title: Anticipatory cognitive stress appraisal and the acute procoagulant stress response in men.
abstract: OBJECTIVE
  Acute mental stress elicits blood hypercoagulability. Following a transactional stress model, we investigated whether individuals who anticipate stress as more threatening, challenging, and as exceeding their coping skills show greater stress reactivity of the coagulation activation marker D-dimer, indicating fibrin generation in plasma.
  
  
  METHODS
  Forty-seven men (mean age 44 +/- 14 years; mean blood pressure [MBP] 101 +/- 12 mm Hg; mean body mass index [BMI] 26 +/- 3 kg/m(2)) completed the Primary Appraisal Secondary Appraisal (PASA) scale before undergoing the Trier Social Stress Test (combination of mock job interview and mental arithmetic task). Heart rate, blood pressure, plasma catecholamines, and D-dimer levels were measured before and after stress, and during recovery up to 60 minutes poststress.
  
  
  RESULTS
  Hemodynamic measures, catecholamines, and D-dimer changed across all time points (p values <.001). The PASA "Stress Index" (integrated measure of transactional stress perception) correlated with total D-dimer area under the curve (AUC) between rest and 60 minutes poststress (r = 0.30, p = .050) and with D-dimer change from rest to immediately poststress (r = 0.29, p = .046). Primary appraisal (combined "threat" and "challenge") correlated with total D-dimer AUC (r = 0.37, p = .017), D-dimer stress change (r = 0.41, p = .004), and D-dimer recovery (r = 0.32, p = .042). "Challenge" correlated more strongly with D-dimer stress change than "threat" (p = .020). Primary appraisal (DeltaR(2) = 0.098, beta = 0.37, p = .019), and particularly its subscale "challenge" (DeltaR(2) = 0.138, beta = 0.40, p = .005), predicted D-dimer stress change independently of age, BP, BMI, and catecholamine change.
  
  
  CONCLUSIONS
  Anticipatory cognitive appraisal determined the extent of coagulation activation to and recovery from stress in men. Particularly individuals who anticipated the stressor as more challenging and also more threatening had a greater fibrin stress response.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland.
authors.forename: Petra H
authors.initials: PH
authors.lastname: Wirtz
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ehlert
authors.forename: Luljeta
authors.initials: L
authors.lastname: Emini
authors.forename: Katharina
authors.initials: K
authors.lastname: Rüdisüli
authors.forename: Sara
authors.initials: S
authors.lastname: Groessbauer
authors.forename: Jens
authors.initials: J
authors.lastname: Gaab
authors.forename: Sigrid
authors.initials: S
authors.lastname: Elsenbruch
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002395:Catecholamines / Q000097:blood; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D019851:Thrombophilia / Q000523:psychology*
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D