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Psychological stress disrupts the integrity of the intestinal barrier and is strongly linked to emotional disorders, behavioral changes, and gastrointestinal dysfunction. However, there are limited treatment options available for repairing the damage to the intestinal barrier. As a natural plant-based health beverage, tea (Camellia sinensis) has been shown to have various potentially advantageous effects on the intestinal barrier and immune function. In this study, we extracted bioactive molecules from tea leaves, named exosome-like nanoparticles (ELNs), and then examined their potential protective properties for the intestinal barrier. Through in vitro experimentation, we investigated whether tea-derived ELNs (TELNs) could offer a protective effect against lipopolysaccharides-induced damage to the intestinal barrier. In an in vivo experiment, rats were exposed to water avoidance stress and subsequently administered TELNs orally. The administration of TELNs resulted in the enhancement of the epithelial barrier in the intestine, effectively preventing bacterial translocation to the submucosae. Additionally, TELNs were found to improve the function of the intestinal immune barrier through the mediation of interleukin-22 and the increased secretion of antimicrobial peptide Reg3g. Notably, miR-44 and miR-54 in TELNs exhibited similar protective effects on the intestinal barrier. These findings suggest that TELNs possess the ability to restore the integrity of the intestinal barrier in the context of psychological stress.

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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic induced psychological distress, which is linked to emotional eating and symptoms of addiction to ultra-processed foods (UPFs). OBJECTIVE: This study aimed to investigate whether symptoms of addiction to UPFs mediate the relationship between psychological stress due to the COVID-19 pandemic and emotional eating behaviour. METHODS: A cross-sectional online study was conducted from May to November 2021 among 368 undergraduate Brazilian students. The participants answered demographic questions and completed validated scales, including the Coronavirus Stress Measure, Modified Yale Food Addiction Scale 2.0 and Emotional Eating Questionnaire. Mediation analysis was employed to examine the hypothesised relationships. RESULTS: The results revealed a significant indirect effect, indicating that symptoms of food addiction mediated the association between perceived stress during the COVID-19 pandemic and emotional eating behaviour. Specifically, 61% of the influence of perceived stress on emotional eating during the pandemic was explained by symptoms of UPF addiction. CONCLUSION: These findings suggest that addressing symptoms of UPF addiction could be pivotal in public health strategies aimed at promoting healthy eating habits among distressed undergraduate students in the post-COVID-19 era.

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BACKGROUND: The banking sector is one of the job sectors that experience high stress, workload, complex interpersonal relationships, and job burnout as it involves interaction with the public and financial responsibilities, which leads to high burnout and stress. The present study was conducted to assess the prevalence of burnout and stress among bank employees and to find the associated factors. METHODS: This cross-sectional survey was conducted among 282 bank employees of Kollam district, Kerala, India. Data was collected using a self-administered questionnaire related to the socio-demographic and professional details. We used the Oldenburg Burnout Inventory (OLBI) to screen for burnout levels. Depression Anxiety Stress Scale (DASS 21) to screen for the levels of depression, anxiety, and stress among study participants. Descriptive statistics were used to summarize the data, and logistic regression was used to identify the factors associated with the levels of burnout and stress. RESULTS: Of 282 study participants, moderate to high levels of burnout were observed in 232 participants (82.2%), and 74 participants (26.2%) had mild to extremely severe levels of stress. Daily average working duration showed an association with higher levels of burnout (adjusted odds ratio [ORAdj]: 2.391; 95% confidence interval [CI]: 1.12-5.10) and stress (ORAdj: 3.37; 95% CI: 1.58-7.16). CONCLUSIONS: A high prevalence of burnout and stress was observed in the present study. The duration of working hours was associated with both burnout and stress. Therefore, regulating the working hours may help adequately manage stress and burnout, thereby improving the mental health of bank employees.

