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There have been several attempts to subtype depression in prior research, but none of them have gained sustained traction – with the exception of separating seasonal depression as its own subtype. Prior attempts to subtype depression have lacked a convincing theoretical framework. We present the rationale for subtyping depression based on evolutionary psychiatry, arguing that depression is not a single disorder but a heterogeneous syndrome comprising multiple evolutionarily distinct subtypes. From an evolutionary psychiatric perspective, a depressive episode may be (1) a prolonged adaptative response to a specific adaptive problem (thus representing a prolonged version of an adaptive short-term mood change); (2) a maladaptive state arising from an environmental mismatch as a result of modern lifestyle; or (3) a by-product of other adaptations. Depressive episodes caused by the latter two can lead to malfunctioning of the mood-controlling system. This can produce a pathological depressive state without any adaptive function. The 12 subtypes of depression discussed in this chapter are: depression induced by (1) infection, (2) long-term stress, (3) loneliness, (4) traumatic experiences, (5) hierarchy conflict, (6) grief, (7) loss of romantic relationship or romantic rejection, (8) postpartum events, (9) the season, (10) chemicals, (11) somatic diseases, and (12) starvation.
An evolutionary perspective on bipolar disorder integrates evolutionary history with psychoneuroimmune mechanisms to explain the various factors that contribute to mood changes between depression and mania. It also highlights the evolutionary novelty of many of these factors. Manic and hypomanic episodes are often triggered by stressful life events, partially because stress can impair the functioning of the internal circadian clock. Stress can also induce gut dysbiosis, low-grade systemic inflammation, and neuroinflammation. However, increased dopaminergic activity observed during mania can suppress inflammatory processes. The anti-inflammatory effect of dopamine can explain the absence of typical manifestations of sickness behavior (such as slow psychomotor activity, lethargy, weakness, and anhedonia) that characterize depression and other inflammatory states but that are absent in mania. In the depressive phase of bipolar disorder, in contrast, the dopaminergic system is downregulated, and symptoms of sickness behavior tend to be present. Astrocytes are another proximate mechanism that dysregulates circadian rhythm, leading to bipolar mood shifts via low sleep quality and quantity. The evolutionary psychoneuroimmunological model presented in this book indicates that bipolar disorder is a result of an environmental mismatch between the environments in which humans evolved and the environments and lifestyles that are typical for contemporary western populations.
The multifactorial risk landscape for depression includes endogenous and exogenous factors ranging from biological sex (higher risk in women), genetics, sex hormones, personality, chronic stress, and environmental toxins. Lower testosterone is associated with worse mood in men, and testosterone replacement therapy has been shown to improve depression symptoms in men with hypogonadism (i.e., having chronically low testosterone levels). In women, the association between testosterone and depression risk is unclear. Women’s mood often follows the cyclical changes in their hormone levels during the menstrual cycle. More broadly, the monoamine hypothesis of depression has long been dominant in psychiatry. The hypothesis posits that the central mechanism underlying clinical depression is the depletion of monoamines (noradrenaline, serotonin, and dopamine) and the resulting downregulation of neurotransmission. Recent large-scale genetic research does not, however, lend support to the hypothesis. Despite decades of behavioral genetic research, there seems to be no single gene that explains why some people are more likely to get depressed than others. Genes do play a role in depression risk, but the risk is polygenic, likely consisting of small effects found across hundreds of genetic loci. Genetics alone do not by any means wholly dictate a person’s mental health trajectory.
Besides diet, many other lifestyle factors affect the proximate mechanisms underlying increased susceptibility to depression and bipolar disorder. Physical activity and exercise can alleviate both disorders. This can be caused by many different pathways, such as the anti-inflammatory effects of exercise as well as its ability to lower stress hormone levels, improve stress tolerance, improve sleep quality, increase brain-derived neurotrophic factor levels, improve gut microbiota composition, and reduce visceral fat mass, thereby lowering low-grade systemic inflammation. Other lifestyle interventions for depression and bipolar disorder discussed in this chapter include improving sleep quality and quantity by using such chronobiological therapies as bright light therapy; improving mental health outcomes by avoiding smoking and alcohol; taking care of oral health to reduce risk of low-grade systemic inflammation; having a social life that provides salutary effects on mental health; reducing exposure to media; and being regularly exposed to the healing power of nature. Although many of these interventions mimic characteristics associated with the evolutionary lifestyle of Homo sapiens, romanticizing the lifestyle of hunter-gatherers is beside the point; instead, an evolutionarily informed twenty-first-century approach to depression and bipolar disorder can adopt the best parts of contemporary and ancestral human lifestyles.
