A very special thank you to our sponsors:
NaviCare/SoinsNavi
NB bilingual Virtual Health Centre for Children with Complex Care Needs
Our general approach can be titled developmental psychoneuroimmunology (PNI). PNI seeks to unravel interactions between psychological, neural, endocrine, and immune processes and how these processes impact health. More precisely, developmental PNI studies these interactions in early life and subsequent changes to health and immunity across the lifespan.
The mission of the Psychobiology of Stress & Health Lab is to take a biopsychosocial approach to health to investigate the impact of stress and stress-related disorders, namely depression and anxiety, on physical health across the lifespan.
Specifically, we focus on the biobehavioural mechanisms linking stress and health from a developmental perspective. We have a particular interest in: (1) maternal and paternal coping strategies when caring for children with chronic or complex health conditions; (2) patient/family navigation and peer-to-peer support for families of children/youth with complex care needs; & (3) biological (i.e. inflammatory and endocrine) mechanisms linking maternal prenatal depression and anxiety to birth weight, to postnatal stress response, and health.
At PSHL, we have examined behavioural and biological pathways of health, with a focus on the endocrine (HPA axis) and immune (inflammatory biomarkers) processes. In order to do that, we use psychiatric, behavioural, and biomedical methods. We also use mixed methods and qualitative analysis in our health services and clinical research with families of children with complex care needs, mainly around our NaviCare/SoinsNavi and related projects.
NaviCare/SoinsNavi is a free-of-charge, bilingual virtual navigational centre for NB children and families who have complex care needs. These needs may be due to physical, mental or behavioural complex health conditions. In addition to our team of over 30 people, our centre employs two patient navigators and we are now in the process of expanding our services to include peer-to-peer support for family members (children/youth, parents, and siblings). You can read about NaviCare/SoinsNavi here: www.navicarenb.ca
Our other main project about the PNI of pregnancy has been a multi-hospital site (NB, NS) prospective clinical study that investigated the impact of prenatal depressive symptoms and anxiety on maternal biomarkers (CRP, pro-inflammatory cytokines, vitamin D, cotinine, etc.) on birth outcomes. See details under the description of this project.
About 10-12% of Canadian women suffer from prenatal depression. Prenatal depressive symptoms are common and severe, even when they do not reach clinical levels. Since depression and anxiety often co-occur, many pregnant women suffer from new or worsening anxiety symptoms. Prenatal depression may have a detrimental impact on fetal growth. Low birth weight, which is related to increased risk of death, illness, and developmental issues, places an economic burden on our healthcare system. This project investigated: (1) whether prenatal depressive and anxiety symptoms are differentially associated with increased inflammation; and (2) whether inflammation is a plausible mechanism linking prenatal depressive and anxiety symptoms to low birth weight.
Several Honours students worked on sub-parts of this project. Some have been involved as co-authors of publications with our pilot data. Ongoing manuscripts with preliminary findings are underway. This study resulted in a rich dataset hosted at our lab in the Psychology Department at Mount Allison University. This dataset (N = 165 pregnant women and their newborns) includes biomarkers, cord blood and birth outcomes, maternal self-reports, and clinical fetal variables. We would be delighted to collaborate with researchers potentially interested by our data!
Sometimes called one of the most stressful jobs in the country, are the workers in this career satisfied?
Authors: Santander & Azar
Status: Manuscript-in-Progress
Description: The correctional officer (CO) is almost universally understood to be working in a high-stress situation. At times dangerous, at times tedious, the job exacts a toll from almost all who choose the work. We set out to examine satisfaction in COs by analyzing a recent survey issued to all federal employees. More information to follow.
Authors: Lewis & Azar, 2015
Status: Published in the Journal of Men's Health
Description: Feelings of loss resulting from miscarriage can have a significant impact on some men and women. However, in this area of research, men have not received as much attention as women. We have reviewed the literature on men’s depression following miscarriage. More to come!
Authors: Azar, Paquette, Zoccolillo, Baltzer, & Tremblay, 2007
Status: Published in the Journal of Biological Psychiatry
Background: Adolescent pregnancy can be associated with major depression (MD) and conduct disorder (CD). Some infants of adolescent mothers are prenatally exposed to these factors, which may result in heightened risk for perturbations of their stress systems. Between 2 and 4 months, a normal shift occurs in the adrenocortical system in which we observe a marked decrease in infant cortisol response when facing mild stressors. This study aimed to explore whether MD (lifetime, during pregnancy, postpartum), CD, and maternal overcontrol are associated with increased cortisol reactivity in 4-month-old infants of teenage mothers.
Methods: Using arm restraint as a stressor, morning salivary cortisol was taken prestressor and poststressor in 212 infants during a laboratory visit. Major depression and CD were measured with the computerized National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS), postpartum depressive mood was measured with the Edinburgh Postnatal Depression Scale, and overcontrol was observed with the CARE-Index.
Results: Independent of the predictors, there was a dampened cortisol response. Infants of mothers with lifetime MD and of average to highly overcontrolling mothers showed increased cortisol reactivity. Conduct disorder and cortisol levels were not associated.
Conclusions: Future studies should detect whether the absence of a dampened cortisol response in infants whose mothers have lifetime MD or display overcontrolling parenting is stable over time.