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Introduction: Increasing imaging examination rates leads to a corresponding rise in the detection rates of unruptured intracranial aneurysms (UIAs). There is limited knowledge on how the detection of UIA affects health-related outcomes in untreated patients. Research question: Is the diagnosis of UIA associated with psychosocial outcomes, healthcare services utilisation, or sick leave in untreated individuals? Material and methods: Nested case-control study with 96 participants diagnosed with UIAs through magnetic resonance angiography (MRA) screening, not receiving preventive aneurysm obliteration. Comparisons were made with Control1 (192 participants with negative MRAs) and Control2 (192 individuals not MRA screened). Quality of life, psychological distress, and health anxiety were assessed using EQ-5D-5L including EQ VAS, Hopkins Symptom Checklist-10, and Whiteley Index-6, respectively. Healthcare service utilisation and sick leave was measured using registry data. Median follow-up was 32-55 months for the different outcomes. Results: UIA were in general not associated with psychosocial outcomes, neither compared to pre-screening values nor to controls. The exemption was a lower mean EQ VAS score at follow-up for cases (76.7) versus Control1 (80.0), regression coefficient -3.87 (95% CI (-7.60, -0.14). Cases had significantly higher rates of radiology exams compared to controls, with 1.47 (95% CI 1.25, 1.74) exams per person-year versus 0.91 (C95% CI 0.75, 1.09) for Control1 and 0.95 (95% CI CI 0.79, 1.14) for Control2. No significant differences were observed in other psychosocial outcomes, healthcare services utilisation, or sick-leave. Discussion and conclusions: The overall impact of untreated UIAs appears to be limited when assessed years after diagnosis.

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Health personnel may seek chaplain support to discuss stressors related to complex patient cases, difficult team dynamics, and personal issues. In this survey study of 1376 healthcare interprofessional clinicians, participants reported interacting with chaplains most frequently over patient-related stressors in the prior 12 months. Factors associated with chaplain interactions to discuss all three stressors included: reporting chaplains provide spiritual support to health personnel, more years of service, seeking professional help to deal with stressors, and higher levels of secondary traumatic stress. Being a registered nurse (RN) and working in a critical care specialty were associated with increased odds of interactions with a chaplain to discuss patient-related stressors while identifying as Catholic or Protestant was associated with chaplain interactions to discuss team-related and personal stressors. Chaplains should tailor interventions to promote health personnel's spiritual well-being based on patient-related, team-related, and personal stressors. Healthcare institutions which do not employ chaplains should advocate for this resource. Leaders in healthcare settings with chaplains should promote increased staff awareness that chaplains are available to support wellbeing by discussing patient, team, or personal stressors.

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Emerging evidence shows that psychological stress promotes the progression of Parkinson's disease (PD) and the onset of dyskinesia in non-PD individuals, highlighting a potential avenue for therapeutic intervention. We previously reported that chronic restraint-induced psychological stress precipitated the onset of parkinsonism in 10-month-old transgenic mice expressing mutant human α-synuclein (αSyn) (hαSyn A53T). We refer to these as chronic stress-genetic susceptibility (CSGS) PD model mice. In this study we investigated whether ginsenoside Rg1, a principal compound in ginseng notable for soothing the mind, could alleviate PD deterioration induced by psychological stress. Ten-month-old transgenic hαSyn A53T mice were subjected to 4 weeks' restraint stress to simulate chronic stress conditions that worsen PD, meanwhile the mice were treated with Rg1 (40 mg· kg-1 ·d-1, i.g.), and followed by functional magnetic resonance imaging (fMRI) and a variety of neurobehavioral tests. We showed that treatment with Rg1 significantly alleviated both motor and non-motor symptoms associated with PD. Functional MRI revealed that Rg1 treatment enhanced connectivity between brain regions implicated in PD, and in vivo multi-channel electrophysiological assay showed improvements in dyskinesia-related electrical activity. In addition, Rg1 treatment significantly attenuated the degeneration of dopaminergic neurons and reduced the pathological aggregation of αSyn in the striatum and SNc. We revealed that Rg1 treatment selectively reduced the level of the stress-sensitive protein RTP801 in SNc under chronic stress conditions, without impacting the acute stress response. HPLC-MS/MS analysis coupled with site-directed mutation showed that Rg1 promoted the ubiquitination and subsequent degradation of RTP801 at residues K188 and K218, a process mediated by the Parkin RING2 domain. Utilizing αSyn A53T+; RTP801-/- mice, we confirmed the critical role of RTP801 in stress-aggravated PD and its necessity for Rg1's protective effects. Moreover, Rg1 alleviated obstacles in αSyn autophagic degradation by ameliorating the RTP801-TXNIP-mediated deficiency of ATP13A2. Collectively, our results suggest that ginsenoside Rg1 holds promise as a therapeutic choice for treating PD-sensitive individuals who especially experience high levels of stress and self-imposed expectations.