Placental pathologic examination plays a crucial role in identifying mechanisms contributing to adverse fetal and neonatal outcomes, particularly concerning brain injury. While correlations between placental pathology and intrauterine stressors are established in literature, the challenge lies in the interpretation of these findings within the clinical context of individual cases. This difficulty arises from limited prospective studies linking specific clinical abnormalities to placental pathology and the scarcity of relevant animal models, resulting in largely retrospective, population-based associations. Therefore, interpretation of abnormal placental findings and their potential contribution to neurologic outcomes often requires nuanced consideration. The authors’ consensus presented here underscores the evolving framework of experimental data that inform clinicopathologic interpretations, emphasizing the need for continuous improvement in the diagnostic accuracy and insights derived from placental examinations over time. Interpretation of placental pathology remains a complex endeavor that can significantly influence clinical management and understanding of neurologic injuries.
How healthy you are is dependent on where you live. Americans suffer more cancers, heart disease, mental illness, and other chronic diseases than those who live in other wealthy nations, despite having the most expensive healthcare system in the world. Why? Embark on a journey to unravel the profound impact of public policies on American health from before birth in Born Sick in the USA: Improving the Health of a Nation. Delve into the intricate web where economic inequality weaves a tapestry of sickness stemming from a highly stressed society. This compelling read illuminates the need for transformative change in social safety nets and public policies to uplift national health and well-being. Through vivid storytelling, the book unveils the symptoms, diagnosis, and 'medicine' required to steer the nation toward a healthier future. Join the movement for a healthier America by embracing the insightful revelations and empowering calls to action presented within the pages of this eye-opening book.
Status comparisons are constantly made in many societies today, leading to an inferiority complex. Income inequality is linked to diverse health and social outcomes in the world, including violence, lack of trust, prevalence of heart failure, environmental degradation, and poor oral health. Chronic stress, induced by inequality, leads to many of the chronic diseases we face. Economic inequality influences power distribution, which is now captured by big corporations in the US. Middle-aged White American men, especially those without college degrees, have seen their mortality increase though drugs, alcohol, and suicides, termed deaths of despair, as their livelihoods have declined because their jobs have migrated to poor countries. Ranking countries by life expectancy situates the US tied with Cuba for longevity
When necessary, the turning on of your stress physiologic response can save your life. Maternal stress can affect the fetus so it engages survival strategies. Socioeconomic inequality in early life impacts adults in various ways. Stress in infancy can be positive, such as when taking the first step, tolerable, such as when a family member is seriously ill but supportive adults are present, or toxic, when there is strong, frequent, or prolonged activation in the absence of buffers, which can have lifelong effects. Stress impacts various cellular organelles and produces inflammation. Cumulative chronic stresses produce wear and tear, limiting effective activation when needed to save your life. Those lower down the socioeconomic gradient have poorer functioning organs and suffer more harmful effects of stress. Ever more common obesity can be related to increasing chronic stresses of modern life. Metabolic syndrome, the way energy is stored, is related to many chronic diseases today. Prenatal stress and low birthweight predispose children to this condition
Cumulative stress exposure is extensively involved in carcinogenesis. However, cancer risk associated with allostatic load (AL), a valid measure of chronic stress, has not been comprehensively evaluated in large cohorts, and the combined effect of AL and personality trait on cancer risk remains unknown.
Methods
This prospective cohort study was conducted based on 245,683 participants from the UK Biobank, with a median follow-up of 13.5 years. The AL score was calculated based on 11 biomarkers. Personality traits were constructed and categorized into two clusters. Multivariable Cox regression model was used to assess the risk of incident cancer according to AL and personality clusters, and multiplicative and additive interactions were evaluated.
