 2007–2008, 9.5% of infants and toddlers in the United States and 16.9% of children aged 6 to 19 years were estimated to be obese 1. Child obesity prevention programs typically emphasize making changes to children’s diet and physical activity behaviors, and such programs have shown moderate success 2, 3. Although including child caretakers has been recommended for boosting obesity prevention program success, 4 targeting specific changes in mothers’ behaviors has not often been a focus of childhood obesity prevention programs. Programs that have targeted parenting practices, such as child-feeding strategies, rarely address issues such as parents’ depression, emotional distress, or anxiety 5. Yet parents of overweight and obese children report higher rates of negative emotions 6, 7. Growing evidence suggests that mothers’ psychological stress is associated with children’s decreased consumption of fruits, vegetables and high-calcium foods 8, as well as lower physical activity parenting, perceived lower importance of child physical activity, and higher child sedentary behavior 9, 10. These behaviors increase children’s risk for obesity or compromised nutritional status 5, 7, 11–17. Studies examining different facets of parental stress such as social, financial, and parenting stress show associations with increased rates of obesity in children 15, 17, 18. However, not all studies find a significant relationship between parental stress and child obesity risk.19–21 Conflicting findings underscore the need for conclusive, summative evidence. Untested moderators such as type of maternal stress, child’s own experience of stress, and child age may account for the observed inconsistencies in the size and direction of the association between maternal stress and child obesity. In particular, mothers’ stress that is specifically tied to parenting may be associated with child obesity risk in ways that differ from other types of stress. Parenting stress is characterized by feelings of distress combined with a dysfunctional parent-child relationship and a difficult child. 22, 23 Parenting stress has been shown to interact with parenting behaviors, 24 but whether its effect on child obesity risk is stronger than that of generalized stress remains an open question. In addition, children’s experience of stress may exacerbate the effects of maternal stress on children’s obesity risk. In children, chronic stress repeatedly activates the hypothalamic-pituitary-adrenal axis (HPA) and release of stress hormones (e.g., glucocorticoids), which are associated with subsequent metabolic syndrome, including visceral adiposity, with particularly damaging effects during crucial stages of brain development 25–27. Stressors experienced by the child, such as maltreatment and abuse, have been associated with higher rates of concurrent and subsequent obesity 28, 29. Finally, child age may moderate the relationship between maternal stress and child obesity, with a smaller effect for older children. Although parent feeding practices play an important role in child eating behaviors, childcare and school settings have an increasingly strong influence as children spend more time away from home with age 30. Peers and media also contribute to child dietary consumption patterns 31, and media exposure may increase as children age. For infants, the introduction of solid foods creates variability in their diet, and consistent provision of healthy foods in appropriate quantities could be disrupted by maternal stress. Child age could be a proxy for these types of changes, reducing the effect of maternal stress on the incidence of child obesity risk for older children. The current meta-analysis synthesized data from cross-sectional and longitudinal studies measuring the association between maternal stress and child obesity in order to estimate an overall effect size and test moderators of the effect. Data from cross-sectional studies were expected to provide evidence about whether there are concurrent, but not necessarily directional, associations between stress and obesity. Results from longitudinal studies were expected to shed light on whether maternal stress, especially coupled with children’s stress or present during critical periods of development, increased children’s subsequent obesity risk. Based on the existing evidence, we hypothesized that the effect size for maternal stress and child BMI would be (a) positive, (b) larger when children would have also experienced the stressor, and (c) smaller for older children.

Stress-induced sensitization: the hypothalamic–pituitary–adrenal axis and beyond

Abstract: Exposure to certain acute and chronic stressors results in an immediate behavioral and physiological response to the situation followed by a period of days when cross-sensitization to further novel stressors is observed. Cross-sensitization affects to different behavioral and physiological systems, more particularly to the hypothalamus-pituitary-adrenal (HPA) axis. It appears that the nature of the initial (triggering) stressor plays a major role, HPA cross-sensitization being more widely observed with systemic or high-intensity emotional stressors. Less important appears to be the nature of the novel (challenging) stressor, although HPA cross-sensitization is better observed with short duration (5-15 min) challenging stressors. In some studies with acute immune stressors, HPA sensitization appears to develop over time (incubation), but most results indicate a strong initial sensitization that progressively declines over the days. Sensitization can affect other physiological system (i.e. plasma catecholamines, brain monoamines), but it is not a general phenomenon. When studied concurrently, behavioral sensitization appears to persist longer than that of the HPA axis, a finding of interest regarding long-term consequences of traumatic stress. In many cases, behavioral and physiological consequences of prior stress can only be observed following imposition of a new stressor, suggesting long-term latent effects of the initial exposure.

