The present study aimed to investigate the impact of chronic psychosocial stress and resilience, including at a biological level (immune and neuroendocrine function) in Portuguese citizens with psychic anomaly/mental disorder. The sample aggregated 69 participants. It has been used the following psychometric instruments: 21-item depression, anxiety and stress scales (DASS-21), in the Portuguese validated version; measuring state resilience (MSR), in the Portuguese validated version; the Portuguese scale of 23 questions on vulnerability to stress. Serum levels of cortisol, dehydroepiandrosterone sulfate, antibodies anti-viral capsid antigen of Epstein-Barr virus, triglycerides, high density lipoprotein-cholesterol and body mass index have been measured. It has been concluded that factors of vulnerability to stress and chronic stress, of social nature (lack of social support, adverse living conditions), correlate positively with depression, anxiety and stress, and, through alostatic load, are involved in a greater propensity for immune and neuroendocrine dysfunction in this population.
The structural model of Smith and Lazarus (1993) [
Subjects with low levels of positive affectivity are characterized by sadness, apathy, anxiety, stress and not rewarding social involvement. The negative affectivity and positive affectivity are not independent. The positive affectivity provides a rupture of stress and supports ongoing efforts to replenish depleted resources from stress [
Resilience is a multidimensional phenomenon, defined by Reich, Zautra and Hall (2010) [
genetic factors associated with resilience to stress, immune responsiveness and regulation (biological), positive emotional resources, hope/optimism/agency, cognitive functioning, learning/memory, high executive functioning (individual), safe kinship relationships, close social ties (inter-personal/family), green spaces, involvement in activities in a natural environment (for example, community gardening), voluntarism, satisfactory professional life (community/organizational). Active coping strategies, such as planning and problems solving have been associated with a higher degree of well-being and ability to cope with stress, trauma and disease [
In the present study, a convenience sampling has been selected, with subjects residents in Olhão, Portugal, referred by general practitioners, to a first psychiatric appointment at the outpatient consultation of psychiatry of hospital of Faro, Portugal, with attributed generic diagnostic hypothesis of anxiety and mood disorders (depression), according to the tenth edition of the international classification of diseases of world health organization [
The scales have been validated for their use by Portuguese population. It is presented a brief description of the psychometric scales used in this work.
The Portuguese scale of 23 questions on vulnerability to stress (23QVS) [
21-items depression, anxiety and stress scales (DASS) [
The scale for measuring state resilience(MSR) [
The departure point of this research focused on the biological impact, particularly at the level of immune and neuroendocrine functions, of vulnerability to stress and chronic stress in patients with psychopathological symptomatology (anxiety and depression). The clinical diagnosis has been confirmed according to the results provided by DASS. In line with technical methodology used at laboratorial medicine unit of hospital of Faro, Portugal, there have been collected morning (08:00 AM) blood samples in peripheral venous blood, for: dosing cortisol (chemical luminescence method); titrating levels of antibodies against viral capsid antigen of Epstein- Barr virus (EBV-ab) (EIA method); determining triglycerides (TGL)/high density lipoprotein-cholesterol (HDL) ratio (enzyme method GPO PAP) (biochemical indicators of vulnerability/risk); titrating levels of dehydroepiandrosteronesulfate (DHEA-S) (chemical luminescence method) (biochemical indicator of protection/resi- lience factor). It has been calculated body mass index (BMI). For ethical and deontological reasons, it was not considered a subjects-control group (for not requesting diagnostic tests to healthy subjects). This study is descriptive, transversal and quantitative, correlational, not experimental. It has been used Pearson correlation coefficient r.
The internal consistency values of all used scales are high, attesting the reliability of the results. Cronbach’s alpha coefficient is: 0.864, for 23QVS; 0.945, for DASS-depression; 0.886, for DASS-anxiety; 0.899, for DASS- stress; 0.838, for MSR. Concerning the existence of disorders in participants, taking as references the cutoff points indicated by the used scales, in 62% of the subjects there is vulnerability to stress, 54% exhibit depression, 65% manifest anxiety, 58% have stress and 43% of the participants have resilience. Cortisol levels have an average value of 14.8, with a dispersion of values of 44% (normal range values: 5 - 25 micrograms per deciliter), 89% of the elements present normal cortisol levels, 5% have hypocortisolemia and 6% have hypercortisolemia (with 5 missing values). DHEA-S levels have an average value of 146.7, with a dispersion of values of 82% (normal range values: 35 - 430 micrograms per deciliter), 8% of the elements have values of DHEA-S lower than normal and 3% have higher than normal values (with 5 missing values). EBV-ab levels have an average value of 67.8, with a dispersion of values of 54% (the cutoff point is equal to or greater than 10 Units per milliliter), and 92% of the elements have values greater than EBV-ab normal values (with 5 missing values). The TGL/HDL ratios have an average value of 2.88, with a dispersion of values of 104% (the cutoff point is greater than 3.5), 23% of the elements have values of TGL/HDL ratios higher than normal (with 4 missing values). The BMI have an average value of 26.1, with a dispersion of values of 20% (the cutoff point is greater than 25), 46% of the elements present BMI greater than normal, i.e., overweight (with 2 