Results
High AL was associated with an increased cancer risk compared to low AL (hazard ratio [HR] = 1.06, 95% confidence interval [CI]: 1.04–1.09), particularly for cancers of stomach, liver, kidney, esophageal, lung, colorectal, breast, and leukemia (HR ranged from 1.08 to 1.43). Personality clusters was associated with risk of lung cancer (HR = 1.14, 95% CI: 1.05–1.23), but not overall cancer. Significant synergistic interaction was observed between high AL and ‘nervous-dominant’ personality for overall cancer risk, with the strongest association observed for liver cancer (HR = 1.58, 95% CI: 1.24–2.02).
Conclusions
High AL was related to higher risks of overall cancer and site-specific cancers, particularly when combined with nervous-dominant personality, highlighting the interplay between chronic physiological stress and psychological factors in cancer development.
As the global shift towards autocracy continues and soft political repression rises, it is crucial to understand its long-term health implications. Typical tactics of soft political repression are surveillance, denunciation and harassment, operating beneath the threshold of criminal or violent persecution. Despite its prevalence, soft repression remains underexplored, particularly in terms of its psychobiological health consequences.
Aims
The current study investigates the long-term sequelae of soft political repression in the German Democratic Republic (GDR: 1949–1990), focusing on psychological distress, systemic inflammation and cellular ageing.
Method
The cross-sectional laboratory study included 100 50–78 years old participants from the states of Thuringia and Saxony in Germany. Participants in the repression group (n = 49) had experienced at least two forms of state-organised soft repression in the GDR. The age, gender and origin matched control group reported no such experiences. Psychological measures included depressive, anxiety and trauma symptoms. Physiological health outcomes were measured through the inflammatory markers interleukin-6 and high sensitivity C-reactive protein (hs-CRP), as well as telomere length as a marker of cellular ageing. Resilience, social support and socioeconomic status were included in the analyses as potential buffers of repression effects.
Results
Participants with repression experience (versus control group) scored significantly higher on all psychological distress variables. Furthermore, they exhibited higher levels of interleukin-6, indicating increased systemic inflammation. No group differences were found for hs-CRP or telomere length. However, in the repression group, lower social support was associated with shorter telomeres.
Conclusions
This study is the first to explore the psychobiological health consequences of soft political repression. Findings emphasise its long-term consequences on the psyche and immune system and highlight the potential role of social support in mitigating cellular ageing. As authoritarian tactics are becoming more prevalent worldwide, understanding the impact of soft repression on health is essential for supporting affected individuals.
Noradrenergic activation in the central and peripheral nervous systems is a putative mechanism explaining the link between hypertension and affective disorders.
Aims
We investigated whether these stress-sensitive comorbidities may be dependent on basal noradrenergic activity and whether vascular responses to centrally acting stimuli vary according to noradrenergic activity.
Method
We examined the relation of affective disorders and stress-mediated vascular responses to plasma concentrations of normetanephrine, a measure of noradrenergic activity, in subjects with primary hypertension (n = 100, mean ± s.d. age 43 ± 11 years, 54% male). The questionnaires Patient Health Questionnaire-9 (PHQ-9), 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDSSR-16) and Generalized Anxiety Disorder-7 (GAD-7) were used for evaluation of symptoms of depression and anxiety. Forearm blood flow (strain gauge plethysmography) was used to assess vascular responses to mental stress and to device-guided breathing (DGB), interventions that respectively increase or decrease noradrenergic activity in the prefrontal cortex and locus coeruleus.
Results
Low mood and high anxiety were two- to threefold higher for hypertensive subjects in the highest compared with the lowest normetanephrine tertiles (each P < 0.005). Forearm vasodilator responses to mental stress and vasoconstrictor responses to DGB were attenuated in those with high compared with low normetanephrine (28.3 ± 21% v. 47.1 ± 30% increases for mental stress and 3.7 ± 21% v. 18.6 ± 15% decreases for DGB for highest versus lowest tertiles of normetanephrine, each P ≤ 0.01).
Conclusions
A hyperadrenergic state in hypertension is associated with mood disturbance and impaired stress-modulated vasomotor responses. This association may be mediated by chronic stress impinging on pathways regulating central arousal and peripheral sympathetic nerve activity.
