Literature suggests that occupational stress is associated with a higher risk of metabolic syndrome; yet less is known whether other sources of stress have similar effects. This review aims to examine whether the relationship between psychological stress and metabolic syndrome differs by sources of stress. Three databases (PubMed, Web of Science, and CINAHL) were searched for eligible articles; metaanalyses were conducted using the random effects model. After controlling for covariates, adults in the high-stress groups had 45% higher chance of having metabolic syndrome than adults in the low-stress groups (odds ratio [OR] = 1.450; 95% confidence interval [CI], 1.211-1.735; P < .001). The subsequent meta-analysis based on cross-sectional studies suggested that occupational stress showed the strongest effect (OR = 1.692; 95% CI, 1.182-2.424; P = .004), while perceived general stress showed the weakest effect (OR = 1.217; 95% CI, 1.017-1.457; P = .032).Unfortunately, there is a lack of longitudinal studies for subsequent meta-analysis based on sources of stress. There is a need for continued research to examine the long-term relationship between different sources of stress and the risk of metabolic syndrome. Traditional recommendations for preventing metabolic syndrome (eg, low-fat diet and exercise) may not achieve the best outcome if clinicians overlook patients' psychosocial stress. KEYWORDS metabolic syndrome, occupational stress, perceived stress, psychological stress 1 | INTRODUCTION About 30% of adults have metabolic syndrome worldwide. 1,2 The economic burden of metabolic syndrome is substantial. For instance, the annual medical costs for Americans with metabolic syndrome are 60% higher than those without metabolic syndrome. [3][4][5] The development of metabolic syndrome is a multifaceted continuum of metabolic dysregulation, including hyperglycemia, hypertension, visceral adiposity, and atherogenic dyslipidemia. 6 Psychological stress has been linked to metabolic syndrome for decades, but its underlying mechanism is not yet fully understood.Allostasis refers to a normal physiological process where the brain activates the sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes and stimulates adrenal glands to release stress hormones (eg, corticosteroids) and catecholamine (eg, epinephrine and norepinephrine) to combat against stressful environmental demands. 7 According to the allostatic load framework (ALF), the repeated cycles of activation and deactivation of allostasis over time, or a failure to disengage the stress response during and after each stressful life demand, could alter adults' diurnal cortisol rhythm and decrease the capacity of glucocorticoids to suppress endotoxin-stimulated cytokine production, resulting in a

PURPOSE The purpose of this study was to explore the responses of primary care clinicians to patients who complain of symptoms that might indicate depression, to examine the clinical strategies used by clinicians to recognize depression, and to identify the conditions that infl uence their ability to do so. METHODSThe grounded theory method was used for data collection and analysis. In-depth, in-person interviews were conducted with a purposeful sample of 8 clinicians. All interviews were audiotaped and transcribed.RESULTS This study identifi ed 3 processes clinicians engage in to recognize depression-ruling out, opening the door, and recognizing the person-and 3 conditions-familiarity with the patient, general clinical experience, and time availability-that infl uence how each of the processes is used. CONCLUSIONSThe likelihood of accurately diagnosing depression and the timeliness of the diagnosis are highly infl uenced by the conditions within which clinicians practice. Productivity expectations in primary care will continue to undermine the identifi cation and treatment of depression if they fail to take into consideration the factors that infl uence such care.

The purpose of this study was to determine whether the defense style of hospitalized depressed adults improved over the course of treatment. Thirty-one inpatients (24 women and 7 men) with an admitting diagnosis of major depression completed the 40-item Defense Style Questionnaire and the 20-item Center for Epidemiologic Studies-Depression Scale. Participants completed the Defense Style Questionnaire and the Center for Epidemiologic Studies-Depression Scale within 48 hours after admission and within 24 hours before or after discharge. The average admission and discharge Center for Epidemiologic Studies-Depression Scale ratings (+/-SD) were 41.93+/-9.93 and 26.45+/-12.19, respectively. The average hospital length of stay was 7.1+/-2.8 days. Two-tailed t-test comparisons of the Defense Style Questionnaire admission and discharge ratings showed significantly higher discharge mature ratings, significantly lower discharge immature ratings, and stable neurotic ratings. We concluded that for some depressed women and men, improvement in defense style can occur within days after the initiation of standard inpatient treatment.

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