Stress in Atlantic salmon: response to unpredictable chronic stress

Abstract: Combinations of stressors occur regularly throughout an animal's life, especially in agriculture and aquaculture settings. If an animal fails to acclimate to these stressors, stress becomes chronic, and a condition of allostatic overload arises with negative results for animal welfare. In the current study, we describe effects of exposing Atlantic salmon parr to an unpredictable chronic stressor (UCS) paradigm for 3 weeks. The paradigm involves exposure of fish to seven unpredictable stressors three times a day. At the end of the trial, experimental and control fish were challenged with yet another novel stressor and sampled before and 1 h after that challenge. Plasma cortisol decreased steadily over time in stressed fish, indicative of exhaustion of the endocrine stress axis. This was confirmed by a lower cortisol response to the novel stressor at the end of the stress period in chronically stressed fish compared with the control group. In the preoptic area (POA) and pituitary gland, chronic stress resulted in decreased gene expression of 11βhsd2 , gr1 and gr2 in the POA and increased expression of those genes in the pituitary gland. POA crf expression and pituitary expression of pomc s and mr increased, whereas interrenal gene expression was unaffected. Exposure to the novel stressor had no effect on POA and interrenal gene expression. In the pituitary, crfr1 , pomc s, 11βhsd2 , gr s and mr were down-regulated. In summary, our results provide a novel overview of the dynamic changes that occur at every level of the hypothalamic-pituitary gland–interrenal gland (HPI) axis as a result of chronic stress in Atlantic salmon.

Stress and Coping Mechanisms: A Historical Overview

Abstract: Stress is not new experience to all of us, it’s seen as modern society’s illness, as most people, no matter how well adjusted, will suffer at least short-term distress while they negotiate periods of transition, trauma, challenges and loss. Stress has great impact on one performance and efficiency; however, the intense pressure and the demands of coping determine the consequence of stress on performance. Therefore, this paper discusses on the relationship between stress and coping mechanisms. The purpose of this study is twofold: to understand the history of stress related problems, and to provide suitable model that brings all ways of coping mechanism into one. Eventually, the important variables or factors associated with stress, and their direct or indirect effects on various outcome measures such as mental health, physical health, and performance will be taken into account. The result and the explanations of this literature might help everyone to find out the main reason for their stressors, best way to cope and greatest technique to use in managing stress. DOI: 10.5901/mjss.2015.v6n2s1p479

Stress effects on the neural substrates of motivated behavior

Abstract: Exposure to stress has profound, but complex, actions on motivated behavior and decision-making. These effects are central to core symptoms of a number of psychiatric disorders that are precipitated or augmented by stress, such as depressive disorders and substance use disorders. Studying the neural substrates of stress's effects on motivation has revealed that stress affects multiple targets on circuits throughout the brain using diverse molecular signaling processes. Moreover, stress does not have unitary effects on motivated behavior, but differences in the intensity, duration, intermittency, controllability and nature of the stressor produce qualitatively and quantitatively different behavioral endpoints. Unsurprisingly, the results of neuroscientific investigations into stress and motivation often open more questions than they resolve. Here we discuss contemporary results pertaining to the neural mechanisms by which stress alters motivation, identify points of contention and highlight integrative areas for continuing research into these multifaceted complexities.

