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Cited by 10Mindfulness and Compassion InterventionsStress Responses and CortisolPsychosomatic Disorders and Their Treatments

Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes.

Open access
Skoranski, Amanda, Kelly, Nichole R., Radin, Rachel M., Thompson, Katherine A., Galescu, Ovidiu, Demidowich, Andrew P., Brady, Sheila M., Chen, Kong Y. +3 more·2018·Journal of Child and Family Studies
DOI 10.1007/s10826-018-1065-9PMC PMC6085111
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Abstract

Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12-17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.

Integrity signals

Registry

Crossref · 10.1007/s10826-018-1065-9

Cites

68 of 68 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

30 of 72 cited sources checked · 16 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Higher serum cortisol tracks with more severe and progressive insulin resistance among healthy adolescents and those predisposed to Type 2 diabetes, after body fat is considered.

    “Serum cortisol is associated with greater insulin resistance and worsening of insulin resistance in healthy adolescents and those at risk for Type 2 diabetes, even after accounting for body fat (Adam et al., 2010; Huybrechts et al., 2014; Prodam et al., 2013).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Adam et al., 2010 source

      The Longitudinal analysis reports that higher baseline cortisol was associated with a greater one-year decline in insulin sensitivity; the Statistics section says the correlations were adjusted for total fat mass. But the Participants section limits the study to overweight Latino youth with a family history of type 2 diabetes, not healthy adolescents generally. The Cross-sectional analysis also reports no association between cortisol and insulin sensitivity at baseline. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Huybrechts et al., 2014 source
    • cites Prodam et al., 2013 source

      The ‘Associations between ACTH, cortisol and metabolic parameters’ section reports a positive unadjusted association between cortisol and insulin resistance, but says that association was lost after adjustment for confounders, including BMI. This contradicts the claim that it persists after accounting for body fat. The study is cross-sectional and does not establish worsening insulin resistance over time; page numbers are unavailable in our copy. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Altered stress response contributes to the development of cardiometabolic disease through mechanisms such as chronic HPA axis overactivation.

    “Stress response has been proposed to contribute to the etiology of cardiometabolic disease through a host of mechanisms, including chronic over-activation of the hypothalamic-pituitary-adrenal (HPA) axis (Downs & Faulkner, 2015; Loucks et al., 2015; Pervanidou & Chrousos, 2012).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Downs & Faulkner, 2015 source
    • cites Loucks et al., 2015 source
    • cites Pervanidou & Chrousos, 2012 source
  • Premisecitation

    Among developing youth, higher perceived stress forecasts larger increases in BMI across time.

    “In observational studies of developing youth, subjective, perceived stress predicts more excessive gains in adolescents’ BMI over time (Tomiyama, Puterman, Epel, Rehkopf, & Laraia, 2013).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Tomiyama, Puterman, Epel, Rehkopf, & Laraia, 2013 source

      The Step 4: Conditional Growth Model section reports that higher chronic perceived stress predicted steeper BMI growth over ten years. The study followed Black and White girls aged 10–19, so the citing sentence’s broader reference to adolescents is not established for boys. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    In generally healthy adults, a short mindfulness induction produced a faster post-stressor cortisol decrease than a neutral control.

    “Similarly, a brief mindfulness manipulation experimentally induced faster decline in cortisol following a social stressor, as compared to a neutral control condition, among adults in good general health (Bergeron, Almgren-Dore, & Dandeneau, 2016).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bergeron, Almgren-Dore, & Dandeneau, 2016 source

      The Cortisol results report a greater early post-stressor cortisol decline after implicit mindfulness priming than after neutral priming. The Participants section describes 91 undergraduate students and gives French proficiency as the inclusion criterion; it does not establish that they were in good general health. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    The normal rise in insulin resistance during puberty makes the teen years a vulnerable window for Type 2 diabetes.

    “Puberty is also accompanied by a normative rise in insulin resistance, making adolescence a sensitive period for developing Type 2 diabetes (Goran, Shaibi, Weigensberg, Davis, & Cruz, 2006), and youth who experience greater psychosocial distress may be more vulnerable.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Goran, Shaibi, Weigensberg, Davis, & Cruz, 2006 source
  • Classified as probably not a substantial claim. 41
  • May combine two claims. 29

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Quicker cortisol recovery and decline are interpreted as less physiological stress impact in more mindful people, presumably yielding health and well-being benefits.