Stress leads to neurobiological changes, and failure to regulate these can contribute to chronic psychiatric issues. Despite considerable research, the relationship between neural alterations in acute stress and coping with chronic stress is unclear. This longitudinal study examined whole-brain network dynamics following induced acute stress and their role in predicting chronic stress vulnerability.
Methods
Sixty military pre-deployment soldiers underwent a lab-induced stress task where subjective stress and resting-state functional magnetic resonance imaging were acquired repeatedly (before stress, after stress, and at recovery, 90 min later). Baseline depression and post-traumatic stress symptoms were assessed, and again a year later during military deployment. We used the Leading Eigenvector Dynamic Analysis framework to characterize changes in whole-brain dynamics over time. Time spent in each state was compared across acute stress conditions and correlated with psychological outcomes.
Results
Findings reveal significant changes at the network level from acute stress to recovery, where the frontoparietal and subcortical states decreased in dominance in favor of the default mode network, sensorimotor, and visual states. A significant normalization of the frontoparietal state activity was related to successful psychological recovery. Immediately after induced stress, a significant increase in the lifetimes of the frontoparietal state was associated with higher depression symptoms (r = 0.49, p < .02) and this association was also observed a year later following combat exposure (r = 0.49, p < .009).
Conclusions
This study revealed how acute stress-related neural alterations predict chronic stress vulnerability. Successful recovery from acute stress involves reducing cognitive–emotional states and enhancing self-awareness and sensory–perceptual states. Elevated frontoparietal activity is suggested as a neural marker of vulnerability to chronic stress.
Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system infrastructures, and a robust assessment of their effectiveness and sustainability. HEE is anchored in the premise that strategic intervention at the individual level, tailored to the needs of the most at-risk people, can pave the way for achieving equitable health standards at a broader population level. HEE provides a scientific framework guiding health equity research to equip the medical community with a robust set of tools to enhance health equity for current and future generations.
The intense socialization of law school is where students are introduced to the pressures that dehumanize the lawyering culture. The law school environment, featuring extreme competition, isolation, and alienation, undermines well-being and can transform students into dispirited zombies. Rather than inspiring positive emotions and the formation of new and robust relationships, the intense workload and stressful learning environment promote negative emotions and deterioration of relationships, when students are forced to compete with each other for the few high grades at the top of the grade curve. Engagement and meaning are thwarted by the mandatory grade curve and the frustration and learned helplessness it generates. The culture of legal practice is not an improvement, with overwork and chronic stress as its key features. Much like the grade curve that drives the competitive learning environment at law schools, the billable hour drives the tradition of overwork in legal practice. Stress intensifies, meaning and purpose are lost, social support deteriorates, and negative emotions take over. International Bar Association research indicates there is a global crisis in lawyer well-being.
Stress causes brain damage. Unrelenting stress is an essential feature of legal education and legal practice, and chronic stress hurts the brain. Lawyers suffer from higher rates of anxiety and depression than the rest of the population and they rank fourth in professions with the highest number of suicides. Lawyers’ anxiety, depression, and suicide rates are likely linked to overwork and exposure to toxic chronic stress. Anxiety and depression can cause changes in the brain that are related to an overactive fight-or-flight stress response system. Lawyer languishing, a state of incomplete mental health, may be a precursor to lawyer’s anxiety or depression. The rat-fumbling researcher Hans Seyle noticed that the discomfort his lab rats suffered made them sick. He used the term stress to describe the general unpleasantness his rats experienced when he routinely dropped, chased, and recaptured them during his experiments. The culture of his lab was making his rats sick. When law school or legal practice cultures subject students or lawyers to a broad array of incessant stressors; the general unpleasantness is prone to make them physically and emotionally sick; and it damages their brain.