Causes of stress before, during and after organizational change: a qualitative study

Abstract: Purpose – Since prior empirical research has seldom compared causes of stress before, during and after organizational change the purpose of this paper is to identify stressors as change unfolded over time and to identify what led to variations in stress levels. Design/methodology/approach – Semi-structured interviews were conducted in 2012 with 31 staff in clinical and non-clinical positions in a New Zealand public health organization that had experienced considerable change. Findings – For most respondents the transition phase was the most stressful as it created job insecurity and was handled with insufficient information, consultation and support. For the balance stress increased after the change, which created additional demands that usually needed to be met with fewer resources. The stress of others emerged as a new category of stressor during the transition stage. Research limitations/implications – Memories fade and the lines between stages of change are often blurred with one change sometimes occu...

Pregnant women's cognitive appraisal of a natural disaster affects DNA methylation in their children 13 years later: Project Ice Storm.

Abstract: Prenatal maternal stress (PNMS) can impact a variety of outcomes in the offspring throughout childhood and persisting into adulthood as shown in human and animal studies. Many of the effects of PNMS on offspring outcomes likely reflect the effects of epigenetic changes, such as DNA methylation, to the fetal genome. However, no animal or human research can determine the extent to which the effects of PNMS on DNA methylation in human offspring is the result of the objective severity of the stressor to the pregnant mother, or her negative appraisal of the stressor or her resulting degree of negative stress. We examined the genome-wide DNA methylation profile in T cells from 34 adolescents whose mothers had rated the 1998 Quebec ice storm's consequences as positive or negative (that is, cognitive appraisal). The methylation levels of 2872 CGs differed significantly between adolescents in the positive and negative maternal cognitive appraisal groups. These CGs are affiliated with 1564 different genes and with 408 different biological pathways, which are prominently featured in immune function. Importantly, there was a significant overlap in the differentially methylated CGs or genes and biological pathways that are associated with cognitive appraisal and those associated with objective PNMS as we reported previously. Our study suggests that pregnant women's cognitive appraisals of an independent stressor may have widespread effects on DNA methylation across the entire genome of their unborn children, detectable during adolescence. Therefore, cognitive appraisals could be an important predictor variable to explore in PNMS research.

Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study.

Abstract: Stress among women is common, with 23% of U.S. women reporting high levels of stress and nearly 69% reporting stress levels above what is considered healthy.1 Psychosocial or perceived stressors, defined as challenges that individuals view as taxing or exceeding their coping abilities,2 are of particular concern for women's health, as they can increase the risk of adverse health outcomes, including cardiovascular disease, depression, and autoimmune disorders.2 Among premenopausal women, prolonged physical stressors such as excessive dieting or intensive exercise have been linked to reproductive dysfunction (e.g., hypothalamic amenorrhea),3 but the effects of short-term perceived stress on reproductive hormones and ovulatory function among healthy eumenorrheic women are unknown. Multiple pathways have been proposed linking perceived stress with reproductive function, including activation of the hypothalamic pituitary adrenal (HPA) axis leading to a delay or inhibition of the luteinizing hormone (LH) surge3, and activation of the sympathetic medullar system leading to altered blood flow through the fallopian tubes and interrupted gamete transport.4 While both nonhuman primate and experimental studies in humans have helped inform mechanistic hypotheses,5, 6 few studies have assessed the effects of stress on reproductive hormones and menstrual cycle function among premenopausal women; none of these prospectively assessed perceived stress or used more than one stress instrument.7, 8 Global measures of psychosocial stress, such as the Perceived Stress Scale (PSS),9 have been used for decades to study relationships between stress and adverse health outcomes. However, recent evidence indicates that daily perceived stress captured via diary designs have the added advantage of not only reducing memory bias by minimizing the time elapsed between an experience and the account of the experience, but also of capturing within-person changes in perceived stress over time.10,11 Additionally, capturing perceived stress via a daily diary is particularly relevant when exploring the temporal relationship between stress and menstrual cycle function.12 To better understand the potential effects of multiple psychosocial stressors on reduced female fecundity, 4, 13 larger population-based studies with repeated measurements of daily stressors, hormones, and ovulation over more than one menstrual cycle are needed. To address this gap, we evaluated the association between perceived stress, captured via both a daily diary and the PSS, and reproductive function among a cohort of healthy premenopausal women.