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Mental Health

Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

Соотношение кортизол/ДГЭА-С

CORTISOL/DHEA-S RATIO OF LONGEVITY

A complex interaction between cortisol and dehydroepiandrosterone-sulphate (DHEA-S) is crucial in the stress system balance. In particular, significantly higher or lower cortisol/DHEA(S) ratios have been associated with depression1 and aggression2. In general, DHEA-S levels affect various body systems, as well as prevent aging (Chahal and Drake 2007). That is why the Cortisol DHEA ratio is a very informational indicator, which, along with other indicators calculated in Healsens, provides important information about human health. Thus, using the ratio of cortisol / DHEA-S, you can assess body responses to exercise or evaluate mental health. Another benefit is that you can check your cortisol and DHEA-S levels at home.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 4 March 2021.

How Cortisol and DHEA Sulfate Affect the Body

Let’s start by looking at how cortisol and DHEA-S affect overall health. Dehydroepiandrosterone (DHEA) and cortisol are produced in the adrenal glands and are both derived from pregnenolone. So, DHEA and DHEA-S production reaches its peak at the age of 20–30 and then declines progressively with age. When it comes to cortisol levels, while some studies show that cortisol increases with age3, others do not support this observation4. However, everyone agrees that the reduction in DHEA-S entails disruption of various physiological systems.

Stress Level

As mentioned above, DHEA and DHEA-S play a protective role during acute stress as an antagonist to the action of the stress hormone cortisol56. In turn, cortisol also helps to effectively manage stress. Let’s see how this happens.

About 15 minutes after a stressful situation, cortisol levels rise and remain elevated for several hours. This marks the onset of stage 1. During this stage, there are elevations in cortisol with no corresponding changes in DHEA. Subsequently, glucose is mobilized, non-essential organ systems are suppressed, and inflammation is reduced. All of these physiological responses collectively enable the body to effectively cope with stress.

However, in cases of chronic stress, this adaptive reaction can take a catastrophic turn: cortisol loses its ability to function normally. This transition ushers in stage 2. In this latter stage, the persistence of stress leads to a sustained peak in cortisol levels, matched by a corresponding elevation of DHEA.

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It becomes increasingly challenging to maintain appropriate blood sugar levels, to allow for adequate rest, to achieve high-quality sleep, and to achieve a harmonious balance among other hormones. This signals the arrival of stage 3, wherein stress persists and becomes chronic. During this stage, cortisol levels decrease, while DHEA remains elevated. In the absence of timely intervention, prolonged adrenal hyperstimulation can result in adrenal exhaustion. This condition is eventually manifested by a decline in both cortisol and DHEA, a phase often denoted as adrenal exhaustion or stage 4. Ultimately, this process may culminate in adrenal failure.

Thus, the optimal ratio between salivary cortisol and DHEA is approximately 5:1 to 6:1, serving as an indicator of a normal state of adaptation to stress7.

When the body’s ability to maintain its normal stress adaptation is compromised, a process known as stress maladjustment can ensue. This phenomenon is now recognized as a chronic stress response, often identified by terms like pregnenolone steal, cortisol escape, or an elevated cortisol to DHEA ratio. The longer one remains in a state of chronic stress, the more pervasive its negative impact becomes on various aspects of physical well-being.

As a result, individuals grappling with depression or heightened anxiety levels (measured at 0.24 ± 0.03 in the healthy group compared to 0.41 ± 0.12 in the group of individuals with severe anxiety)8, along with those dealing with post-traumatic stress disorder, exhibit disruptions in the cortisol to DHEA ratio9. Nevertheless, it’s worth noting that certain studies have demonstrated the potential of DHEA treatment to mitigate the adverse health effects associated with stress.

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Musculoskeletal disorders

We have already mentioned that cortisol dysfunction entails disorders of the musculoskeletal system10. Thus, the higher the cortisol / DHEA-S ratio, the more serious the risk of this problem.

Moreover, multiple regression analysis showed that the independent risk factor for sarcopenia was a serum cortisol/DHEA-S ratio ≥ 0.211. Sarcopenia is a type of muscle loss that occurs with aging and/or immobility.

