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International Journal of Behavioral Medicine

, Volume 21, Issue 5, pp 821–832 | Cite as

Gender-Specific Associations of Perceived Stress and Coping Strategies with C-Reactive Protein in Middle-Aged and Older Men and Women

  • Chisato ShimanoeEmail author
  • Yasuko Otsuka
  • Megumi Hara
  • Hinako Nanri
  • Yuichiro Nishida
  • Kazuyo Nakamura
  • Yasuki Higaki
  • Takeshi Imaizumi
  • Naoto Taguchi
  • Tatsuhiko Sakamoto
  • Mikako Horita
  • Koichi Shinchi
  • Keitaro Tanaka
Article

Abstract

Background

Perceived stress and coping strategies may influence the risk of cardiovascular disease through their possible association with inflammation, but data remain controversial for perceived stress or scanty for coping strategies.

Purpose

We examined the associations of perceived stress and coping strategies with serum high-sensitivity C-reactive protein (CRP) in a Japanese general population.

Methods

This cross-sectional study included 2,971 men and 4,902 women aged 40–69 years who were enrolled between 2005 and 2007. Subjects with possible inflammation-related disease, CRP levels ≥3,000 ng/mL, or currently used analgesics or lipid-lowering drugs were excluded. Analyses were performed by gender with adjustment for lifestyle, socioeconomic, and psychosocial factors.

Results

Unexpectedly, elevated perceived stress was significantly associated with lower CRP levels in men (P trend < 0.001) but not in women (P trend = 0.90) after adjustment for age and covariates. Among five items of coping strategies evaluated, “disengagement” showed a significant inverse association with CRP in men only (P trend = 0.027). In addition, a possible interaction between “emotional support seeking” and perceived stress on CRP was detected in men (P interaction = 0.021); “emotional support seeking” was associated with lower CRP at the high stress level only (P trend = 0.028).

Conclusions

Both perceived stress and coping strategies may be associated with systemic inflammation in Japanese men, yet caution must be exercised before accepting the stress–inflammation–disease pathway.

Keywords

Coping strategy C-reactive protein Disengagement Perceived stress 

Notes

Acknowledgments

This work was supported by Grants-in-Aid for Scientific Research on the Special Priority Areas of Cancer (no. 17015018) and Innovative Areas (no. 221S0001), Scientific Research (a) no. 20249038 and (b) no. 18390182, and Young Scientists (a) no. 20689014 and (b) no. 18790380 from the Ministry of Education, Culture, Sports, Science and Technology, Japan. The authors thank Dr. Monji Akira at the Department of Psychiatry, Faculty of Medicine, Saga University, for his critical reading of this manuscript.

Conflict of Interest

All authors declare that they have no conflicting interests.

