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  • 1.
    Folkesson Hellstadius, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Psychobiological functioning in mid-adolescent girls and boys: Linkages to self reported stress, self-esteem and recurrent pain2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Among adolescents, the day-to-day functioning of the hypothalamo-pituitary-adrenal-axis (HPA-axis) and of the autonomic nervous system (ANS) and their relationships with stress, subjective health complaints and psychological factors such as self-esteem, studied in naturalistic settings, have been largely unexplored. This thesis aimed to investigate the diurnal activity of the HPA-axis (Studies I & II) in terms of salivary cortisol and the ANS/SNS system (Study III) in terms of salivary alpha-amylase (sAA) in mid-adolescent girls and boys. Additionally, linkages between self-reported stress, self-esteem, recurrent pain and biomarkers were investigated. A further aim was to describe potential differences between girls and boys respectively. Study I showed that both girls and boys exhibited the typical diurnal cortisol profile with high levels in the morning that decreased throughout the day. Girls had higher total cortisol levels, while no differences emerged for measures of the cortisol increase. Study II showed no significant linkages between self-ratings of stress and cortisol. However, stress was associated with recurrent pain in girls. Study III showed that, for girls, both self-esteem and self-reported stress were related to morning levels of both cortisol and sAA, to the diurnal sAA output and to a conjoint measure of amylase over cortisol, AOC. To conclude, the findings suggest that both stress and self-esteem may be linked to different measures of ANS and HPA-axis activity, but also to measures of ANS and HPA-axis dysregulation, particularly among mid-adolescent girls.

  • 2.
    Folkesson Hellstadius, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Viveca, Östberg
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    How do self-reported stress and self-esteem relate to diurnal profiles of salivary alpha-amylase and cortisol in mid-adolescent girls and boysManuscript (preprint) (Other academic)
    Abstract [en]

    Salivary cortisol and alpha-amylase (sAA), that reflect hypothalamo-pituitary-adrenal axis (HPA-axis) activity and sympathetic activity within the autonomic nervous system (ANS) respectively, are biomarkers with pronounced diurnal rhythms. While research on salivary cortisol is increasing, less is known about the diurnal rhythm of sAA, particularly in adolescents. Also, the linkages between individual factors, such as self-esteem, stress and the biomarkers cortisol and sAA and their combinations remain to be investigated. Besides detailing the diurnal rhythms of salivary cortisol and sAA in 14-16 year-old girls and boys, this study investigated how self-reported stress and self-esteem relate to aggregate measures of salivary cortisol and sAA and their combinations. In addition to self-reports in questionnaires, self-administered salivary samples were collected from 47 girls and 23 boys during a school day. Results showed that girls had higher levels of morning cortisol than did boys, while there were no differences in sAA. Moreover, self-esteem and stress were associated with cortisol and sAA measures, but for girls only. Taken together, the findings suggest that both stress and self-esteem are linked to both separate and combined measures of ANS and HPA-axis activity, particularly among mid-adolescent girls.

  • 3.
    Folkesson, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Economic vulnerability and adolescent health: Fragile family finances and health functioning among Swedish adolescents2010In: International Journal of Behavioral Medicine: The Offical Journal of the International Society of Behavioral Medcine / [ed] Joost Dekker, Springer , 2010, p. S275-S275Conference paper (Refereed)
    Abstract [en]

    Background: While adult health is known to vary by socioeconomic status (SES) and gender, less is known about the linkages between socioeconomic circumstances and various aspects of health in adolescents.

    Aim: This study set out to investigate how household financial insecurity relates to different aspects of health in adolescent girls and boys aged 10-18.

    Method: Data came from the Swedish Child LNU and Child-Ulf studies of 2000-2003 that include approximately 5400 children aged 10-18 who answered questions relating to health. Parents were also asked to report "cash-margin" a frequently used single-item measure asking whether parents can access 12,000 SEK in a week's time if they have to.

    Results: A majority, 85% of the parents were able to access 12,000 SEK in a week if necessary while 15% were unable to do so. Analyses performed separately for girls and boys showed significant main effects of cash margin on somatic health, negative functioning and positive functioning for both groups. There was no significant age x cash margin interactions. Cash margin was significantly related to stomach ache, insomnia, difficulties concentrating, irritability, short temperedness, sadness, tension/nervousness, belief in the future, endurance and happy mood in both girls and boys. Girls with no cash margin reported more headache while boys with no cash margin reported higher levels of self-assurance. No other significant relationships emerged.