missing values). In terms of medical comorbidity, 31% of the participants have endocrine and metabolic disease (predominantly, hypercholesterolemia, diabetes) and hypertension, 40% have oncological diseases (predominantly, breast cancer, uterine cancer, prostatic cancer), and auto-immune disease (lupus) (29% of respondents have no comorbidity). When analysis is performed in terms of absolute values, for each variable obtained with the application of 23QVS and biological/physiological measures, it is verified the occurrence of a statistically significant negative correlation between full scale values (vulnerability to stress) and values of EBV-ab, r = −0.274; p = 0.029. Apart from this, there are levels of statistical significance in the correlations between factor 3 of 23QVS (lack of social support) and cortisol values, r = −0.248, p = 0.048, between factor 3 of 23QVS (lack of social support) and EBV-ab, r = −0.264; p = 0.035 and between the factor 4 of 23QVS (adverse living conditions) and EBV-ab, r = −0.277; p = 0.027, remaining negative. The negative correlation between the DASS dimensions and MSR are related in a statistically significant way (r = −0.437, p < 0.01, for the negative correlation between MRS and DASS-depression; r = −0.374, p < 0.01, for the negative correlation between MRS and DASS-anxiety; r = −0.318, p < 0.01, for the negative correlation between MSR and DASS-stress).The 23QVS (vulnerability to stress) and all its dimensions are positively correlated with all dimensions of DASS (depression, anxiety and stress). There have been more strong correlations (above 0.5) between: 23QVS and depression, r = 0.714, p < 0.001; 23QVS and anxiety, r = 0.691, p < 0.001; 23QVS and stress, r = 0.663, p < 0.001; Factor 1 of 23 QVS (perfectionism and intolerance to frustration) and anxiety, r = 0.558, p < 0.001; Factor 1 of 23QVS (perfectionism and intolerance to frustration) and stress, r = 0.599, p < 0.001; Factor 2 of 23QVS (inhibition and functional dependence) and depression, r = 0.656, p < 0.001; Factor 2 of 23 QVS (inhibition and functional dependence) and anxiety, r = 0.579, p < 0.001; Factor 2 of 23 QVS (inhibition and functional dependence) and stress, r = 0.554, p < 0.001; Factor 6 of 23QVS (subjugation) and depression, r = 0.535, p < 0.001; Factor 6 of 23QVS (subjugation) and anxiety, r = 0.547, p < 0.001; Factor 7 of 23QVS (deprivation of affection and rejection) and depression, r = 0.635, p < 0.001; Factor 7 of 23QVS (deprivation of affection and rejection) and anxiety. r = 0.647, p < 0.001; Factor 7 of 23QVS (deprivation of affection and rejection) and stress, r = 0.578, p < 0.001.
In this empirical study, vulnerability to stress correlates positively with depression, anxiety and stress. Also, depression, anxiety and stress correlate negatively with resilience. It has been shown that disturbances of mood and anxiety correlated more consistently with defects in the amygdala, hippocampus, subgenual anterior cingulate cortex and prefrontal cortex [
The lack of social support correlates negatively with serum levels of cortisol. The factor, of vulnerability to stress, lack of social support integrates two dimensions/items (3. When I have problems that bother me I can count on one or more friends to serve me as confidants; 6. When I have a problem to solve I usually have someone for helping me). A large body of epidemiological research suggests that individuals with lack of social support are at greater risk for mental and physical health problems. The low social support is related to higher levels of depression, anxiety and dissatisfaction with life. The existence of social support is also associated with low mortality from all causes, but particularly due to cardiovascular disease. The interface between social support and processes related stress is crucial in understanding these epidemiological associations [
The lack of social support and adverse living conditions correlate negatively with serum levels of anti-Eps- tein-virus antibodies. The factor, of vulnerability to stress, adverse living conditions, integrates two dimensions/ items (4. Often I have enough money to meet my personal needs; 21. The amount of money I have isn’t enough to use it in my essential expenses). Repeated or prolonged stress can determine dysregulation or suppression of immune function. Chronic stress suppresses immune-protective parameters such as the production of antibodies [
In this study, 23% of participants present triglyceride (TGL)/high density lipoprotein-cholesterol (HDL) ratio levels higher than normal; 46% of participants present body mass index (BMI) greater than normal, and, in terms of medical comorbidity, 31% of the participants have endocrine-metabolic disorder (mainly, hypercholesterolemia, diabetes) and hypertension; 40% have oncological disease (predominantly, breast cancer, uterine cancer, neoplasia prostate), and auto-immune disease (lupus). Alostatic load determines long-term effects on cardiovascular system (determining atherosclerosis and cardiovascular disease), brain (with decreased neurogenesis and increased dendritic remodeling in the hippocampus, causing loss of the ability to adapt to environmental requirements), adipose tissue and muscle (determining the development of obesity and metabolic syndrome) and immune system (increasing the risk of infection and autoimmune disease) [
Chronic stress, associated with increased alostatic load, in persons with psychic anomaly/mental disorder may depress immune function (with decreased production of antibodies) and neuroendocrine function (with decreased formation and release of cortisol). This trend is observed in this study, placing subjects with psychic anomaly/mental disorder at risk for infectious, oncologic, autoimmune and endocrine diseases.
EduardoGoncalves,Saul Nevesde Jesus, (2015) Vulnerability and Resilience to Stress and Immune and Neuroendocrine Function in Portuguese Subjects with Psychic Anomaly (Anxiety and Depression). Open Journal of Psychiatry,05,362-373. doi: 10.4236/ojpsych.2015.54041