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BACKGROUND: Caregiving in the African American community is informed by strong cultural expectations but may be associated with negative experiences and poor mental health outcomes. OBJECTIVE: The purpose of this convergent mixed-methods study is to understand the relationship between caregiving experiences and mental health and explore stress management strategies in African American family caregivers of adults with chronic or disabling conditions. METHODS: African American family caregivers (N = 100) were recruited using community-engaged methods and completed a sociodemographic questionnaire, the Caregiver Reaction Assessment scale, and the Center for Epidemiologic Studies Depression (CES-D-10) Scale. A subsample (n = 24) participated in semi-structured interviews. Data were analyzed using linear regression and content analysis. A matrix was developed to integrate quantitative and qualitative results. RESULTS: Participants were on average 59 years old. Most were women and provided care to a parent. Lack of family support (B = 1.37, P = .03) and impact of caregiving on caregivers' finances (B = 1.74, P = .004), schedule (B = 2.92, P < .001), and health (B = 3.26, P < .001) were associated with depressive symptoms and were reported as stressful experiences. Negative interactions with the care recipient and caring for multiple people emerged as other sources of stress. Participants used independent and interpersonal coping strategies, as well as strategies to facilitate their caregiving role to reduce their stress. Values of reciprocity, limited use of community-based resources, and mental health stigma emerged as important cultural considerations. CONCLUSIONS: Our findings suggest the need for culturally-sensitive interventions to improve communication and care coordination within African American family caregiving networks and educational programs about mental health and caregiving resources endorsed by trusted community sources.

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Vitiligo is an acquired autoimmune skin disease characterized by patchy depigmentation of the skin, often accompanied by white hair. The aetiology of vitiligo is complex and difficult to cure, and its disfiguring appearance significantly impacts patients' mental and physical health. Psychological stress is a major factor in inducing and exacerbating vitiligo, as well as affecting its treatment efficacy, though the specific mechanisms remain unclear. Increasing research on the brain-skin axis in skin immunity suggests that psychological stress can influence local skin immunity through this axis, which may play a crucial role in the pathogenesis of vitiligo. This review focuses on the role of brain-skin axis in the pathogenesis of vitiligo, and explores the possible mechanism of brain-skin axis mediating the pathogenesis of vitiligo from the aspects of sympathetic nervous system, hypothalamic-pituitary-adrenal (HPA) axis and hormones and neuropeptides, aiming to provide the necessary theoretical basis for psychological intervention in the prevention and treatment of vitiligo.

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Anti-N-methyl-ᴅ-aspartate receptor (NMDAR) encephalitis is a rare disease with a range of neurological and psychiatric presentations. Antibodies against NMDAR receptor are purported to be pathologic, and the two known potential immunological triggers are tumors and viral infection. In half of the cases, the trigger is not known. We present two cases where stress seemed to have triggered encephalitis. These cases illustrate the possible role of stress in leading to immune dysregulation, which can lead to encephalitis. We review the role of stress in anti-NMDAR encephalitis and possible mechanisms by which stress can trigger an immune dysregulation.