Immunity and Cortisol DHEA Ratio

In addition, an increase in the cortisol / DHEA-S ratio with age (Phillips et al. 2007) is associated with immune dysfunction and the risk of infection in the elderly due to the fact that DHEA-S enhances immunity. However, cortisol has an inverse immunosuppressive effect (Buford and Willoughby 2005). It is also worth adding that DHEA-S is known for its antioxidant properties12.

Metabolic Syndrome

Various studies have shown that both cortisol and DHEAS are related to metabolic syndrome13, and type 2 diabetes14. While high cortisol concentrations are associated with an increased risk of metabolic syndrome, high DHEA-S levels appear to be protective. By far, the strongest associations were observed for the cortisol / DHEA-S ratio. According to observations, the higher the coefficient, the greater the risk of metabolic syndrome. This ratio is also strongly associated with four of the five components of metabolic syndrome.

Alzheimer’s Disease

The cortisol / DHEA-S ratio may also be crucial in Alzheimer’s disease. For example, some studies have found a link between the cortisol / DHEA-C ratio and a decrease in hippocampal volume15. It is worth saying that a decrease in the volume of the hippocampus is one of the early diagnostic signs of Alzheimer’s disease.

This finding has been confirmed by other studies, observing the relationship between cortisol / DHEA-S and hippocampal atrophy (HA)1617. For example, such a direct relationship was observed in patients with Cushing’s syndrome18. Moreover, HC volume partially recovered following treatment-induced cortisol decrease. However, not all studies support this association within normal cortisol levels in healthy people19.

To sum up, the ratio of cortisol / DHEA sulfate can reflect:

  • psychological health (high level of anxiety, depression, etc.).
  • more favorable hormonal profile which implies higher levels of DHEA sulfate and a lower cortisol / DHEA-S ratio.
  • increased risk of sarcopenia.
  • increased risk of metabolic syndrome and type 2 diabetes.
  • mortality in general, which is strongly associated with the cortisol / DHEA-S ratio

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 4 March 2021.

Assessing Exercises

DHEA (Aldred et al. 2009; Cumming et al. 1986) and DHEA-S (Tremblay et al. 2004) have been shown to increase in response to active exercise. Measuring the ratio of cortisol to DHEA-S can help determine the intensity of physical activity. A higher level of cortisol and/or a lower level of DHEA-S may indicate significant physical stress. This can be valuable information for assessing whether the workout is sufficiently intense or if a lighter approach is needed to prevent overtraining. However, resistance training showed a stronger increase compared to endurance training (Tremblay et al. 2004). It’s also worth noting that trained and untrained people can cause different hormonal responses to exercise. So, untrained people experienced more significant increases in DHEA and cortisol levels2021. Such result was observed in both young people and people over 60 years old22.

How to define intensity of exercise?

For this purpose, the researchers used heart rate (HR) indicators. So the exercise was stopped as soon as the participants had reached 75% of their maximum HR. You can also determine maximum HR by the Tanaka formula:

208 − (age × 0.7)

So, for a 65-year-old person, the maximum heart rate will be 162 beats per minute. Consequently, 75% of this figure will be 121 bpm. Healthwise, muximum loads are not advisable. Therefore, it is recommended to use between 50% and 80% of the maximum.

Research has shown that 16 weeks of regular exercise decreased cortisol/ DHEA ratio by nearly 30%. In addition, athletes with the highest performance levels and the greatest amount of training had the lowest ratio. So,

Healthy Cortisol/DHEA-S Ratio

1 : 5 – 1 : 6

1:6 corresponds to 0.167 & 1:5 corresponds to 0.2

Adrenal/DHEA Restoration

High Adrenal/DHEA-S Ratio

Taking this into account, DHEA supplementation may be considered. Research confirms that it has a significant effect on the concentration of cortisol. For example, even a single morning dose of 200 mg DHEA can lower cortisol concentrations23. Moreover, in women, such a decrease was more pronounced.

An earlier study in healthy people came to the same result24. By the way, researchers also found that taking DHEA (300 mg) did not improve memory. However, supplementation is rational only in cases of decreased DHEA-S levels. In addition, it is important to monitor the sex steroid hormones as well as DHEA-S, because both deficiency and excess of DHEA can lead to negative symptoms.