    “Faster cortisol recovery and decline reflect mitigation of the physiological impact of the stressor among those who are more mindful in the moment, which would purportedly have positive effects on health and well-being (Bergeron et al., 2016).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bergeron et al., 2016 source

      The Cortisol results report a greater early decline in cortisol after the mindfulness prime, and the Discussion interprets this as potentially faster recovery from stress. The study tested implicit priming, not whether participants were more mindful in the moment; it reports situational well-being but does not establish subsequent health benefits (no page numbers provided). (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Stress response dysregulation occurs in adults with Type 2 diabetes.

    “Dysegulation in stress response has been observed in adults with Type 2 diabetes (Champaneri et al., 2012; Siddiqui, Madhu, Sharma, & Desai, 2015).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Champaneri et al., 2012 source
      Experimental — accuracy not yet measured
    • cites Siddiqui, Madhu, Sharma, & Desai, 2015 source
      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Longer mindfulness-based programs tested in randomized trials with adolescents have lowered depression and anxiety symptoms and salivary cortisol relative to control conditions.

    “Randomized controlled trials evaluating more prolonged (e.g., three-month) mindfulness-based interventions have shown reductions in adolescents’ psychological distress, including depression and anxiety symptoms, and reduced salivary cortisol as compared to a control group (Sibinga et al., 2013; Weigensberg et al., 2014).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Sibinga et al., 2013 source
    • cites Weigensberg et al., 2014 source

      The Results (Intervention outcomes; no page supplied) report lower salivary cortisol immediately after guided-imagery sessions than after control sessions in a 12-week adolescent trial. They also report no significant between-group change in perceived stress or diurnal cortisol measures across the intervention. This was a guided-imagery intervention, not a mindfulness-based program, and the paper does not report reductions in depression or anxiety symptoms. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    HPA axis overactivation causes subtle sustained cortisol elevations, which promote visceral fat accumulation, insulin resistance, and metabolic syndrome, precursors to Type 2 diabetes and cardiovascular disease.

    “Over-activation of the HPA axis results in subtle, tonic elevations of the stress hormone cortisol, which promotes selective accumulation of visceral fat, insulin resistance, and a metabolic syndrome, key physiological precursors in the progression to Type 2 diabetes and cardiovascular disease (Joseph & Golden, 2017; Rosmond, 2003).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Joseph & Golden, 2017 source

      The Physiology of the HPA axis passage (page unavailable) says chronic stress may cause sustained cortisol elevation. The discussion of subclinical hypercortisolism (page unavailable) links cortisol to visceral fat accumulation and insulin resistance as precursors to type 2 diabetes. It does not establish the claimed progression through metabolic syndrome to cardiovascular disease, and it presents the subclinical cortisol–diabetes link cautiously rather than as a settled causal chain. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Rosmond, 2003

  • May combine two claims.

    Premisecitation

    In adults newly diagnosed with Type 2 diabetes, subjective stress, evening cortisol, and cortisol reactivity to an acute lab challenge are higher than in adults without diabetes, after BMI adjustment.

    “For instance, adults with new-onset Type 2 diabetes report greater subjective stress, have higher evening cortisol, and display a more pronounced cortisol response to an acute laboratory stressor than adults who do not have diabetes, even after controlling for differences in body mass index (BMI; Siddiqui et al., 2015).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Siddiqui et al., 2015 source

      The Results (page unavailable) report higher perceived-stress scores and 10 p.m. salivary cortisol in newly detected diabetes than in normal glucose tolerance; evening cortisol also remained an independent predictor in a model including BMI. The study did not test cortisol reactivity to an acute laboratory stressor: its post-challenge measure assessed suppression after an overnight dexamethasone dose. The BMI-adjusted analysis does not establish that every reported group difference persisted after adjustment. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Study design and conductcitation

    The study used well-validated psychological and physiological measures and had good representation of racially/ethnically disadvantaged groups at heightened risk of developing Type 2 diabetes.

    “Study strengths include the examination of an important issue using well-validated psychological and physiological measures, in a sample with a good representation of racially/ethnically disadvantaged groups (e.g., African Americans) at heightened risk of developing Type 2 diabetes (Dabelea et al., 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Dabelea et al., 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Mindful Attention Awareness Scale has shown acceptable test-retest reliability, internal consistency, and convergent validity against other internal-state awareness measures.