Lawyers are the leaders who defend society’s light. Like artists, lawyers must “dream the culture forward.” The responsibility to understand and improve lawyers’ brain health and mental strength extends to our communities because of the privilege, power, and prestige we enjoy. The neuro-intelligent lawyer and legal organization can enlighten government, business, media, education, and philanthropic entities. Like Seth Godin’s insight in The Song of Significance that work is not working for many employees, society isn’t working for many people. Social structures that feature fear, scarcity, exclusion, steep hierarchy, and extreme competition are dehumanizing. And humans are suffering. Maverick lawyer leaders must first dream, and then act, to move the culture forward. They must make neuro-intelligence available to all people, so they can experience the full range of their identities and capabilities. We cannot afford to exclude and lose humans and the light they could bring to the world. These lawyer leaders must educate us about the toxicity of extreme competition and cultures built on fear, scarcity, and chronic stress. These Mavericks can lead the social moonshot movement to further heal and humanize society.
Lawyer leaders can transform cultures that feature chronic stress, overwork, and lawyer impairment into neuro-intelligent cultures that make cognitive well-being a priority, reaping benefit at both the individual and institutional levels. Neuro-intelligent cultures promote brain health and mental strength, and they develop environments rich with cognitive power. Neuroscience and psychology research reveals what a culture of concern and respect can mean to individual lawyers. It also supports moving away from grind culture and toward a healthier and more productive neuro-intelligent culture. The American and International Bar Associations have called for action that improves the well-being of individual lawyers. They have also challenged legal organizations to make the legal profession more sustainable. Transformation of the lawyering culture will involve detoxing from overwork, minimizing burnout, leveraging the energy of both introvert and extrovert lawyers, cultivating neurosignature diversity, facilitating psychological safety, reducing hierarchy, limiting competition, and embracing the Maverick lawyer leader professional identity.
Discrimination on the basis of race, gender identity, and age, among others, has been associated with negative cognitive outcomes. However, the mechanisms by which perceived discrimination impacts cognition are not yet well understood. Discrimination can lead to chronic stress, which disrupts glucocorticoid pathways and induces susceptibility to metabolic dysregulation. On the basis of this prior work, and the known associations between metabolic syndrome and cognition, the current study examined the hypothesis that metabolic syndrome mediates the relationship between discrimination and cognition.
Participants and Methods:
1,063 adults (Mean age = 54.92 years, SD = 11.68) who participated in the Midlife in the United States project were included. Confirmatory factor analysis was used to examine the acceptability of a bifactor model of metabolic syndrome using four subfactors (insulin resistance, adiposity, dyslipidemia, and blood pressure). The mediating effect of the metabolic syndrome latent factor on the association between discrimination and cognition was tested using PROCESS (Hayes, 2013). Exploratory analyses were conducted to examine which cognitive domains and which metabolic syndrome subfactors were driving these relationships. Mediation analyses adjusted for age, race, sex, and education.
Results:
The three most frequently reported reasons for discrimination were gender (n = 209), age (n = 174), and race (n = 129). The CFA of metabolic symptoms was deemed acceptable based on previously outlined goodness of fit criteria (CFI = 0.986, TLI = 0.976, RMSEA = 0.040, SRMR = 0.034). Results of the mediation analysis indicated a significant indirect effect of major events discrimination on the total cognition composite through the general metabolic syndrome factor (B = -0.0029, 95% CI [-0.0016, -0.0066]). Further examination revealed that this relationship was driven through an indirect path of metabolic syndrome on the relationship between discrimination and executive functioning (B = -0.0024, 95% CI -0.0059, -0.0001]). We examined which subfactors were driving these relationships and found that there were significant indirect effects of major events discrimination on total cognition through the insulin resistance (B = -0.0028, 95% CI -0.0065, -0.0003]) and dyslipidemia factors (B = -0.0026, 95% CI -0.0064, -0.0002]).
Conclusions:
Our findings provide evidence that metabolic syndrome can help explain differences in cognitive functioning based on experiences of discrimination, even after adjusting for relevant demographic factors. Results from this study suggest that understanding the impact of perceived discrimination on metabolic syndrome and developing lifestyle interventions that can improve metabolic syndrome may be helpful in reducing stress-related cognitive disparities.