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Objective: Depression is a common mental illness with a high prevalence rate and is a significant contributor to the global burden of diseases. Various factors are associated with depression, and its etiology is complex. Instead of focusing on single-factor effects, this study aimed to explore a combination of high-risk factor sets for depression among adult community residents. Methods: We conducted a cross-sectional survey in Shenzhen, China, from January 2021 to March 2021. A simple sampling method was used to enroll participants. A total of 1,965 adult residents completed the survey and were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Eysenck Personality Questionnaire-Revised Short Scale for Chinese (EPQ-RSC), and the Psychosocial Stress Survey for Groups (PSSG). The fuzzy-set qualitative comparative analysis method was used to explore the high-risk factor sets for depression among adult community residents. Results: The prevalence of depression among the surveyed adult residents in Shenzhen was 6.36%. The mean scores of PHQ-9 were higher among women and unmarried residents. The combination of low extroversion (e) and high neuroticism (N) in personality traits, along with high scores for life events (V), negative emotional responses to events (G), positive emotional responses to events (O), and positive coping styles to events (I) (denoted as e*N*V*G*O*I) constituted a high-risk factor set for depression. The overall consistency was 0.843, and the overall coverage was 0.330. Conclusion: Our study suggested that stressful life events together with personality traits including neuroticism and introversion serve as crucial factors for depression among adult community residents, regardless of the coping strategies they adopt. This study provides data for developing comprehensive interventions such as regulating neuroticism and introversion levels and reducing stressors to prevent the occurrence of depression among adult community residents.

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Chronic psychological stress has been reported to decrease circulating iron concentrations and impair hematopoiesis. However, the underlying mechanisms remain unclear. This study aimed to investigate the effects of psychological stress on biological iron metabolism by using the social defeat stress (SDS) model, a widely used model of depression. Compared with control mice, mice subjected to SDS (SDS mice) had lower social interaction (SI) behavior. The SDS mice also showed impaired hematopoiesis, as evidenced by reduced circulating red blood cell counts, elevated reticulocyte counts, and decreased plasma iron levels. In the SDS mice, the iron contents in the bone marrow decreased, whereas those in the spleen increased, suggesting dysregulation in systemic iron metabolism. The concentrations of plasma hepcidin, an important regulator of systemic iron homeostasis, increased in the SDS mice. Meanwhile, the concentrations of ferroportin, an iron transport protein negatively regulated by hepcidin, were lower in the spleen and duodenum of the SDS mice than in those of the control mice. Treatment with dalteparin, a hepcidin inhibitor, prevented the decrease in plasma iron levels in the SDS mice. The gene expression and enzyme activity of furin, which converts the precursor hepcidin to active hepcidin, were high and positively correlated with plasma hepcidin concentration. Thus, furin activation might be responsible for the increased plasma hepcidin concentration. This study is the first to show that psychological stress disrupts systemic iron homeostasis by activating the hepcidin-ferroportin axis. Consideration of psychological stressors might be beneficial in the treatment of diseases with iron-refractory anemia.

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Introduction: Stress occurs more frequently in groups in which the degree of responsibility and decision-making power play notable roles in society, such as professors and health professionals. Objectives: To measure and understand the stress of professors in the undergraduate course of Medicine and Dentistry of a private educational institution in northeastern Brazil. Methods: Observational, descriptive and exploratory study with a quantitative approach was conducted between November 2018 and September 2019. A total of 184 professors participated in the study, answering the following instruments: demographic sociodata questionnaire, Stress Symptoms Inventory and the Preliminary Burnout Identification Questionnaire. The Post-Traumatic Stress Symptoms Scale was applied to the 60 professors with stress. The data obtained were submitted to data analysis through Pearson's chi-square test and logistic regression. Results: Stress was present in 40.3% of the professors, with a predominance of the resistance phase (85%) and signs indicative of burnout. There was a significant correlation between the presence of stress and the time of traumatic event either with the individual himself or with some relative and/or close friend. There was no correlation between the traumatic events and Post Traumatic Stress Disorder, although a significant correlation was observed between Post Traumatic Stress Disorder and burnout. Conclusions: The results point to the need to properly identify and manage stress so that the teaching experience is healthy and conducive to the teaching-learning process.