    “This measure has demonstrated adequate test-retest reliability, internal consistency, and convergent validity with alternate measures of internal state awareness (Brown & Ryan, 2003; Park, Reilly-Spong, & Gross, 2013; Visted, Vøllestad, Nielsen, & Nielsen, 2015).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Brown & Ryan, 2003 source
    • cites Park, Reilly-Spong, & Gross, 2013 source
    • cites Visted, Vøllestad, Nielsen, & Nielsen, 2015 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Theory proposes that mindfulness protects against the impact of psychological distress on stress reactivity.

    “In addition to the potential direct effects of mindfulness on stress response, mindfulness also has been theorized to serve as a buffer of the effects of psychological distress on stress response (Brown, Weinstein, & Creswell, 2012; Daubenmier, Hayden, Chang, & Epel, 2014).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Brown, Weinstein, & Creswell, 2012 source

      The Conclusions describe a theory that mindfulness protects against the effects of stressful events, and the Discussion reports attenuated cortisol and affective responses to a social-evaluative stressor. The paper does not propose that mindfulness specifically buffers the effect of psychological distress on stress reactivity; it treats distress-related traits as variables to control for, not as the stressor whose effects mindfulness moderates. Page numbers were not available in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Daubenmier, Hayden, Chang, & Epel, 2014 source

  • May combine two claims.

    Premisecitation

    Adult research supports trait mindfulness as a moderator of distress and stress reactivity, yet adolescent studies are scarce.

    “Although a number of studies in adults support dispositional mindfulness as a moderator of psychological distress and stress response (Brown et al., 2012; Daubenmier et al., 2014), there is a paucity of published studies that have evaluated this possibility in adolescents.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Brown et al., 2012 source
      Experimental — accuracy not yet measured
    • cites Daubenmier et al., 2014 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Other work indicates that depression and anxiety symptoms are tied to exaggerated or extended cortisol reactions to acute stress.

    “However, other studies suggest that depressive and anxiety symptoms relate to hyper or prolonged cortisol response to acute stress (Lopez-Duran, Kovacs, & George, 2009).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lopez-Duran, Kovacs, & George, 2009 source

      The Results and Discussion sections report higher cortisol responses and delayed recovery after psychological stress in depressed adolescents. But the evidence concerns depressed youth, not anxiety symptoms; the Discussion also reports blunted reactivity in depressed preschoolers and says evidence on psychological stress responses is limited. Page numbers are not available in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Prior studies in adults at risk for Type 2 diabetes have shown modest effects of mindfulness-based stress reduction on weight loss and cardiometabolic symptoms, though findings are mixed.

    “Prior studies among adults at risk for Type 2 diabetes have shown modest effects of mindfulness-based stress reduction on improving weight loss and cardiometabolic symptoms (Miller, Kristeller, Headings, Nagaraja, & Miser, 2012; Rosenzweig et al., 2007), although findings have been mixed (Loucks et al., 2015).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Miller, Kristeller, Headings, Nagaraja, & Miser, 2012 source

      The Abstract and Discussion report modest weight loss and improved glycemic control, with no significant difference from diabetes self-management education. But the study tested mindful eating training, not mindfulness-based stress reduction, in adults who already had type 2 diabetes—not adults merely at risk for it. The cited paper also does not establish that findings across prior studies were mixed. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites Rosenzweig et al., 2007
    • cites Loucks et al., 2015 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Center for Epidemiologic Studies-Depression Scale has sound psychometric properties among adolescents.

    “Additional inclusion criteria required that girls have mild-to-moderate depressive symptoms as indicated by a score ≥16 on the Center for Epidemiologic Studies-Depression (CES-D) Scale (Radloff, 1977), which has good psychometric properties in this age group (Garrison, Addy, Jackson, McKeown, & Waller, 1991).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Radloff, 1977 source
    • cites Garrison, Addy, Jackson, McKeown, & Waller, 1991 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior research in community samples of adolescents and adults has established a link between dispositional mindfulness and reduced pain and negative affect in response to stress.

    “These findings are in line with prior research in community samples of adolescents and adults establishing a link between dispositional mindfulness and reduced pain and negative affect in response to stress (Brown et al., 2012; Petter et al., 2013).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Brown et al., 2012 source

      The Results report that higher trait mindfulness predicted lower negative affect in response to the social-evaluative stress task. But the Methods identify the participants as 44 undergraduate students, not a community sample, and this paper does not report pain outcomes or adolescent participants. Those parts of the joint claim are not supported by Brown et al. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Petter et al., 2013 source

  • May combine two claims.