In addition to DHEA supplements, your doctor may recommend pregnenolone25 and seriphos (phosphatidylserine)26. Seriphos was developed to aid in lowering cortisol. Besides, it contains key nutrients for stress resiliency. As for about pregnenolone, it is a steroid hormone. It plays a key role in the production of other steroid hormones, such as progesterone, DHEA, and estrogen.

Research also shows that fish oil supplements2728 and an Asian herbal medicine called ashwagandha both help to reduce cortisol levels29.

Calculated Cortisol/DHEA-S Ratio in Healsens App

Clinical Note

Improving adrenal function (augmenting DHEA and pregnenolone) can significantly enhance thyroid function, thereby reducing the amount of thyroid medication necessary. If this possibility is taken into account, it is suggested that any patient on thyroid should be closely monitored and lower dosages of pregnenolone and DHEA should be initially considered.

Low Adrenal/DHEA-S Ratio

So, as discussed in previous chapters, exercise has a positive effect on DHEA and cortisol levels. Besides, your doctor may recommend taking licorice extract. This is because licorice helps the adrenal glands prevent the breakdown of cortisol. In some cases, cortisol supplementation may be required.

Either with increased and decreased cortisol / DHEA-S ratio, an adrenal support program is recommended. So, try to balance your intake of protein, healthy fats, and carbohydrates. It will also be very beneficial to increase your vegetable intake to get the required amount of vitamins and minerals. To this end, foods high in vitamin C, B-5, B-6 and magnesium will assist in maintaining adrenal health.

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Kirtan Kriya

DISCOVER THE BENEFITS OF KIRTAN KRIYA FOR STRESS REDUCTION

A growing number of medical studies confirm that Kirtan Kriya (KK) meditation is not only a stress management tool, but can also aid in the treatment of cognitive impairment, memory improvement and, as a result, it plays a role in Alzheimer’s Disease Prevention1. KK has also been proven to improve sleep, reduce depression, reduce anxiety, activate immune system genes2, and even increase telomerase3. Therefore, it is obvious that we paid our attention to Kirtan Kriya benefits for a reason, since it has already passed a rigorous randomized controlled trial (RCT) design. So, its effectiveness has been confirmed experimentally. We will start by telling you more about the research carried out. Hopefully, after reading this, some of you will make this wonderful practice a part of your healthcare plan.

This article was last reviewed by Svetlana Baloban, Healsens, on January 24, 2020. This article was last modified on 7 March 2021.

Cognitive Function and Memory Improvement

There are many studies proving that yoga practices are increasingly shown to be effective for the treatment of age-related cognitive issues.

Let us start with a 2017 12-week study that tested the effects of kundalini yoga training on mild cognitive impairment (MCI)4. What makes this study interesting is that the results of yoga practice were compared with the results of training to improve memory MET.

MET was developed by researchers within the UCLA Longevity Center. It is well studied and has become a gold standard intervention for cognitive training. At the same time, improvement in memory with MET training is observed in both healthy people and people with cognitive problems5. Thus, MET provides a rigorous control for KY meditation.

It also needs to be noted, that cognitive decline is a strong predictor of Alzheimer’s disease leading to dementia6. Overall, the study provides evidence of the benefits of Kundalini yoga, including Kirtan Kriya, for improving cognitive function in individuals with MCI

The Design Research

The trial participants were gathered among the people ≥55 y.o. with a mild cognitive impairment. To assess the impact of training, 2 different groups were created. So, part of the people randomly got into a 12-week program on kundalini yoga (KK). All others were involved in the MET memory improvement training, which we wrote about above.

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In addition, all program participants were administered extensive tests assessing their cognitive abilities. Researchers assessed their verbal and visual memories, visual-spatial skills, individual executive, and executive functions. People were also tested for depression, present symptoms of apathy, and psychological resilience to stress. You can also take these tests on our website or by downloading👇 the app.

The participants of the experiment passed such testing several times. The tests were passed at baseline (pre-intervention) and repeated at 12 and 24 week post-intervention.

Let’s say a few more words about what exercises were performed in the yoga group. First, once a week the participants would hook up for a 60-minute kundalini lesson. In addition, all participants were required to do a 12-minute Kirtan Kriya meditation daily.