Introdução: O estresse ocorre de forma mais recorrente em grupos em que o grau de responsabilidade e poder de decisão perpetram notáveis papéis na sociedade, tais como docentes e profissionais de saúde. Objetivos: Mensurar e compreender o estresse docente dos cursos de graduação de Medicina e Odontologia de uma instituição de ensino privada do Nordeste do Brasil. Métodos: Tratou-se de um estudo observacional, descritivo, analítico e exploratório, com abordagem quantitativa no período de novembro de 2018 a setembro de 2019. Participaram do estudo 184 docentes, respondendo aos seguintes instrumentos: um questionário sociodemográfico, o Inventário de Sintomas de Estresse e o Questionário Preliminar de Identificação de Burnout. Já a Escala de Sintomas de Estresse Pós-Traumático foi aplicada nos 60 docentes com estresse. Foi realizada a análise de dados através do teste de qui-quadrado de Pearson e de regressão logística. Resultados: O estresse estava presente em 40,3% dos docentes, com predomínio da fase de resistência (85%) e sinais indicativos de burnout. Houve correlação significativa entre estresse e tempo de acontecimento traumático, seja com o próprio indivíduo ou com algum familiar e/ou amigo próximo. Não houve correlação entre o acontecimento traumático e o transtorno de estresse pós-traumático, embora tenha sido observada correlação significativa de transtorno de estresse pós-traumático e burnout. Conclusões: Os resultados apontam para a necessidade de identificar e manejar adequadamente o estresse para que a experiência docente seja salutar e propícia ao processo de ensino-aprendizagem.

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The COVID-19 epidemic not only impacted China's economy but also induced periodic anxiety among employees, especially during its peak. Even as governmental controls relaxed, enterprises seemed unaffected externally. However, beneath the surface, the lingering effects on employee mental health persisted. Many faced dual stressors concerning their job and personal well-being due to the epidemic, heightening work-related anxieties. This research, a year after China resumed work, delves into the psychological stress influencing this sustained anxiety. A survey of 516 employees helped test the hypothesis using a multiple regression model. Findings indicated heightened continuous work anxiety due to the epidemic, particularly in hard-hit areas. However, individual resilience, organizational, and social support were found to mitigate these effects. The study underscores the sustained psychological aftermath of the epidemic on employees, urging health authorities to address it.

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(1) Background. The post-COVID-19 era has imposed unique challenges on educators, significantly impacting their psychological and physical well-being. This study examines the interrelationships among psychological stress, sleep quality, and somatization in a sample of teachers, elucidating the impact of these factors during the ongoing recovery from the pandemic. (2) Methods. Using validated instruments such as the Pittsburgh Sleep Quality Index (PSQI) and the Mesure du Stress Psychologique (MSP), this research investigates how stress and sleep disturbances correlate with somatization among teachers. The study also considers the influence of demographic factors such as age, gender, and years of experience. (3) Results. The results indicated that sleep quality significantly correlates with both psychological stress and somatic pain, emphasizing the crucial role of sleep in managing stress-induced physical symptoms. Additionally, the fear of COVID-19 significantly exacerbates these effects, illustrating the complex interplay of psychological and physical health factors during the pandemic. Contrary to initial hypotheses, demographic factors such as gender, age, and years of experience did not significantly influence these primary relationships. (4) Conclusions. The findings emphasize the necessity of addressing both psychological stress and sleep quality to mitigate their combined effects on somatization. Educational institutions and policymakers are urged to develop targeted interventions that address these issues to support teachers' health and well-being in a post-pandemic landscape.

