Self-esteem levels and cardiovascular and inflammatory responses to acute stress
Introduction
Psychosocial factors are known to influence physical health. Studies of reactivity to and recovery from acute mental stress have been used to elucidate possible pathways through which psychosocial factors contribute to disease risk. The influence of psychosocial risk factors on autonomic, neuroendocrine and immune reactions to acute stress has been established (Brotman et al., 2007, McEwen, 2007). In recent years, attempts have also been made to identify psychosocial factors which could help to protect against the risk of disease. Positive psychosocial factors such as optimism, positive emotions and social support have been associated with improved health outcomes and reduced biological stress reactivity (Pressman and Cohen, 2005, Rozanski and Kubzansky, 2005). Another potentially important protective factor is self-esteem.
Self-esteem refers to subjective judgements of personal worth or adequacy and self-acceptance. Self-esteem is partly heritable, but is also dependent on childhood and early life approval and self-belief generated through interaction with family, peers and others (Baumeister et al., 2003, Raevuori et al., 2007). Those with high self-esteem tend to posses clearer self-concepts, are less vulnerable to depression and anxiety, and are more likely to value positive affect and persist in the face of failure (Lyubomirsky et al., 2006). The relationship between self-esteem and depression is well established. A classic series of papers by Brown et al., 1990a, Brown et al., 1990b, Brown et al., 1990c, Brown et al., 1990d documented the role of self-esteem not only in predicting the onset of clinical depression, but its relationship with other risk factors and influence on the course of recovery. Findings regarding self-esteem and physical health have been less consistent. Baumeister et al. (2003) reviewed the literature on health behavior, and concluded that self-esteem had a variable association with smoking, alcohol abuse, drug use and sexual behavior. One prospective observational epidemiological study found a twofold increased risk for all cause mortality over a period of 10–15 years in those with low self-esteem, with the relationship appearing to be largely mediated by hopelessness (Stamatakis et al., 2004). Relationships between self-esteem and biological measures have also been studied. Pruessner et al. (2005) found that self-esteem levels were related to hippocampal volume, as assessed using structural magnetic resonance imaging in both young and old adults. The presence of the association across a wide age spectrum could mean that hippocampal volume changes precede self-esteem differences rather than the reverse, so the causal direction is uncertain. However, Reitzes and Mutran (2006) found that self-esteem predicted changes in functional health over two years in a sample of 737 older adults, while an analysis of the Dunedin Health and Development Study showed that low self-esteem levels in adolescents predicted poorer physical health at age 26 (Trzesniewki et al., 2006). Therefore, there is preliminary evidence that self-esteem levels are relevant to physical health.
There may also be direct psychobiological links between self-esteem and health related processes. Studies have focussed mainly on cardiovascular and neuroendocrine responses to stress. Seeman et al. (1995) showed in the MacArthur studies of successful aging that self-esteem in a small sample of 70 years old was inversely associated with cortisol responses to a driving simulation task, while differences in cortisol response were only related to self-esteem in a study of younger adults when perceptions of failure were induced with negative feedback (Pruessner et al., 1999). A similar pattern has been observed in relation to cardiovascular reactivity (Hughes, 2007, Rector and Roger, 1997). For example, Hughes (2007) measured self-esteem levels prior to participants performing a picture-matching task. They were then given feedback comparing their performance to average scores. The feedback was randomised to be positive, negative or neutral. Negative feedback provoked an adverse response with a larger cardiovascular reaction in those with low self-esteem. By contrast, in a series of studies concerned primarily with self affirmation, Taylor and colleagues did not find that a positive psychological responses construct loading heavily on self-esteem was associated with cardiovascular or neuroendocrine stress reactivity (Creswell et al., 2005, Taylor et al., 2003).
No studies to date have investigated the relationship between self-esteem and autonomic cardiac control or inflammatory responses to acute stress. We measured both heart rate and heart rate variability in this study. Increased heart rate is related to the progression of coronary atherosclerosis and cardiovascular mortality (Fox et al., 2007) and as such is an important element of cardiovascular disease risk. Short-term heart rate variability is determined by cardiac autonomic balance, and impaired heart rate variability predicts cardiovascular disease risk and prognosis (Stein and Kleiger, 1999, Task Force, 1996). Heart rate variability is reduced during acute and chronic stress (Chandola et al., 2008, Hemingway et al., 2001, Lucini et al., 2005), and has been associated with depression, obesity and hypertension (Masi et al., 2007, Rottenberg, 2007). The relation between self-esteem and heart rate variability is not yet defined.
We also assessed the relation between self-esteem and interleukin-6 (IL-6), tumor-necrosis factor-alpha (TNF-α) and interleukin-1 receptor antagonist (IL-1Ra) responses to mental stress. All three cytokines are implicated in pathogenesis and coronary heart disease etiology (Steptoe and Brydon, 2008). These cytokines are sensitive to acute stress tasks in humans (Steptoe et al., 2007) and individual differences in responsivity predict cardiovascular risk progression (Brydon and Steptoe, 2005). One study of middle-aged women demonstrated a negative correlation between plasma IL-6 and self-esteem levels (Sjögren et al., 2006), but did not measure IL-6 responses to stress. To our knowledge no studies to date have investigated the relation between IL-1Ra, TNF-α and self-esteem, either under resting conditions or following acute mental stress.