Results

As a result of the experiment, both groups had significant improvement in memory. However, the yoga team additionally showed a broader effect on executive functioning, with greater improving in their mood7. In addition, such positive dynamics persisted after the end of the training. Impressive, isn’t it?

A similar RCT was conducted in 20168. Here the results of the meditation group were compared with the machine learning program. The researchers came up with the same result. Kirtan Kriya meditation can help people with early memory loss. It is worth mentioning that the participants practiced the 12 minutes kirtan kriya meditation only. And this is only 12 minutes a day at home and at a convenient time.

Cerebral Blood Flow Changes

Interestingly, Kirtan Kriya benefits also showed cerebral blood flow changes during the practice of KK910. Thus, there was observed a significant increase in cerebral blood flow (CBF) within the frontal lobe and right superior parietal lobe. Moreover, the posterior cingulate gyrus (PCG) is also activated. All this suggests that such activation of the brain with increased blood flow may have a beneficial effect or provide protection against neurodegeneration11. However, a larger study is needed to confirm this conclusion.

And finally, Luders’s study concluded that someone who practices meditation regularly, has a 7.5 years younger brain12.The age was calculated as BrainAGE index. It was also found that with every passing year, meditators’ age reduced. Thus, the researchers concluded that Kirtan Kriya benefits help maintain the brain and its activity in good shape.

Kirtan Kriya Helps to Improve Mood

Various studies have shown that Kirtan Kriya markedly improves mood, reduces anxiety, tension, and fatigue. There was also a significant improvement in depressive symptoms and mental health. And this effect was observed both in healthy people13, so in people with memory loss14. It is worth mentioning that the latter participated in the 8-week Kirtan Kriya meditation program, which highlights Kirtan Kriya benefits.

Studies have also shown that 8 weeks of KK helped in alleviating worry15 and soaring positive mood and energy. In addition, a majority of patients found the sessions relaxing, calming, peaceful, and uplifting, demonstrating the multiple Kirtan Kriya benefits.

Better Sleep

In the same way, sleep disruption has negative effects on health, performance, and quality of life. It is also known to impair cognitive function in healthy people16, to accelerate cognitive decline17, and to predict incident MCI and dementia18. In addition, sleep disturbances can generate glucose intolerance, obesity, and hypertension19. And finally, sleep impairment has likewise been linked to increased risk for type 2 diabetes and some other diseases.

That being said, research shows that an 18-week 12-minute daily meditation program may be effective in reducing stress and improving sleep and mood2021.

Influence at Telomere Length and Activity

Research supported by the Alzheimer’s Research and Prevention Foundation (ARPF), and by the National Institutes of Health22 published the results of a study on the effect of two 12-week Kirtan Kriya meditations on telomere length (TL), telomerase activity (TA), and plasma amyloid-β(Aβ) levels (biomarkers of cellular aging). In addition to biomarkers, the researchers also assessed cognitive function and psychosocial status. For this, an assessment was carried out at baseline, after 3 months and 6 months.

So, during the experiment, all participants were randomly divided into 2 groups. Thus, one part of the people joined a group of the 12-minute Kirtan Kriya (KK). The second group of people joined the music listening (ML) program. They were instructed to listen to 12-minutes of relaxing instrumental music each day. The ML CD contained selections from Bach, Beethoven, Debussy, Mozart, Pachelbel, and Vivaldi. They were asked to try each composer at least once in 12 weeks.

As a result, the KK group showed a significantly greater increase in Aβ40 than the ML group. At the same time, the activity of telomerase TA increased in both groups. Increases in plasma Aβ levels were significantly correlated with gains in memory and cognitive function. There was also an improvement in mood, stress, sleep, and QOL.

A similar conclusion was also reached in a study of the effect of meditation on family dementia caregivers23. First, the practice of Kirtan Kriya resulted in improved mental health and decreased depressive symptoms. Second, this improvement was also associated with increased telomerase activity. This indicates an improvement in stress-induced cellular aging. However, these findings will need to be replicated in a larger sample.

An alternative Treatment for Depression

Depression is one of the most common mental illnesses in the world. In its turn, researchers are studying yoga as an alternative and complementary treatment for depression. As a rule, yoga is usually combined with other treatments for depression, anxiety, and stress-related disorders. Studies, in turn, support this approach, for example, with antidepressant treatment (Janakiramaiah et al., 2000).