    Premisecitation

    Mindfulness has been proposed to buffer suffering during stress and discomfort by reducing automatic negative habitual responding to a stressor and promoting positive engagement of self-directed coping strategies.

    “Mindfulness has been posited to buffer the experience of suffering during conditions of stress and discomfort through reducing automatic, negative habitual responding to a stressor and promoting more positive engagement of self-directed strategies for coping (Brown & Ryan, 2003; Hanley & Garland, 2014; Ryan & Deci, 2000).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Brown & Ryan, 2003 source
    • cites Hanley & Garland, 2014 source
    • cites Ryan & Deci, 2000 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Questionnaire measures of self-perceptions of psychological traits are subject to reporting bias and may not capture the moment-to-moment unfolding of mindful attention, which may be better assessed using third-person methods such as breath counting.

    “Moreover, questionnaire measures of self-perceptions of psychological traits are subject to reporting bias, and may not capture the moment-to-moment unfolding of mindful attention which may be better assessed using third-person methods, such as breath counting (Levinson, Stoll, Kindy, Merry, & Davidson, 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Levinson, Stoll, Kindy, Merry, & Davidson, 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Trait mindfulness measured using the MAAS may more accurately reflect "acting with awareness," which encompasses only one dimension of a multifaceted conception of mindfulness that includes nonjudgmental acceptance.

    “Trait mindfulness in the current study, measured using the MAAS, may more accurately reflect “acting with awareness,” which encompasses only one dimension of a multifaceted conception of mindfulness which includes nonjudgmental acceptance (Baer et al., 2006; Van Dam, Earleywine, & Borders, 2010).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Baer et al., 2006 source
    • cites Van Dam, Earleywine, & Borders, 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many self-report questionnaires claim to measure mindfulness, each conceptualizing it differently and assessing different facets of the construct.

    “There are many self-report questionnaires that claim to measure mindfulness, each conceptualizing mindfulness differently and assessing different facets of the construct (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006 source

  • May combine two claims.

    Findingown data

    Girls with higher depressive/anxiety symptoms showed a steeper cortisol decline after the cold-pressor test than girls with lower symptoms, with a significant difference 60 minutes after the stressor (p=.007), despite no pre-test basal cortisol difference (p=.51).

    “Despite no difference in pre-cold-pressor test basal cortisol (p=.51), girls with relatively higher depressive/anxiety symptoms showed a steeper cortisol decline following cold-pressor test as compared to girls with relatively lower depressive/anxiety symptoms, with a significant difference in cortisol emerging 60 minutes following the stressor between these groups (p=.007).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Depressive and anxiety symptoms as measured by the CES-D and related instruments reflect the psychological constructs of depression and anxiety.

  • May combine two claims.

    Findingown data

    On average, the cold-pressor test did not produce a cortisol increase in this sample, and most participants showed no cortisol increase.

    “Thus, the cold-pressor test, on average, did not elicit a cortisol increase in this sample.”
    • Also stated in: § Discussion · plain
      “The majority (70%) of participants showed no increase in cortisol response to a cold-pressor stress test.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Dispositional mindfulness, depressive/anxiety symptoms, and their interaction had no effect on cortisol AUCi (all p's>.05).

    “There was no effect of dispositional mindfulness, depressive/anxiety symptoms, or their interaction on cortisol AUCi (all p’s>.05).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Depressive and anxiety symptoms as measured by the CES-D and related instruments reflect the psychological constructs of depression and anxiety.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Cold-pressor pain and unpleasantness were strongly positively correlated (r=.81, p<.01).

    “There was a strong positive correlation between cold-pressor pain and unpleasantness (r=.81, p<.01) and between cortisol AUCg and peak cortisol (r=.93, p<.01).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cortisol levels decreased during and after the cold-pressor test, with a negative average AUCi of −210.3±1114.3 ng/dL and a range from −2145 to 1575.

    “Consistent with diurnal patterns of cortisol in the late afternoon, there was a decreasing pattern of cortisol levels during and after administration of the cold-pressor test, reflected by a negative, average AUCi for the sample as a whole (−210.3±1114.3 ng/dL), with considerable variability (Range = −2145–1575).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The study included 119 adolescent girls.