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BACKGROUND: Mindfulness-based, in-person programs are effective at reducing stress and enhancing resilience in military and civilian samples, yet few studies have examined or compared training offered via real-time, interactive social media. Such a program would have a wider-reach and could include those unable to attend in-person. There is also interest in resolving ambiguity about the effects of mindfulness training on individual difference variables, such as self-compassion. OBJECTIVE: The purpose of this research was to compare pre/post self-compassion for three interventions; Mindfulness-based Stress Reduction delivered in-person (IP), mindfulness meditation training delivered via a Virtual World (VW), and a wait-list Control Group (CG) among active duty and veteran U.S. military. METHODS: A 2 (pre/post)×3 (group) factorial design was conducted with 250 active duty and veteran U.S. Military service members, with self-compassion measures as dependent variables. RESULTS: Self Compassion improved 10% for the IP group and 14% for the VW group, while the CG group did not improve. Combined treatment groups yielded a 10.3% improvement in self-compassion compared with no change in the CG and with a group×time interaction effect (p < 0.01). Participants with lower initial self-compassion experienced greater benefits than those with higher baseline self-compassion (p < 0.01). CONCLUSION: IP and VW Mindfulness Meditation training were equally effective in increasing self-compassion. Adding effective on-line mindfulness delivery will promote self-compassion among a more extensive audience, likely yielding improved coping, confidence, connectedness, cheerfulness, steadiness, and self-satisfaction, while lessening anxiety, fear-of-failure, and stress among participants.

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OBJECTIVE: To explore the association of Occupational chronic psychological stress with transaminase, heat shock protein70(HSP70)gene family and their protein interaction with metabolic syndrome(MS). METHODS: A case-control study was used. According to the inclusion and exclusion criteria, from March 2015 to March 2016, 583 unrelated MS patients were selected as the case group and 585 unrelated healthy people as the control group among hospitalized and physical examination subjects aged 20-60 in Wuzhong People's Hospital and General Hospital of Ningxia Medical University. Questionnaire survey, physical examination, clinical and biochemical indicators, serum HSP70 level and five-locus polymorphism detection of HSP70 gene were carried out. GMDR 0.7 software was used to analyze the relationship between psychological stress, transaminase, HSP70 gene and its protein interaction and MS. RESULTS: After adjusting for age and sex, the rs1008438, rs1061581, rs539689 and rs222795 locus of HSP70 gene in the Co-dominant model and Dominant model and the rs222795 loci in the Over-dominant model carry wild homozygous genotype and heterozygous genotype were all related to the reduction of MS risk(OR<1, P<0.05). GMDR result: the 2-factor interaction model composed of psychological stress and serum HSP70, the 2-3 factor interaction model composed of transaminase activity, and the 2-6 factor interaction model composed of five locus of HSP70 gene, the 2-9 factor interaction model consisting of psychological stress and transaminase activity, HSP70 gene and its protein were all significantly associated with MS(P<0.01, P<0.05), all each factor interaction models were the best, and the 9-factor optimal interaction model had the highest risk of MS(OR=46.51, 95%CI 27.65-78.26), and the risk of MS in high-risk type was 45.23 times higher than that in low-risk type(95%CI 31.29-65.38, P<0.01). CONCLUSION: HSP70 gene family carrying wild-type alleles is a protective factor for MS. The interaction among Occupational chronic psychological stress interacts with transaminases, HSP70 gene and its serum proteins may be associated with MS. With the increase of involvement interaction factors, the risk of MS increased significantly. The interaction of multiple factors can greatly increase its risk.