However, research Shahidi et al. (2011)24showed that yoga itself is a fairly effective tool, at least as effective as a group exercise program in improving depression. How significant is this improvement?

The study of 2017, which we’ve already written above25 also revealed Kirtan Kriya benefits with a significant improvement in a depressive mood.

To assess mood, the researchers used the Geriatric Depression Scale (GDS). This scale is widely used among the elderly. As a result, the KY group showed significant improvements in depression ratings (GDS: ES (KY) = -0,62).

the Geriatric Depression Scale

How to do Kirtan Kriya Practice

So, in all studies, Kirtan Kriya was used as a home exercise. What does it look like? In fact, KK meditation involves repetitive finger movements while chanting the mantra “Saa, Taa, Naa, Maa”, which means “Birth, Life, Death and Rebirth.” Although kirtan kriya can be of various durations, 12 minutes-one was used in the studies. So, below we will describe the technique in detail.

To start the practice, sit on a chair or on the floor and relax. You need to find a comfortable sitting position with a straight back. Straighten your shoulders, straighten your neck and back.

Eyes

Eyes are closed.

The finger movement

To start the lesson, you need to take a comfortable sitting position with a straight back. You can sit cross-legged or just sit on a chair. Straighten your shoulders, straighten your neck and back.

With your hands placed on the knees, touch each of the other four fingers in sequence(picture 1) with your thumb. Both hands perform the same movements simultaneously. On the sound “Saa”, touch the index fingers on both hands with the thumbs. Then, at “Taa”, touch the middle fingers with the thumbs; at “Naa”, touch the ring fingers with the thumbs; at “Maa”, touch the little fingers with the thumbs.

The sequence is always forward: thumb to index finger, middle finger, ring finger, and pinky.

The sounds

As we wrote above, KK uses the sounds Saa, Taa, Naa, Maa. Sing “Saa, Taa, Naa, Maa” while also performing the movements with the fingers of both hands (as shown in the picture above). Wherein, follow the next sequence:

  1. Sing out loud for two minutes.
  2. Then, for the next two minutes, sing in a whisper.
  3. For the next four minutes, say the sound silently to yourself.
  4. Return to a whisper for two minutes
  5. And complete the sequence by singing out loud for the last two minutes.

It is convenient to use a ready-made audio recording, where the out loud / whisper / silent transitions are already timed. If outside thoughts intrude, simply return your focus to the sounds and visualization.

The visualization

The sound is visualized coming down from the top of the head, and out the middle of the forehead (the third eye).

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КАК СТРЕСС ВЛИЯЕТ НА ЗДОРОВЬЕ

HOW STRESS AFFECTS THE BODY

Today’s life rhythms and demands are often complex and require intense physical and psychological efforts. Generally, acute stress reactions in young healthy individuals do not cause any harm to their health. However, if the threat is not eliminated, such stimuli that exceed a specific person’s ability to adapt can cause significant damage1. But how dangerous is such harm and how exactly does stress affect the body?

Positive and negative stress

As mentioned earlier, not all stress has a negative effect. When the body experiences stress and uses it to overcome lethargy or increase productivity, stress becomes positive and healthy 2. This type of stress is also known as eustress. Therefore, stress is positive when it prompts us to adapt and thus enhances our adaptive mechanisms. This stimulating effect of stress gives athletes a competitive edge and speakers enthusiasm.

Stress is negative when it exceeds our ability to cope with it. Such stress exhausts the body’s systems and leads to behavioral or physical problems. This harmful stress is called distress. If an event triggers an excessive reaction, confusion, poor concentration, and anxiety, it leads to a decrease in productivity.

.

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Fortunately, under normal circumstances, within three minutes 3 after the threatening situation disappears and the real or perceived danger is eliminated, the “fight or flight” response subsides. During this time, our body relaxes and returns to its normal state. Heart rate, blood pressure, respiration, muscle tension, digestion, metabolism, and the immune system all return to normal. However, if stress persists after the initial “fight or flight” response, the body’s reaction enters the second stage.

At this stage, the activity of the sympathetic nervous system decreases, and adrenaline secretion decreases, but the secretion of corticosteroids (such as cortisol) remains elevated, exceeding normal levels. Finally, if stress continues and the body cannot cope with it, an organism’s energy levels are likely to decline, leading to a state of exhaustion. Depression sets in.