References

  1. 1.
    Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet. 2007;370:1089–100.PubMedCrossRefGoogle Scholar
  2. 2.
    Hamer M, Molloy GJ, Stamatakis E. Psychological distress as a risk factor for cardiovascular events. Pathophysiological and behavioral mechanisms. J Am Coll Cardiol. 2008;52:2156–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364:937–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case–control study. Lancet. 2004;364:953–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Iso H, Cui R, Date C, Kikuchi S, Tamakoshi A, Group JS. C-reactive protein levels and risk of mortality from cardiovascular disease in Japanese: the JACC Study. Atherosclerosis. 2009;207:291–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010;375:132–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Fuligni AJ, Telzer EH, Bower J, Cole SW, Kiang L, Irwin MR. A preliminary study of daily interpersonal stress and C-reactive protein levels among adolescents from Latin American and European backgrounds. Psychosom Med. 2009;71:329–33.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Spitzer C, Barnow S, Völzke H, Wallaschofski H, John U, Freyberger HJ, et al. Association of posttraumatic stress disorder with low-grade elevation of C-reactive protein: evidence from the general population. J Psychiatr Res. 2010;44:15–21.PubMedCrossRefGoogle Scholar
  9. 9.
    Puustinen PJ, Koponen H, Kautiainen H, Mäntyselkä P, Vanhala M. Psychological distress and C-reactive protein: do health behaviours and pathophysiological factors modify the association? Eur Arch Psychiatry Clin Neurosci. 2011;261:277–84.PubMedCrossRefGoogle Scholar
  10. 10.
    Hänsel A, Hong S, Cámara RJ, von Känel R. Inflammation as a psychophysiological biomarker in chronic psychosocial stress. Neurosci Biobehav Rev. 2010;35:115–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Copeland WE, Shanahan L, Worthman C, Angold A, Costello EJ. Cumulative depression episodes predict later C-reactive protein levels: a prospective analysis. Biol Psychiatry. 2012;71:15–21.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Shivpuri S, Gallo LC, Crouse JR, Allison MA. The association between chronic stress type and C-reactive protein in the multi-ethnic study of atherosclerosis: does gender make a difference? J Behav Med. 2012;35:74–85.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Ranjit N, Diez-Roux AV, Shea S, Cushman M, Seeman T, et al. Psychosocial factors and inflammation in the multi-ethnic study of atherosclerosis. Arch Intern Med. 2007;167:174–81.PubMedCrossRefGoogle Scholar
  14. 14.
    McDade TW, Hawkley LC, Cacioppo JT. Psychosocial and behavioral predictors of inflammation in middle-aged and older adults: the Chicago health, aging, and social relations study. Psychosom Med. 2006;68:376–81.PubMedCrossRefGoogle Scholar
  15. 15.
    Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med. 1993;55:234–47.PubMedCrossRefGoogle Scholar
  16. 16.
    Roohafza H, Talaei M, Pourmoghaddas Z, Rajabi F, Sadeghi M. Association of social support and coping strategies with acute coronary syndrome: a case–control study. J Cardiol. 2012;59:154–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Martin LA, Critelli JW, Doster JA, Powers C, Purdum M, et al. Cardiovascular risk: gender differences in lifestyle behaviors and coping strategies. Int J Behav Med. 2013;20:97–105.PubMedCrossRefGoogle Scholar
  18. 18.
    Penley JA, Tomaka J, Wiebe JS. The association of coping to physical and psychological health outcomes: a meta-analytic review. J Behav Med. 2002;25:551–603.PubMedCrossRefGoogle Scholar
  19. 19.
    Miller GE, Wrosch C. You've gotta know when to fold 'em: goal disengagement and systemic inflammation in adolescence. Psychol Sci. 2007;18:773–7.PubMedCrossRefGoogle Scholar
  20. 20.
    von Känel R, Mausbach BT, Dimsdale JE, Mills PJ, Patterson TL, et al. Ways of coping and biomarkers of an increased atherothrombotic cardiovascular disease risk in elderly individuals. Cardiovasc Psychiatry Neurol. 2012. doi: 10.1155/2012/875876.Google Scholar
  21. 21.
    Rueggeberg R, Wrosch C, Miller GE, McDade TW. Associations between health-related self-protection, diurnal cortisol, and C-reactive protein in lonely older adults. Psychosom Med. 2012;74:937–44.PubMedCrossRefGoogle Scholar
  22. 22.
    Nielsen NR, Kristensen TS, Schnohr P, Grønbaek M. Perceived stress and cause-specific mortality among men and women: results from a prospective cohort study. Am J Epidemiol. 2008;168:481–91.PubMedCrossRefGoogle Scholar
  23. 23.
    Iso H, Date C, Yamamoto A, Toyoshima H, Tanabe N, et al. Perceived mental stress and mortality from cardiovascular disease among Japanese men and women: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study). Circulation. 2002;106:1229–36.PubMedCrossRefGoogle Scholar
  24. 24.
    Ferraro KF, Nuriddin TA. Psychological distress and mortality: are women more vulnerable? J Health Soc Behav. 2006;47:227–41.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Ohlin B, Nilsson PM, Nilsson JA, Berglund G. Chronic psychosocial stress predicts long-term cardiovascular morbidity and mortality in middle-aged men. Eur Heart J. 2004;25:867–73.PubMedCrossRefGoogle Scholar