    “One hundred nineteen adolescent girls participated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In girls, the teen years are a peak time for depression and other psychopathology symptoms to emerge, and these may disrupt stress responses.

    “Among girls in particular, adolescence marks a peak period for the onset of symptoms of psychopathology, such as depression, which may impair stress responding (Lewinsohn, Rohde, & Seeley, 1998).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lewinsohn, Rohde, & Seeley, 1998 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among healthy teens, trait mindfulness correlates negatively with the extent to which pain disrupts daily life.

    “In healthy adolescents, dispositional mindfulness was inversely associated with pain interference, referring to the degree to which pain interferes with day-to-day life activities (Petter, Chambers, McGrath, & Dick, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Petter, Chambers, McGrath, & Dick, 2013 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Mindfulness has drawn attention as a personal quality relevant to stress reactivity and possibly useful in preventing and managing Type 2 diabetes.

    “Mindfulness has gained increasing attention as an individual attribute important for stress response (Creswell, Pacilio, Lindsay, & Brown, 2014; Kadziolka, Di Pierdomenico, & Miller, 2016; Weinstein, Brown, & Ryan, 2009) and potentially beneficial for Type 2 diabetes prevention and disease management (Medina et al., 2017).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Creswell, Pacilio, Lindsay, & Brown, 2014 source
    • cites Kadziolka, Di Pierdomenico, & Miller, 2016 source
    • cites Weinstein, Brown, & Ryan, 2009 source

  • Classified as probably not a substantial claim.

    Premisecitation

    The HPA axis is the key neuroendocrine system controlling the body's peripheral physiological stress response.

    “The HPA axis is the critical neuroendocrine system that governs the body’s peripheral physiological response to stress (Chrousos, 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chrousos, 2009 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Outliers were adjusted to 1.5 times the interquartile range below or above the 25th or 75th percentile, and this resulted in satisfactory skew and kurtosis for all variables.

    “Outliers were adjusted to 1.5 times the interquartile range below or above the 25th or 75th percentile, resulting in satisfactory skew/kurtosis for all variables (Behrens, 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Behrens, 1997 source

  • May combine two claims.

    Interpretationown data

    Using mindfulness-based stress reduction for diabetes prevention may provide an additional benefit by improving how adolescent girls perceive and respond to challenges, potentially affecting their mental and physical health trajectories.

    “Our findings suggest that utilizing mindfulness-based stress reduction for diabetes prevention may provide an additional benefit by improving how adolescent girls perceive and respond to challenges, which may impact the trajectory of both their mental and physical health outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The small literature on mindfulness-based interventions and adult cortisol has produced inconsistent results.

    “In a small body of existing studies evaluating the effects of mindfulness-based interventions on cortisol in adults, the effects have been mixed (O'Leary, O'Neill, & Dockray, 2016).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites O'Leary, O'Neill, & Dockray, 2016 source

  • Classified as probably not a substantial claim.

    Premisereasoning

    Trait mindfulness differences have been suggested as a moderator that might account for inconsistent distress-cortisol findings.

    “Individual differences in dispositional mindfulness have been proposed to offer one potential moderating factor that explains these discrepancies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Complete bloodwork was unavailable for three adolescents, resulting in three missing insulin resistance values.

    “Complete bloodwork could not be obtained on three adolescents, leading to n=3 missing values for insulin resistance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Certain studies find that depressed adolescents show a reduced cortisol reaction to lab stressors like the cold-pressor test.

    “In some data, adolescents with depressive symptoms display a hypo-responsive or blunted cortisol reaction to laboratory stressors such as a cold-pressor test (Keenan et al., 2013), and this blunted cortisol response profile predicts the subsequent recurrence of elevated depressive symptoms during adolescence (Calhoun et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Keenan et al., 2013 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Statisticians recommend adjusting outliers to 1.5 times the interquartile range because it minimizes their influence, changes the overall distribution only minimally, and avoids bias from removing outliers.

    “This strategy has been recommended by statisticians in order to minimize outliers’ influence on the distribution, minimally change the distribution overall, and avoid potential bias associated with eliminating outliers (Behrens, 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Behrens, 1997 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Theory holds that mindfulness can alter how people engage with and process distress, yielding a healthier response to acute stressors.

    “As such, mindfulness theoretically may shift the way in which an individual relates to and processes psychological distress, resulting in a more adaptive stress response in the face of acute challenges (Garland, Gaylord, & Fredrickson, 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Garland, Gaylord, & Fredrickson, 2011 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Because salivary cortisol usually peaks around 30 minutes after stress, the peak response was defined as the highest cortisol level between 20 and 60 minutes post-stressor.