Depression

When it comes to depression, it is defined as experiencing 5 or more of the listed symptoms persistently for 2 or more weeks, causing significant emotional distress. We have already discussed depression and its diagnosis in the article “Depression Screening | Anxiety and Depression.”

Currently, depression is one of the most common mental disorders worldwide. It is estimated that 350 million people globally suffer from some form of depression 4. It is also the leading cause of disability worldwide. Additionally, it is the most costly mental disorder, accounting for 33% of all brain-related disease costs in Europe. This corresponds to 1% of the entire European economy (GDP) 5. According to the estimates of the Centers for Disease Control and Prevention in the United States, stress accounts for approximately 75% of all doctor visits 6. Patients often come with complaints such as:

  • Back pain
  • Headaches
  • Heart problems
  • Stomach disorders and digestive disturbances
  • Sleep problems
  • Fatigue, and so on.

But can stress cause serious harm to health?

How stress affects health?

Hypertension and Atherosclerosis

When it comes to how stress affects health, it can confidently be stated that prolonged negative stress can damage almost all organs and tissues. For example, chronic stress leads to sustained elevation of blood pressure and vascular hypertrophy 7. This means that the muscles that constrict the blood vessels thicken, causing increased blood pressure. Additionally, there is a tendency to respond to all types of stress with a vascular reaction.

In turn, chronically elevated blood pressure forces the heart to work harder, leading to left ventricular hypertrophy. Over time, this condition can damage arteries and lead to the formation of plaques (atherosclerosis). And this is just one of the many chains of influence of chronic stress on health.

How stress affects the body: Immunity and chronic inflammation

Elevated levels of stress hormones associated with chronic stress also suppress the immune system, directly influencing cytokine profiles 8. Cytokines are communicative molecules primarily produced by immune cells (see Roitt et al., 1998).

In response to a higher number of chronic stressors, pro-inflammatory cytokines disrupt regulation and lead to immune suppression.

As a result, this leads to slower wound healing, weaker antibody response to vaccination, and decreased ability to fight viral infections.

This means that psychological stress can actually induce an acute-phase response typically associated with infections and tissue damage. Such immune imbalance results in a state of low-grade chronic inflammation, which, in turn, can serve as a precursor to the development of other diseases. Diseases associated with both stress and inflammation include:

  • Cardiovascular dysfunctions, including atherosclerosis and ischemic heart disease (IHD)
  • Diabetes
  • Cancer
  • Autoimmune syndromes
  • Mental disorders such as depression and anxiety disorders.

Chronic stress is particularly dangerous for elderly individuals.

Impact on the brain

Chronic stress has been shown to be associated with macroscopic changes in specific brain regions. For example, significant reduction in gray matter has been observed in individuals suffering from prolonged occupational stress 9. However, our understanding of the molecular pathways underlying these changes is still in the early stages of research.

It is worth noting that physical exercise can support brain health in counteracting stress-related depression. This can manifest as overall improvement in cognitive abilities, reduced risk of neurodegenerative diseases, and alleviation of depression.


How stress affects the body: Gastrointestinal disorders

It is known that stress has a significant impact on gastrointestinal disorders such as peptic ulcer disease (PUD) and ulcerative colitis (UC). Specific stressful life events are closely associated with the onset or exacerbation of symptoms in other common chronic digestive system disorders, including:

Functional gastrointestinal disorders

Inflammatory bowel diseases (IBD)

Gastroesophageal reflux disease (GERD).

Furthermore, early-life stress in the form of abuse or trauma also plays an important role in predisposing individuals to the development of gastrointestinal disorders and IBD later in life.


How stress affects the body: Impact on genetic health

Finally, a recent study on stress conducted by Epel and Blackburn demonstrates that stress has a pronounced negative impact on genetic health by reducing the level of telomerase, an enzyme responsible for maintaining the length of telomeres, protective caps of DNA. Shorter telomeres are associated with inflammation, accelerated aging, and Alzheimer’s disease1011. Furthermore, the study revealed that individuals who experienced childhood maltreatment had shorter telomeres12.