Authors: Azar & Richard, 2011
Status: Published in the Journal of Inflammation
Background: We examined salivary C-reactive protein (CRP) levels in the context of tobacco smoke exposure (TSE) in healthy youth. We hypothesized that there would be a dose-response relationship between TSE status andsalivary CRP levels.
Methods: This work is a pilot study (N = 45) for a larger investigation in which we aim to validate salivary CRP against serum CRP, the gold standard measurement of low-grade inflammation. Participants were healthy youth with no self-reported periodontal disease, no objectively measured obesity/adiposity, and no clinical depression, based on the Beck Depression Inventory (BDI-II). We assessed tobacco smoking and confirmed smoking status (non-smoking, passive smoking, and active smoking) with salivary cotinine measurement. We measured salivary CRP by the ELISA method. We controlled for several potential confounders.
Results: We found evidence for the existence of a dose-response relationship between the TSE status and salivary CRP levels.
Conclusions: Our preliminary findings indicate that salivary CRP seems to have a similar relation to TSE as its widely used serum (systemic inflammatory) biomarker counterpart.
Authors: Azar, Paquette, & Stewart, 2010
Status: Published in the Journal of Perinatal Medicine
Background: Prenatal tobacco exposure (PTE) is an important public health concern for the offspring of teen mothers. We examined whether PTE is associated with baseline cortisol levels in four-month-old infants of teenage mothers.
Methods: we assessed salivary cortisol levels of 212 infants. PTE was measured by using self-reports of cigarette smoking during pregnancy. We used a propensity scores matching analysis to compare infants with PTE and those without.
Results: of 212 mothers, 151 smoked during pregnancy. However, there was no association between PTE and infant cortisol levels.
Conclusions: we could not support a relation between PTE and cortisol levels in a sample of four-month-old infants of teenage mothe
Authors: Azar, Nolan, & Stewart, 2012
Status: Published in the Journal of Perinatal Medicine
Background: This study examined whether mild-to-moderate depressive symptoms are associated with increased high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) levels in apparently healthy individuals at high risk for coronary artery disease. We investigated in individuals whether: (1) current depressive symptoms were associated with increased hsCRP and IL-6 levels; (2) persistent depressive symptoms at two time points 6 months apart were associated with hsCRP and IL-6; and (3), sex-based differences in inflammation were a function of depressive symptoms.
Methods: We measured depressive symptoms (twice), hsCRP, and IL-6 (follow-up time point) in 84 apparently healthy individuals (52% women) at high cardiac risk.
Results: Patients with persistent depressive symptoms had higher hsCRP, compared to participants without persistent symptoms (5.55 vs. 1.70 mg/l, p < 0.05, 95% CI 0.11 to 1.09, d = 0.67). Participants with current depressive symptoms had higher hsCRP (3.99 vs. 1.70 mg/l, p = 0.059) than those without symptoms. Findings remained unchanged after controlling for covariates. Women had higher adjusted hsCRP than men (2.91 vs. 1.87 mg/l, p < 0.001). When we entered depressive symptoms, the model remained significant, with a significant interaction between sex and symptoms: women with depressive symptoms had higher hsCRP than men with depressive symptoms and than women without symptoms (6.75 vs. 1.11 mg/l). The hypothesized differences were not observed with respect to IL-6, after controlling for body mass index (95% CI-0.77 to 0.73).
Conclusions: Before a first ischaemic coronary event, persistent mild-to-moderate depressive symptoms were associated with increased hsCRP. Women with depressive symptoms had higher hsCRP than men with symptoms.
Authors: Azar, Zoccolillo, Paquette, Quiros, Baltzer, & Tremblay, 2004 Status: Published in the Journal of the American Academy of Child and Adolescent Psychiatry
Objective: To examine the association between cortisol levels and conduct disorder (CD) in adolescent mothers. Past research has shown that low levels of cortisol were associated with CD, particularly with its aggressive symptoms. The authors tested the hypothesis that adolescent mothers with CD would show lower levels of salivary cortisol compared to mothers without CD at 4 and 9 months postpartum.
Methods: Midmorning salivary cortisol levels were measured in 228 adolescent mothers (age at delivery 16.9 +/- 1 years [mean +/- SD]) during a laboratory visit at 4 and 9 months postpartum. CD was diagnosed during pregnancy according to the CD subsection on the criteria for antisocial personality disorder (DSM-III-R).
Results: Results did not confirm the hypothesis. Lower cortisol levels were not significantly associated with a CD diagnosis, the number of CD symptoms, or aggressive symptoms.
Conclusions: Despite valid measures and strong statistical power, this study failed to find an association between cortisol levels and CD in a sample of adolescent mothers. The results may have been influenced by the fact that participants were 4 and 9 months postpartum and by comparisons of mothers with CD to mothers living in stressful circumstances.
Authors: Azar & Solomon, 2001
Status: Published in the Journal of Pediatric Nursing
Objective: This study identified differences in strategies used by mothers and fathers (N = 60) in coping with their child's insulin-dependent diabetes mellitus. The Ways of Coping Questionnaire (WCQ) was administered during a home interview. Results showed that both parents used planful problem solving, exercised positive reappraisal, and sought social support frequently, with mothers using more planful problem-solving strategies than fathers. Within the family, analyses showed that fathers were more likely to use distancing, independent of the child's sex, whereas mothers were more likely to frequently use all the coping strategies when the child was a girl. The implications of the results for nursing are discussed.
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