    Discussion: While most previous studies use symptom and problem indices, this study covers multiple aspects of health functioning. To conclude, fragile family finances during adolescence as reflected in poor positive functioning and high levels of negative functioning suggest stressful living conditions that may influence academic achievement, life-choices and future health.

  • 4.
    Folkesson, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Riva, Roberto
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Single and aggregate salivary cortisol measures during two schooldays in midadolescent girls and boys2014In: PsyCh Journal, ISSN 2046-0252, E-ISSN 2046-0260, Vol. 3, no 2, p. 121-131Article in journal (Refereed)
    Abstract [en]

    Abstract: The hypothalamic-pituitary-adrenal (HPA) axis, including its regulation of cortisol, is central to bodily functioning and salivary cortisol is a commonly used biomarker that reflects the functioning of the HPA axis. However, knowledge of diurnal cortisol rhythms in healthy adolescents is limited and few studies have examined patterns in midadolescent girls and boys across single and aggregate cortisol measures. To fill this gap, the present study investigated single and aggregate cortisol measures reflecting diurnal rhythms in 14 to 16-year-old girls and boys. Self-administered salivary samples from 79 girls and 42 boys were collected during two schooldays at four timepoints: (a) immediately at awakening, (b) 30 min after waking up, (c) 60 min after waking up, and (d) at 8:00 p.m. Additionally, diary data including time of awakening, sampling times, and other potential confounders were analyzed. As for single measures, both girls and boys exhibited a typical diurnal cortisol profile with high levels in the morning that decreased throughout the day. However, girls had higher morning cortisol than did boys with significant differences at time of awakening, and at 30 and 60 min postawakening. For the aggregate measures, girls had a larger total level of cortisol in terms of cortisol awakening response (CARG), area under the curve (AUCG), and rise over run (slopeawake to last), while no differences emerged for reactivity measures. Taken together, these findings suggest differences in single and aggregate cortisol measures between midadolescent girls and boys. Such differences in diurnal cortisol between pubertal girls and boys may play a role for the differential health trajectories typically found among adult women and men.

  • 5.
    Folkesson, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Östberg, V.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Self-esteem and stress as associated with diurnal profiles of salivary alpha-amylase and cortisol in mid-adolescents2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, no 1 (Suppl.), p. S116-Article in journal (Other academic)
    Abstract [en]

    Salivary cortisol and alpha-amylase (sAA) that reflect hypothalamopituitary-adrenal axis (HPA-axis) activity and sympathetic activity within the autonomic nervous system (ANS) respectively, are biomarkers with pronounced diurnal rhythms. While research on salivary cortisol is increasing, little is known about the diurnal rhythm of salivary alphaamylase, particularly in adolescents. Also, the linkages between individual factors and self-reports of stress as related to HPA-axis activity and autonomic/sympathetic functioning remain to be investigated. This study set out to investigate diurnal rhythms of salivary cortisol and alpha-amylase in 14-16 year-old girls and boys. Moreover, the study investigated whether stress and self-esteem are related to aggregate salivary cortisol and alpha-amylase measures. Besides self-reports in questionnaires, self-administered salivary samples were collected from 47 girls and 23 boys during a school day. Results showed girls had higher levels of morning cortisol than did boys, while there were no differences in morning or diurnal sAA. Additionally, self-esteem and self-reported stress were associated with different measures of cortisol and sAA but for girls only. Taken together, the findings suggest that both self-reported stress and self-esteem are linked to various aspects of sympathetic ANS activity and HPA-axis activity, particularly among mid-adolescent girls.

  • 6.
    Fransson, Emma
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bergström, Malin
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Exploring salivary cortisol and recurrent pain in mid-adolescents living in two homes2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, p. S23-S23Article in journal (Refereed)
    Abstract [en]