  26. 26.
    Zlomke KR, Hahn KS. Cognitive emotion regulation strategies: gender differences and associations to worry. Personal Individ Differ. 2010;48:408–13.CrossRefGoogle Scholar
  27. 27.
    Nolen-Hoeksema S, Aldao A. Gender and age differences in emotion regulation strategies and their relationship to depressive symptoms. Personal Individ Differ. 2011;51:704–8.CrossRefGoogle Scholar
  28. 28.
    Opitz PC, Rauch LC, Terry DP, Urry HL. Prefrontal mediation of age differences in cognitive reappraisal. Neurobiol Aging. 2012;33:645–55.PubMedCrossRefGoogle Scholar
  29. 29.
    Urry HL, Gross JJ. Emotion regulation in older age. Curr Dir Psychol Sci. 2010;19:352–7.CrossRefGoogle Scholar
  30. 30.
    Hamajima N, Group J-MS. The Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study) to detect gene–environment interactions for cancer. Asian Pac J Cancer Prev. 2007;8:317–23.PubMedGoogle Scholar
  31. 31.
    Hara M, Higaki Y, Imaizumi T, Taguchi N, Nakamura K, et al. Factors influencing participation rate in a baseline survey of a genetic cohort in Japan. J Epidemiol. 2010;20:40–5.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Nanri H, Nakamura K, Hara M, Higaki Y, Imaizumi T, et al. Association between dietary pattern and serum C-reactive protein in Japanese men and women. J Epidemiol. 2011;21:122–31.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Sasaki M, Kitaoka K, Morikawa Y, Nakagawa H. Relationship between stress coping and burnout in Japanese hospital nurses. J Nurs Manag. 2009;17:359–65.PubMedCrossRefGoogle Scholar
  34. 34.
    Sasaki M, Yamasaki K. Development of a dispositional version of the General Coping Questionnaire (GCQ) and examination of its reliability and validity. Nihon Koshu Eisei Zasshi. 2002;49:399–408 (in Japanese).PubMedGoogle Scholar
  35. 35.
    Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4:92–100.PubMedCrossRefGoogle Scholar
  36. 36.
    Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9:139–45.PubMedCrossRefGoogle Scholar
  37. 37.
    Health Promotion and Nutrition Division HSB, Ministry of Health and Welfare of Japan. Fifth revision of the recommended dietary allowances for Japanese. Tokyo: Daiichi Syuppan; 1994 (in Japanese).Google Scholar
  38. 38.
    Fujimoto S, Watanabe T, Sakamoto A, Yukawa K, Morimoto K. Studies on the physical surface area of Japanese. 18. Calculation formulas in three stages over all ages. Nihon Eiseigaku Zasshi. 1968;23:443–50 (in Japanese).PubMedCrossRefGoogle Scholar
  39. 39.
    Kumahara H, Schutz Y, Ayabe M, Yoshioka M, Yoshitake Y, et al. The use of uniaxial accelerometry for the assessment of physical-activity-related energy expenditure: a validation study against whole-body indirect calorimetry. Br J Nutr. 2004;91:235–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, et al. CDC/AHA workshop on markers of inflammation and cardiovascular disease: application to clinical and public health practice: report from the laboratory science discussion group. Circulation. 2004;110:e545–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Albert MA, Danielson E, Rifai N, et al. Effect of statin therapy on C-reactive protein levels: the pravastatin inflammation/CRP evaluation (PRINCE): a randomized trial and cohort study. JAMA. 2001;286:64–70.PubMedCrossRefGoogle Scholar
  42. 42.
    Emeny R, Lacruz ME, Baumert J, Zierer A, von Eisenhart RA, et al. Job strain associated CRP is mediated by leisure time physical activity: results from the MONICA/KORA study. Brain Behav Immun. 2012;26:1077–84.PubMedCrossRefGoogle Scholar
  43. 43.
    Hamer M, Stamatakis E. Inflammation as an intermediate pathway in the association between psychosocial stress and obesity. Physiol Behav. 2008;94:536–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Duma D, Collins JB, Chou JW, Cidlowski JA. Sexually dimorphic actions of glucocorticoids provide a link to inflammatory diseases with gender differences in prevalence. Sci Signal. 2010. doi: 10.1126/scisignal.2001077.PubMedGoogle Scholar
  45. 45.
    Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18.PubMedCrossRefGoogle Scholar
  46. 46.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.PubMedCrossRefGoogle Scholar
  47. 47.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2013

Authors and Affiliations

  • Chisato Shimanoe
    • 1
    Email author
  • Yasuko Otsuka
    • 1
  • Megumi Hara
    • 1
  • Hinako Nanri
    • 1
  • Yuichiro Nishida
    • 1
  • Kazuyo Nakamura
    • 2
  • Yasuki Higaki
    • 3
  • Takeshi Imaizumi
    • 1
  • Naoto Taguchi
    • 1
  • Tatsuhiko Sakamoto
    • 4
  • Mikako Horita
    • 1
  • Koichi Shinchi
    • 5
  • Keitaro Tanaka
    • 1
  1. 1.Department of Preventive Medicine, Faculty of MedicineSaga UniversitySagaJapan
  2. 2.St. Mary’s College Faculty of NursingKurumeJapan
  3. 3.Faculty of Sports and Health ScienceFukuoka UniversityFukuokaJapan
  4. 4.Department of ManagementFukuoka Institute of Health and Environmental SciencesDazaifuJapan
  5. 5.Division of International Health and Nursing, Faculty of MedicineSaga UniversitySagaJapan

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