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ONLINE DEPRESSION SCREENING

Depression is one of the most common mental illnesses in the world. It is estimated that there are 350 million people worldwide who have some form of depression1. In the United States, 16 million people had a depressive episode in the past year. Moreover, depression is the leading cause of disability worldwide. But how to understand that a person has depression? For this, various questionnaires are used to screen for depression and assess its severity (degree of depression). Such, for example, as PHQ-9. In general, screening and assessment tools for depression and anxiety include questions about mental health symptoms.

Screening for Depression

The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, has defined depression as2 5 or more of the following symptoms that are present for 2 or more weeks and cause significant emotional distress and/or impairment in functioning. Symptoms are:

  • depressed or sad mood,
  • short-tempered or easily annoyed,
  • loss of interest or enjoyment in hobbies or activities that was previously enjoyed,
  • feeling of worthlessness or guilt,
  • thoughts of death or suicide,
  • difficulty with concentrating or making decisions,
  • feeling tired or fatigue,
  • feeling restless or slow,
  • changes in appetite such as overeating or loss of appetite,
  • changes in weight such as weight loss or weight gain,
  • and changes in sleep pattern.

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Having noted 5 or more factors from the list above, especially if they have been persisting for a long time, you can suspect you have depression. In addition, below 👇 you can take a depression questionnaire and even determine its severity.

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Online Depression Screening

By the link below 👇 you can assess your own level of depression and anxiety! It is important to remember that screening tools only detect symptoms of depression or anxiety. The diagnosis of depressive or anxiety disorder requires a deeper assessment.

Screening for Depression

The PHQ-9 Evidence Appraisal

The PHQ-9 was initially developed by Kroenke et al (2001), as a subset of 9 questions from the full PHQ. It had previously been derived and studied in a cohort of 6,000 patients3. PHQ-9 scores ≥10 were found to be 88% sensitive and also 88% specific for detecting MDD. Criterion validity was also assessed in a sample of 580 patients. self-administration takes 5–7 min.

Beck’s Depression Inventory

Beck’s Depression Inventory Online Test Evidence Appraisal

The Beck Depression Inventory-II (BDI-II) is currently one of the most widely used measures for assessing depression4. The questionnaire was developed from clinical observations of attitudes and symptoms occurring frequently in depressed psychiatric patients and infrequently in non-depressed psychiatric patients5. The questionnaire is commonly self-administered although initially designed to be administered by trained interviewers. Self-administration takes 5–10 min.

Short Form-36 Health Survey (SF-36)

SF-36 is a set of generic, coherent, and easily administered quality-of-life measures. These measures rely upon patient self-reporting and are now widely utilized by managed care organizations and by Medicare for routine monitoring and assessment of care outcomes in adult patients. Self-administration takes 8–14 min.

Geriatric Depression Scale: Short Form

The Geriatric Depression Scale (GDS) has been tested and used extensively with the older population. The GDS Long Form is a brief, 30-item questionnaire in which participants are asked to respond by answering yes or no in reference to how they felt over the past week. A Short Form GDS consisting of 15 questions was developed in 1986. Self-administration takes 4–7 min.

GAD-7 (General Anxiety Disorder-7)

SThe GAD-7, or Generalized Anxiety Disorder-7, is a self-report questionnaire designed to assess the severity of generalized anxiety disorder symptoms in individuals. It consists of seven questions that ask about common anxiety symptoms and their impact on daily life. The GAD-7 is often used as a screening tool in clinical and research settings to help identify individuals who may be experiencing significant levels of anxiety. Self-administration takes 3–5 min.

Pros and Cons of Depression Screening

Above all, еhere is not thought to be any significant harm associated with screening for depression and anxiety. However, some people worry that screening and assessment tools may lead to incorrect diagnoses. Therefore, it is important to remember that screening tools only detect symptoms of depression or anxiety.

At the same time, screening tools can detect most, but not all, cases of possible depression and anxiety. We already talked about connection between our minds and our bodies. So, the main advantage of screening tools is that they are quick and easy. And it’s true for its use and interpreting. A limitation is that they simplify complex experiences and impose artificial symptom thresholds.

It is important to remember that screening tools only detect symptoms of depression or anxiety. Diagnosis of depressive or anxiety disorder requires deeper assessments.

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