    Introduction: Every year, around 50.000 children in Sweden experience a separation between their parents. Joint physical custody (JPC), where the child alternates homes between the parents for about equal amount of time, has become a common living arrangement after parental separation. Children living in two homes can benefit from everyday contact with both parents and access to both parents’ financial resources. However, children can also experience stress from constantly moving and from exposure to any parental conflict. Yet, research on JPC and stress-related biological functioning is limited. The aimof this study was to investigate how living arrangements (intact family/JPC) relate toHPA-axis activity and recurrent pain in mid-adolescents. Methods: Mid-adolescents (106 girls and 51 boys) provided demographic details, self-reports of recurrent pain (headache, stomachache, neck/shoulder and back pain) and salivary samples. Salivary cortisol samples were collected: 1) immediately at awakening, 2) +30 minutes, 3) +60 minutes, and 4) at 8 p.m. Results: Hierarchical regressions showed that living arrangements did not predict morning cortisol levels, the diurnal cortisol rhythm nor recurrent pain. However, sex was significantly associated with both morning cortisol and recurrent pain. Conclusion: Living arrangements were not linked to HPA-axis activity or recurrent pain in this group of well-functioning mid-adolescents. Although this is the first study investigating how living arrangements relate to HPA-axis functioning, which means that additional research is needed, the findings suggest that these mid-adolescents have adapted to their living arrangements and that other factors seem more pertinent for HPA-functioning and subjective health complaints.

  • 7.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Folkesson Hellstadius, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Stress hos flickor och pojkar i tonåren2014In: Psykisk hälsa, ISSN 0033-3212, no 4, p. 30-36Article in journal (Other academic)
    Abstract [sv]

    Under senare år har stress bland ungdomar uppmärksammats i ökad utsträckning. Det hänger samman med att ungdomar i skolålder rapporterar vad som anses vara höga nivåer av upplevd stress och stressrelaterade besvär. Förekomsten av stress ser dock olika ut mellan flickor och pojkar men hänger också samman med ålder. Vanligen rapporterar yngre flickor och pojkar ungefär jämförbara nivåer av stress. Men under tonårstiden ökar skillnaderna. Flickor rapporterar stress och stressrelaterade besvär i större utsträckning än pojkar i samma ålder. Med tanke på att tonårstiden är förenad med olika förändringar och utmaningar av exempelvis fysiologisk, psykologisk och social karaktär är det rimligt att anta att dessa förändringar innebär att tonåringar har att hantera delvis nya situationer. De utmaningar och krav som det medför kan upplevas som stressiga. Utöver att kortfattat beskriva olika källor till stress bland elever i grundskolans årskurs 7–9 kommer vi här att diskutera vad stress är, hur det kan studeras,samt presentera resultat från ett pågående forskningsprojekt som fokuserar på en grupp ungdomar i grundskolans årskurs 8 och 9.

  • 8.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Folkesson Hellstadius, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Perceived stress, recurrent pain, and aggregate salivary cortisol measures in mid-adolescent girls and boys2017In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 58, no 1, p. 36-42Article in journal (Refereed)
    Abstract [en]

    Measures of perceived stress have been criticized for theoretical inconsistency. However, the validated pressure activation stress scale has been suggested as a theoretically sound alternative. But it is unclear how pressure and activation stress relate to objective and subjective measures including commonly used aggregate cortisol measures and health complaints respectively. Specifically, this study aimed at investigating how pressure and activation stress were related to aggregate salivary cortisol measures and recurrent pain in mid-adolescent girls and boys. Mid-adolescents (119 girls and 56 boys) provided self-reports in questionnaires on activation and pressure stress and recurrent pain (headache, stomach ache, neck/shoulder and back pain). Additionally, adolescents sampled saliva during an ordinary school day: (1) immediately at awakening; (2) 30 minutes after waking up; (3) 60 minutes after waking up, and (4) at 8 p.m. These samples were analyzed for cortisol. Hierarchical regressions showed no statistically significant associations between activation and pressure stress and cortisol, neither for girls nor for boys. However, activation and pressure stress were significantly associated with recurrent pain but only for girls. The findings may relate to subjective and objective measures reflecting distinct aspects of stress-related functioning. However, the study participants included mid-adolescents whose bodily systems are flexible and still relatively unaffected by the strain of their daily stress perceptions. To conclude, the non-significant relationships between activation and pressure stress and commonly used aggregate measures of cortisol adds to the understanding of how perceived stress may relate to physiological functioning in the daily life of adolescents when using such aggregate measures.

