title: Stress exposure and sensitivity in the clinical high-risk syndrome: initial findings from the North American Prodrome Longitudinal Study (NAPLS).
abstract: There is inconsistent evidence for increased stress exposure among individuals at clinical high risk (CHR) for psychosis. Yet similar to patients with a diagnosed psychotic illness, the preponderance of evidence suggests that CHR individuals tend to experience stressful life events (LE) and daily hassles (DH) as more subjectively stressful than healthy individuals. The present study utilizes data from the North American Prodrome Longitudinal Study Phase 2 (NAPLS-2) to test the hypotheses that (1) CHR individuals manifest higher self-reported stress in response to both LE and DH when compared to healthy controls (HC), (2) group differences in self-reported stress increase with age, (3) baseline self-reported stress is associated with follow-up clinical status, and (4) there is a sensitization effect of LE on the response to DH. In contrast to some previous research, the present findings indicate that the CHR group (N=314) reported exposure to more LE when compared to the HC group (N=162). As predicted, CHR participants rated events as more stressful, and those who progressed to psychosis reported a greater frequency of LE and greater stress from events compared to those whose prodromal symptoms remitted. There was also some evidence of stress-sensitization; those who experienced more stress from LE rated current DH as more stressful. The results indicate that the "prodromal" phase is a period of heightened stress and stress sensitivity, and elevated cumulative lifetime exposure to stressful events may increase reactions to current stressors.
authors.affiliation: Department of Psychology, Emory University, Atlanta, GA 30322, USA. Electronic address: htrotma@emory.edu.
authors.forename: Hanan D
authors.initials: HD
authors.lastname: Trotman
authors.affiliation: Department of Psychology, Emory University, Atlanta, GA 30322, USA.
authors.forename: Carrie W
authors.initials: CW
authors.lastname: Holtzman
authors.affiliation: Department of Psychology, Emory University, Atlanta, GA 30322, USA.
authors.forename: Elaine F
authors.initials: EF
authors.lastname: Walker
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Addington
authors.affiliation: Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, CA, USA.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Bearden
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA, USA.
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Cadenhead
authors.affiliation: Department of Psychology, Yale University, New Haven, CT, USA.
authors.forename: Tyrone D
authors.initials: TD
authors.lastname: Cannon
authors.affiliation: Department of Psychiatry, Zucker Hillside Hospital, New York, NY, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Cornblatt
authors.affiliation: National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heinssen
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Mathalon
authors.affiliation: Department of Psychiatry, University of California, Irvine, CA, USA.
authors.forename: Ming T
authors.initials: MT
authors.lastname: Tsuang
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Diana O
authors.initials: DO
authors.lastname: Perkins
authors.affiliation: Department of Psychology, Harvard University, Boston, MA, USA.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Seidman
authors.affiliation: Department of Psychiatry, Yale University, New Haven, CT, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Woods
authors.affiliation: Department of Psychiatry, Yale University, New Haven, CT, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: McGlashan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000453:epidemiology*; D055500:Resilience, Psychological; D012306:Risk; D057566:Self Report; D013315:Stress, Psychological / Q000453:epidemiology*; D055815:Young Adult
keywords: Clinical high risk; Daily Stress Inventory; Daily hassles; PERI Life Events Scale; Prodrome; Stress