Finding effective, innovative, and accessible methods of coping with and mitigating stress has been increasingly relevant in the midst of the COVID-19 pandemic. To do so, it is important to understand the impact of acute stress responses on cognition, behavior, and emotional functioning. The young adult population in particular has been known to show higher levels of stress. Studies have shown that deep breathing interventions are associated with improved affect, decreased stress levels, and improved cognitive functioning. The autonomic nervous system, particularly the functioning of the vagus nerve, has been thought to be a key mechanism in the effect of breathing on stress and mood. Most studies to date investigating the efficacy of breathing practices in stress reduction and mood improvement have lacked appropriate methodology, including adequate control groups, randomization, and cross-sectional designs. This single-blind, randomized, waitlist-controlled study investigated the feasibility of using a mobile application to train in resonance frequency breathing and its efficacy in reducing stress and improving cognitive functioning in a non-clinical sample of young adults with elevated stress.
Participants and Methods:
80 healthy young adults with elevated stress levels were recruited from the NY/NJ community and the Queens College undergraduate research subject pool. Inclusion criteria: ages 18-29, Perceived Stress Scale score >13. Exclusion criteria: regular (at least 3 times per week) practice of any form of meditation, yoga, or breathing exercise; severe medical or psychiatric disorder; active suicidal ideation; drug or alcohol abuse within the past year; use of medication with a known negative impact on cognition or autonomic nervous system (ANS) arousal. Participants were randomized to a waitlist control group or breathing group. Participants in the breathing group were instructed to complete 10-minute breathing sessions using the free mobile application “The Breathing App” twice a day for five days per week for four weeks. Cognitive assessments were administered over the phone (pre and post-treatment) and self-report measures were completed online due to quarantine restrictions.
Results:
There were no significant main effects of group across any of the neuropsychological variables, including verbal memory, letter fluency, category fluency, cognitive flexibility, processing speed, basic attention span, and working memory. This indicated that breathing training did not significantly impact neuropsychological performance. Mediation analysis also demonstrated that breathing training did not indirectly lead to improvement in basic attention, processing speed, working memory, set-shifting, verbal fluency, category fluency, or cognitive flexibility, through its effects on stress reduction.
Conclusions:
These results do not support literature suggesting that breathing at resonance frequency is associated with improved cognitive functioning such as greater cognitive flexibility, improved decision-making, stronger response inhibition, faster processing speed, and increased working memory. Future study designs should consider implementing active control groups (e.g., mindfulness meditation) and differential dosages of the breathing treatment.
Psychosocial stress has been associated with impaired cognition and risk for neurodegenerative disease. However, the intermediate pathways underlying this relationship are not yet well understood. Chronic exposure to stress causes endocrine and immune dysregulation that can lead to heightened systemic inflammation. Moreover, chronic, low-grade inflammation has been linked to neurodegeneration, impaired neurogenesis and cognitive decline. Given the strength of the individual links between stress, inflammation and cognition, the current study tested the hypothesis that inflammatory biomarkers would mediate the relationship between perceived stress and executive functions.
Participants and Methods:
Data from the Midlife in the United States Study (MIDUS) (N=863; Mean age= 52.72) provided measures of perceived psychological stress, inflammatory biomarkers [C-reactive protein (CRP) and interleukin-6 (IL-6)] and executive functions. Structural equation modeling (SEM) was used to test for the mediating effect of inflammation on the relationship between perceived stress and executive functions. Exploratory analyses were conducted to investigate whether sex-differences were driving these relationships. Mediation analyses adjusted for age and history of smoking.
Results:
In the full sample of men and women, there was a significant indirect effect of perceived stress on executive functions through inflammation [ß=-0.021, z=-2.841, p=0.005]. Further examination revealed that this effect was present in women [B=-0.039, z=-2.680, p=0.007] but not men [ß=-0.003, z=-0.558, p=0.577]. While inflammation was negatively associated with executive functions in both men and women [ß=-0.126, z=-1.930, p=0.050; ß=-0.279, z=-0.558, p>0.001], pathways linking perceived stress to inflammation and executive functions were only significant in women [ß=0.014, z=-3.190, p=0.001; ß=-0.192, z=-3.355, p=0.001].
Conclusions:
These findings suggest that inflammatory biomarkers are a viable pathway for explaining how experiencing stress can negatively affect executive functions. Results indicate that women may be particularly vulnerable to the inflammatory and cognitive consequences of stress. As such, psychosocial stress and associated inflammation may be important targets for improving cognitive health outcomes, particularly in women.