Previous research has shown that acute stress can cause contractions in plasma volume, since elevated blood pressure increases hydrostatic pressure, moving plasma from capillaries to interstitial spaces (Pattersson et al., 1995). This could result in a corresponding change in cytokine concentration, even if the absolute levels in the circulation remained the same (Mischler et al., 2005). Changes in plasma volume are typically assessed through measurements of hematocrit and hemoglobin (Dill and Costill, 1974), but in this study we used hematocrit to control for the extent to which changes in hemoconcentration accounted for stress-induced cytokine responses.
The aim of this study was to examine the relationships between global self-esteem levels and hemodynamic, autonomic and inflammatory responses to stress. It was hypothesized that higher levels of self-esteem would be associated with attenuated reactivity to and quicker recovery from acute stress.
Section snippets
Participants
One hundred and three participants were recruited from University College London. Participants were mainly students and consisted of 34 (33%) males and 69 (77%) females. They were recruited as part of a broader study that examined stress responsivity and family history of cardiovascular disease risk. Results from this study have previously demonstrated heightened cardiovascular responsivity in individuals with a family history of cardiovascular disease risk, while cytokine responses were
Participants’ characteristics
Mean self-esteem scores were 24.9 ± 2.53, 30.3 ± 1.03 and 36.1 ± 2.48 for the low, medium and high tertiles, respectively. Table 1 presents the descriptive characteristics and baseline measures of the participants in relation to self-esteem level. There were no differences between the three self-esteem groups in age, gender distribution, smoking status, BMI, habitual physical activity level or baseline HRV, TNF-α, IL-6 or IL-1Ra. There were, however, differences in subjective stress ratings and heart
Discussion
The present study was designed to assess autonomic, hemodynamic and inflammatory responses to acute stress in relation to self-esteem. Individuals who had higher self-esteem had lower subjective stress levels and heart rates throughout the session. In addition, higher levels of self-esteem were related to smaller reductions in heart rate variability in response to tasks, and smaller stress-induced increases in TNF-α and IL-1Ra concentration. These findings were independent of the effects of
Acknowledgment
This research was supported by the Medical Research Council, the Economic and Social Research Council, and the British Heart Foundation.
References (69)
- et al.
The cardiovascular toll of stress
Lancet
(2007) - et al.
Socioeconomic status and stress-induced increases in interleukin-6
Brain Behav. Immun.
(2004) Biologic basis for interleukin-1 in disease
Blood
(1996)- et al.
Increased serum IL-6 and IL-1 receptor antagonist concentrations in major depression and treatment resistant depression
Cytokine
(1997) - et al.
Respiratory sinus arrhythmia and diseases of aging: obesity, diabetes mellitus, and hypertension
Biol. Psychol.
(2007) - et al.
The effect of repeated acute mental stress on habituation and recovery responses in hemoconcentration and blood cells in healthy men
Life Sci.
(2005) - et al.
The role of TNF-α in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk
J. Lipid Res.
(2007) - et al.
Low self-esteem, induced failure and the adrenocortical stress response
Person. Individ. Diff.
(1999) - et al.
Self-esteem, locus of control, hippocampal volume, and cortisol regulation in young and old adulthood
NeuroImage
(2005) - et al.
Self-esteem stability, cynical hostility, and cardiovascular reactivity to challenge
Person. Individ. Diff.
(1996)
The stress buffering effects of self-esteem
Person. Individ. Diff.
Cardiac vagal control in depression: a critical analysis
Biol. Psychiatry
On the relation between neuroticism, self-esteem and depression: results from the National Comorbidity Survey
Compr. Psychiatry
Self-esteem and neuroendocrine response to challenge: MacArthur studies on successful ageing
J. Psychosom. Res.
Interleukin-6 levels in relation to psychosocial factors: studies on serum, saliva, and in vitro production by blood mononuclear cells
Brain Behav. Immun.
Self-esteem and mortality: prospective evidence from a population-based study
Ann. Epidemiol.
The effects of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis
Brain Behav. Immun.
Family history of cardiovascular disease is associated with cardiovascular responses to stress in healthy young men and women
Int. J. Psychophysiol.
Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link?
Atherosclerosis
Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles?
Psychol. Sci. Public Interest
Measures of self-esteem
TNF-mediated inflammatory disease
J. Pathol.
Self-esteem and depression. I. Measurement issues and prediction of onset
Soc. Psychiatry Psychiatr. Epidemiol.
Self-esteem and depression. II. Social correlates of self-esteem
Soc. Psychiatry Psychiatr. Epidemiol.
Self-esteem and depression III. Aetiological issues
Soc. Psychiatry Psychiatr. Epidemiol.
Self-esteem and depression. IV. Effect on course and recovery
Soc. Psychiatry Psychiatr. Epidemiol.
Stress-induced increases in interleukin-6 and fibrinogen predict ambulatory blood pressure at 3 year follow-up
J. Hypertens.
Stress-induced cytokine responses and central adiposity in young women
Int. J. Obes.
Work stress and coronary heart disease: what are the mechanisms?
Eur. Heart J.
Cytokine pathways and joint inflammation in rheumatoid arthritis
N. Engl. J. Med.
Affirmation of personal values buffers neuroendocrine and psychological stress responses
Psychol. Sci.
Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration
J. Appl. Psychol.
Resting heart rate in cardiovascular disease
J. Am. Coll. Cardiol.
Acute threat to the social self: shame, social self-esteem, and cortisol activity
Psychosom. Med.
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