    “Peak cortisol response was evaluated as the highest cortisol value 20–60 minutes after the stress exposure, as salivary cortisol response manifests approximately 30 minutes following exposure. Peak response allows for variability in inter-individual differences in the timing of physiological reactions to stress (Lopez-Duran, Mayer, & Abelson, 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lopez-Duran, Mayer, & Abelson, 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Ten degrees Celsius is a frequently recommended water temperature for pediatric and adolescent cold-pressor protocols.

    “a commonly recommended set point for cold-pressor studies with children and adolescents (von Baeyer, Piira, Chambers, Trapanotto, & Zeltzer, 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites von Baeyer, Piira, Chambers, Trapanotto, & Zeltzer, 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Six adolescents declined the cold-pressor test and therefore had missing data for that procedure.

    “Six adolescents had missing cold-pressor test data because they declined to take part in that procedure.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A dampened cortisol response pattern forecasts the return of higher depressive symptoms later in adolescence.

    “In some data, adolescents with depressive symptoms display a hypo-responsive or blunted cortisol reaction to laboratory stressors such as a cold-pressor test (Keenan et al., 2013), and this blunted cortisol response profile predicts the subsequent recurrence of elevated depressive symptoms during adolescence (Calhoun et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Calhoun et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The MAAS showed adequate internal consistency in this sample, with alpha equal to .87.

    “Internal reliability in the current sample was adequate (α=.87).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The negative affect scale demonstrated adequate internal consistency in this sample, with alpha equal to .76.

    “This scale had adequate internal reliability in the current sample (α=.76).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Youth Self-Report depressive/anxiety subscale showed adequate internal consistency in this sample, with alpha equal to .78.

    “The depressive/anxiety subscale of the Youth Self-Report (current sample, α=.78) was chosen for the current study (versus the depressive/withdrawal subscale, for example) because it encompassed the range of internalizing symptoms that have been linked with altered stress response in prior studies with children and adolescents (Lopez-Duran et al., 2009).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Because all adolescents had mild-to-moderate depressive symptoms on the CES-D but were not clinically depressed, variability in depressive/anxiety symptoms was restricted, and generalizability is cautioned to adolescents without depressive symptoms and to those with major depressive disorder or an anxiety disorder.

    “Likewise, because all adolescents had mild-to-moderate depressive symptoms on the CES-D, but were not clinically depressed, variability in depressive/anxiety symptoms was also somewhat restricted and generalizability is cautioned to adolescents without depressive symptoms, as well as to those with major depressive disorder or an anxiety disorder.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Depressive and anxiety symptoms as measured by the CES-D and related instruments reflect the psychological constructs of depression and anxiety.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Youth Self-Report is commonly used with adolescents and has shown acceptable reliability and validity.

    “The Youth Self-Report is widely utilized in adolescents and has demonstrated adequate reliability and validity (Achenbach, 1991).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Achenbach, 1991

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    This was a secondary data analysis, and post-hoc power analysis indicated adequate (≥80%) power to detect small-to-moderate effects.

    “This was also a secondary data analysis; post-hoc power analysis indicated that we had adequate (≥80%) power to detect small-to-moderate effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The preponderance of research shows that mindfulness can promote more positive responses to stress and reduce negative evaluations of stressful encounters.

    “Such findings would be in line with the preponderance of research showing that mindfulness can promote more positive responses to stress (e.g. engaging self-regulation; Kadziolka et al., 2016) and reduce negative evaluations of stressful encounters (e.g., Creswell et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kadziolka et al., 2016 source
    • cites Creswell et al., 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Missing survey data were minimal: seven cases for dispositional mindfulness and one case for depressive/anxiety symptoms.

    “There were minimal missing data for survey measures of dispositional mindfulness (n=7) and depressive/anxiety symptoms (n=1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The insulin assay used had low cross-reactivity with proinsulin and C-peptide, sensitivity of 2 μU/mL, and inter- and intra-assay coefficients of variation of 5.8% and 3.6%.

    “The cross-reactivity of the insulin assay with proinsulin was <8% and with Cpeptide was <1%, sensitivity was 2 µU/mL, and the mean inter- and intra- assay coefficients of variation were 5.8 and 3.6%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The use of cross-sectional data limits interpretation of the direction of influence between variables.