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INTRODUCTION: Based on the Combined Cognitive Biases Hypothesis, the current study via two parallel studies aims to explore the potential mediating role of attention biases and attention control regarding the link between trait mindfulness and psychological stress in adolescents. METHODS: For Study 1, we collected self-reported data from 2123 Chinese adolescents (mean age = 15.6 years, SD = 2.37; 52.8% female) in four schools. The participants completed measures of trait mindfulness, perceived stress, and attention bias. Mediation analysis was employed to investigate the potential mediating effect of attention bias. In Study 2, 123 participants (mean age = 17.7 years, SD = 2.68; 41.46% female) completed the attention network task after inducing attention bias. Then, trait mindfulness and perceived stress were measured. Mediation analysis was employed to investigate the potential mediating effect of attention control (alerting, orienting, and conflict monitoring) under attention bias. RESULTS: Study 1 demonstrated a significant mediating effect of negative attention bias ([-0.13, -0.07], p < .05) but not positive attention bias in the relationship between trait mindfulness and psychological stress. Study 2 revealed that conflict monitoring in negative attention bias ([-0.41, -0.16], p < .05), rather than alerting and orienting in negative attention bias, showed a significant mediating effect on the association between trait mindfulness and psychological stress. CONCLUSIONS: Findings from the two studies suggest that conflict monitoring during negative attention bias may be the underlying mechanism through which trait mindfulness helps mitigate psychological stress in adolescents.

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INTRODUCTION: This systematic review aims to highlight the methodological inconsistencies in studying psychosocial safety climate (PSC). Highlighting the diverse dimensions and implications of PSC, this review seeks to enhance the replicability and comparability of studies, contributing to the development of standardised measurement techniques for the construct. METHODS AND ANALYSIS: The methodology encompasses a comprehensive search strategy in PubMed Central, Web of Science, Scopus, JSTOR, Embase, Science Direct, ProQuest, Google and Google Scholar from 28 January 2024 to 30 September 2024. A team of trained reviewers, under the guidance of the authors, will scrutinise eligible studies for inclusion based on predefined criteria. This will ensure a diverse yet focused selection of articles aligned with the research objectives. Robust data extraction and appraisal processes will be followed. Adopting a qualitative synthesis approach, the review aims to generate descriptive and analytical themes, uncovering nuanced dimensions of PSC beyond individual study findings. The protocol emphasises consultation with domain experts and a chartered librarian to refine research questions and optimise search strategies for selecting very relevant articles for the review. We will adopt qualitative data synthesis in summarising and presenting the results and findings for our review of PSC methodological issues. ETHICS AND DISSEMINATION: Ethical approval is not needed for this systematic review because the data for this review will be extracted from already published journal articles. The protocol for this review has been registered in the Open Science Framework. This review and its findings will be published in an academic journal and or presented at scientific conferences. TRIAL REGISTRATION NUMBER: OSF registration: https://doi.org/10.17605/OSF.IO/3UZC2.

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BACKGROUND: Preterm birth and prolonged neonatal hospitalization are potential sources of stress for mothers of preterm and low birth weight infants. AIM: To evaluate maternal stress and its association with neurobehavioral indicators of preterm infants during hospitalization in the neonatal intensive care unit. METHODS: A cross-sectional study was conducted in a neonatal intensive care unit of a hospital in Goiânia, Brazil. The study included preterm and low birth weight infants of both genders and their mothers. The Parental Stressor Scale: Neonatal Intensive Care Unit and the Neurobehavioral Assessment of the Preterm Infant were respectively applied to mothers and infants in the neonatal intensive care unit. RESULTS: The study involved 165 premature infants and their mothers. The mean age of the mothers was 26.3 years and most had a high school education level (57.6%). Mothers perceived the experience of having an infant in the neonatal intensive care unit as moderately stressful (2.96 ± 0.81). The parental role alteration (4.11 ± 1.03) and sights and sounds (2.15 ± 0.90) subscales exhibited the highest and lowest stress levels, respectively. Significant correlations (rho < -0.3; p < 0.05) were found between maternal stress and neurobehavioral indicators of infants. In the multivariate analysis, low leg tone was a predictor of higher maternal stress. Low tone and limited arm movement were predictors of higher maternal stress in the maternal role item. CONCLUSIONS: The experience of having a preterm infant hospitalized was considered moderately stressful for mothers. Maternal stress levels were significantly correlated with low scores on neonatal neurobehavioral indicators.