  • 9.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Linking self-reported stress to aggregate cortisol measures and recurrent pain in midadolescent girls and boys2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, no S1, p. S179-S180, article id P605Article in journal (Refereed)
    Abstract [en]

    Introduction: Previous research has developed an 11-item self-report measure assessing activation and pressure stress among adolescents. However, the biological correlates of this measure are unclear. Considering this, the present study investigated how perceived stress relates to aggregate cortisol measures and recurrent pain in mid-adolescent girls and boys. Methods: Mid-adolescents (119 girls and 56 boys) provided self-ratings of activation and pressure stress and recurrent pain (headache, stomachache, neck/shoulder and back pain) in questionnaires. Additionally, adolescents sampled saliva during an ordinary school day: 1) immediately at awakening, 2) 30 minutes after waking up, 3) 60minutes after waking up, and 4) at 8 p.m. Aggregate cortisol measures including ground and increase measures of the area under the curve and a diurnal slope measure were computed. Hierarchical regression analyseswere performed for girls and boys respectively. Results: Activation and pressure were significantly associated with recurrent pain in girls but not in boys. However, there were no significant associations between self-ratings of stress and salivary cortisol, neither for girls nor for boys. Conclusion:While self-rated activation and pressure stress were related to recurrent pain in girls, but not in boys, neither activation nor pressure was linked to any of the aggregate cortisol measures. The differences between subjective and objective measures perhaps relate to these measures reflecting distinct and unrelated aspects of functioning. However, the findings may also result from the participants being mid-adolescents whose bodily systems are flexible and still unaffected by daily activation and pressure stress.

  • 10.
    Östberg, Viveca
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The Complexity of Stress in Mid-Adolescent Girls and Boys2015In: Child Indicators Research, ISSN 1874-897X, E-ISSN 1874-8988, Vol. 8, no 2, p. 403-423Article in journal (Refereed)
    Abstract [en]

    In many Western countries adolescents, especially girls, report high levels of stress and stress-related health complaints. In this study we investigate the concept of stress in a group of 14-15 year-olds (grade 8 in two Stockholm schools) using a multiple methods approach. The aim is to analyse stress, and gender differences in stress, as indicated by a measure of perceived stress (questionnaires, n = 212), the diurnal variation in the biomarker cortisol (saliva samples, n = 108) and the students' own accounts of stress (semi-structured interviews, n = 49). The results were generated within the traditional framework of each method and integrated at the point of interpretation. The hypothesis that adolescent girls experience more stress than boys was confirmed by all methods used. In the questionnaire, the most commonly experienced aspects of perceived stress were the same among girls and boys, but girls consistently reported higher frequencies. The saliva samples showed that girls had greater cortisol output in the morning. In the individual semi-structured interviews, girls and boys discussed stress in similar ways but both acknowledged a gender gap to the disadvantage of girls. The results as a whole suggests an interpretation of gender differences that focuses girls' attitudes, perceived expectations and coping strategies in relation to school performance, with their focus on achievement, marks, hard work, and worries about the future. The findings point to a need of an increased awareness about the role of perceived expectations in the stress process, and that these expectations and their impact on stress may differ by the gender of the student.

  • 11.
    Östberg, Viveca
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Almquist, Ylva B.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Folkesson, Lisa
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Triangulation of stress in adolescence2012In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 22, no supplement 2, p. 220-220Article in journal (Refereed)
    Abstract [en]

    Large scale surveys show that perceived stress and stress-related complaints are common among young people. Perceived stress increase with age and are more common in girls than boys, resulting in late adolescent girls reporting the highest frequencies. The knowledge is however more limited regarding other measurements and meanings of stress. The purpose of this study is to use a small-scale multiple methods data collection to perform an empirical triangulation of stress in the age group 14–15 years, i.e. to analyse stress, and gender differences in stress, as it appears in questionnaires, biomarkers and interviews within the same population. The study population includes all pupils in the 8th and 9th grades (ages 14–16 years) in two elementary schools in Stockholm, Sweden (n = 545). The data collection was divided into three parts where information was gathered through class room questionnaires (n = 413), saliva sampling (5 time points during the day, number of students delivering complete samples = 190) and semi-structured qualitative interviews (49 pupils in grade 8, mean length 50 minutes).

    In the questionnaires, girls consistently report higher levels of perceived stress. This is true for the activation scale (mean value boys = 2.51, girls = 3.11, p < 0.00) and the pressure scale (boys = 2.62, girls = 3.33, p < 0.00). According to the saliva sampling, girls have higher cortisol concentration both at awakening and 30 minutes later (p < 0.00). According to the qualitative interviews, no distinct differences in boys’ and girls’ associations with the word “stress” were found. However, both male and female interviewees had a perception of girls being more stressed about schoolwork than boys. Many times they linked this to girls way of thinking or coping with life demands, including worries about the future. In conclusion, the picture of adolescent girls being more stressed than boys is largely confirmed by all methods used here.

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