    “In addition, we utilized cross-sectional data, which limits interpretation of the direction of influence between variables.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Dispositional mindfulness and depressive/anxiety symptoms were entered simultaneously as independent variables so that each could account for the other's effects.

    “we entered these variables simultaneously so that any significant effects of mindfulness accounted for the effects of depressive/anxiety symptoms and vice versa.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The current study used the Mindful Attention Awareness Scale (MAAS), which assessed the propensity to maintain mindful awareness in everyday life.

    “The current study utilized the Mindful Attention Awareness Scale (MAAS), which assessed the propensity for individuals to maintain mindful awareness in everyday life (Brown & Ryan, 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown & Ryan, 2003 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study followed recommended guidelines for administering the cold-pressor test to youth.

    “Although the current study followed recommended guidelines for administering the cold-pressor test stressor to youth (von Baeyer et al., 2005), only 30% of the sample had a cortisol response.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites von Baeyer et al., 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Evaluators were thoroughly trained and standardized operating procedures were used, but a single evaluator was not used for all testing sessions, introducing possible tester variability.

    “Although we thoroughly trained evaluators and used standardized operating procedures, we were not able to utilize a single evaluator for all testing sessions, introducing the possibility that some variability may have been attributable to the tester.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Differences in cortisol output could reflect HPA axis dysregulation, which may contribute to worsening insulin resistance in the future.

    “Differences in cortisol output could reflect dysregulation of the HPA axis, which may contribute to worsening insulin resistance in the future.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Taken together, the findings suggest that dispositional mindfulness may be relevant for subjective stress tolerance and support an association of depressive/anxiety symptoms with HPA axis dysregulation in adolescent girls at risk for Type 2 diabetes with mild-to-moderate depressive symptoms.

    “Taken together, these findings suggest that dispositional mindfulness may be relevant for subjective stress tolerance and support an association of depressive/anxiety symptoms with HPA axis dysregulation in adolescent girls at risk for Type 2 diabetes with mild-to-moderate depressive symptoms.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Depressive and anxiety symptoms as measured by the CES-D and related instruments reflect the psychological constructs of depression and anxiety.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The MAAS has been critiqued for inadequately capturing the complex nature of mindfulness as described in Buddhist writings and by practitioners of mindfulness-based interventions.

    “This measure has been critiqued for inadequately capturing the complex nature of mindfulness as it has been described in Buddhist writings and by practitioners of mindfulness-based interventions (Grossman, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grossman, 2011 source
56 of 56

  • The paper relies on this without support.

    Depressive and anxiety symptoms as measured by the CES-D and related instruments reflect the psychological constructs of depression and anxiety.

    “Depressive/anxiety symptoms were negatively correlated with cold-pressor peak cortisol (r=−.20, p<.05).”
    “all adolescents had mild-to-moderate depressive symptoms on the CES-D, but were not clinically depressed”
1 of 1

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Authors
Skoranski, A., Kelly, N. R., Radin, R. M., Thompson, K. A., Galescu, O., Demidowich, A. P., Brady, S. M., Chen, K. Y., Tanofsky-Kraff, M., Yanovski, J. A., & Shomaker, L. B.
Affiliations
  • Colorado State University (US)
  • National Institutes of Health (US)
Corresponding author
Shomaker, Lauren B.
ORCID
Venue
Journal of Child and Family Studies
Publisher
Springer Science and Business Media LLC
Published
2018-03-19
Volume
27
Issue
7
Pages
2254-2264
ISSN
  • 1062-1024 (ISSN-L)
  • 1573-2843
DOI
10.1007/s10826-018-1065-9
PMC
PMC6085111
OpenAlex
W2790953260
Semantic Scholar
39de7add46fb06e28afe1eed8659df6cbe7004d1
Cited by
10
References
69
Citations by year
2026: 1 · 2025: 1 · 2022: 4 · 2021: 1 · 2020: 3
FWCI
1.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Child and Family Studies (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Child Health and Human Development (R00HD069516, K99HD069516, 1ZIAHD000641)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
mindfulness, cortisol response, psychological distress, depressive symptoms, anxiety symptoms, stress response, cold pressor test, pain perception, negative affect, adolescent girls, type 2 diabetes risk, overweight and obesity, family history of diabetes, blunted cortisol response, stress buffering

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

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