Psychological distress and circulating inflammatory markers in healthy young adults

2010 ◽  
Vol 40 (12) ◽  
pp. 2079-2087 ◽  
Author(s):  
S. Goldman-Mellor ◽  
L. Brydon ◽  
A. Steptoe
Keyword(s):  
Cardiovascular Disease ◽  
Young Adults ◽  
Psychological Distress ◽  
Longitudinal Research ◽  
Inflammatory Responses ◽  
General Health Questionnaire ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Cross Sectional ◽  
The Relationship

BackgroundAlthough a substantial body of research points to a link between psychological distress and inflammatory responses in middle-aged and older adults, particularly those with cardiovascular disease, the relationship between inflammation and distress in young, healthy individuals has not been established. This study was designed to investigate the cross-sectional association between psychological distress and inflammatory proteins in a young, healthy representative population of English adults.MethodParticipants were 1338 individuals aged 16–34 years from the 2006 Health Survey for England (HSE). Blood samples to measure plasma fibrinogen and high sensitivity C-reactive protein (hsCRP), as well as measures of psychological distress (using the General Health Questionnaire 12-item scale, GHQ-12) and covariates, were collected during home visits. Linear regression was used to assess the relationship between psychological distress and fibrinogen and hsCRP.ResultsHigher self-rated distress was positively associated with fibrinogen level in this young population, independently of age, sex, ethnicity, body mass index (BMI), high density lipoprotein (HDL) cholesterol, smoking, and alcohol and medication use (β=0.024, p<0.01). Psychological distress was not related to hsCRP.ConclusionsPsychological distress may negatively impact inflammatory processes in young adulthood before the onset of chronic health problems such as hypertension and cardiovascular disease. Longitudinal research is needed to elucidate the relationship between distress and inflammation in young adults and its significance for later disease states.

scholarly journals Pioglitazone-Mediated Changes in Lipoprotein Particle Composition Are Predicted by Changes in Adiponectin Level in Type 2 Diabetes

2012 ◽  
Vol 97 (1) ◽  
pp. E110-E114 ◽  
Author(s):  
Susan Sam ◽  
Steven Haffner ◽  
Michael H. Davidson ◽  
Ralph D'Agostino ◽  
Alfonso Perez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Particle Size ◽  
Adiponectin Level ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Vldl Particle ◽  
The Relationship

Context: In animal and observational studies, adiponectin is associated with lipoprotein risk factors for cardiovascular disease. Objective: We analyzed data from a randomized clinical trial to evaluate the relationship between changes in adiponectin to changes in lipoprotein risk factors after an intervention that alters adiponectin levels. Design and Setting: Adiponectin levels were measured at baseline and follow-up, as were lipoprotein risk factors for cardiovascular disease, at academic medical centers and ambulatory care centers. Patients and Other Participants: Participants included 361 men and women with type 2 diabetes. Intervention: Intervention included randomization to treatment with glimepiride or pioglitazone for 72 wk. Main Outcome Measure: The relationship of treatment-related differences in adiponectin level to treatment-related differences in lipoprotein cardiovascular risk factors at 72 wk was evaluated. Results: Pioglitazone led to an increase in adiponectin compared with glimepiride. Compared with baseline, pioglitazone treatment at 72 wk led to an increase in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particle size and a decrease in very-low-density lipoprotein (VLDL) particle size and LDL particle number. Glimepiride treatment more modestly decreased LDL particle number and increased LDL particle size. At 72 wk, there were significant treatment group differences for HDL, LDL, and VLDL particle size, and triglyceride and HDL cholesterol level. The increase in adiponectin predicted treatment-related improvement for triglyceride and HDL cholesterol level and LDL and HDL particle size. Conclusion: Increased adiponectin contributed to treatment-related benefit in lipoprotein cardiovascular disease risk factors in obese diabetic subjects treated with pioglitazone. These results provide support for a model that mechanistically links changes in adiponectin level to changes in lipoprotein composition in humans.

scholarly journals Factors Associated with Paraoxonase Genotypes and Activity in a Diverse, Young, Healthy Population: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

2008 ◽  
Vol 54 (4) ◽  
pp. 738-746 ◽  
Author(s):  
Bharat Thyagarajan ◽  
David R Jacobs ◽  
J Jeffery Carr ◽  
Ogechika Alozie ◽  
Michael W Steffes ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Young Adults ◽  
Coronary Artery ◽  
Smoking Status ◽  
Hdl Cholesterol ◽  
Macrovascular Disease ◽  
Paraoxonase 1 ◽  
Healthy Population ◽  
Cross Sectional ◽  
Paraoxonase Activity

Abstract Background: Paraoxonase may mitigate oxidative damage and thus lower risk of macrovascular disease. Methods: DNA samples from 2252 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were genotyped for the L55M and Q192R polymorphisms of the PON1 (paraoxonase 1) gene, and paraoxonase activity was measured in serum. Results: The 192R (67.4% vs 29.7%) and 55L (80.0% vs 63.8%) alleles were more common in blacks vs whites. The Q192R locus was the strongest correlate of paraoxonase activity (100.4 nmol/mL/min greater in the 192RR than the 192QQ genotype). After adjustment for the Q192R locus, the L55M locus (12.7 nmol/mL/min difference between 55LL and 55MM) and race (6.6 nmol/mL/min difference between blacks and whites) were correlated with paraoxonase activity (P ≤0.0001), as were concentrations of HDL cholesterol (23.9 nmol/mL/min difference between highest and lowest quintiles), triglycerides (12.6 nmol/mL/min difference between highest and lowest quintiles), LDL cholesterol (8.2 nmol/mL/min difference between highest and lowest quintiles), smoking status (6.3 nmol/mL/min difference between current smokers of ≥15 cigarettes/day and never smokers), and glucose concentrations at the highest quintile (6.5 nmol/mL/min difference between highest and lowest quintiles in nondiabetic participants). There was no cross-sectional or longitudinal association between paraoxonase enzyme activity and coronary artery calcification (CAC), an early marker of cardiovascular disease, or its progression over 5 years. Conclusions: Paraoxonase may not play an important role during the early pathogenesis of cardiovascular disease. However, associations with lipids and glucose suggest that paraoxonase may modify or react to macrovascular disease pathogenesis.

scholarly journals Association of Gender, Triglyceride/HDL Ratio, and Physical Activity of Obese Adolescents in Makassar

2020 ◽  
Vol 8 (T2) ◽  
pp. 81-86
Author(s):  
Nurhaedar Jafar ◽  
Aminuddin Syam ◽  
Yessy Kurniati ◽  
Een Kurnaesih ◽  
Reza Aril Ahri ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Metabolic Disorders ◽  
Density Lipoprotein ◽  
Chi Square ◽  
Cross Sectional ◽  
Obese Adolescents ◽  
Cross Sectional Design ◽  
The Relationship

BACKGROUND: Obesity may cause the increase of triglyceride and decrease of high-density lipoprotein (HDL) levels. Triglyceride/HDL ratio is associated with metabolic disorders. Physical activity is one of the important aspects in preventing obesity. Gender is known to have a relationship with these factors, but it has been inconsistent. AIM: This study aimed to evaluate the relationship between sex and triglycerides, levels of HDL, triglycerides/HDL ratio, and physical activity of obese adolescents in Makassar. METHODS: This study used a cross-sectional design involving 93 samples of obese adolescents from three high schools. Measurement of triglyceride and HDL levels was performed by the Prodia laboratory, while physical activity was measured using the International Physical Activity Questioner. Data analysis was performed with Chi-square and Fisher’s exact tests. RESULTS: The results showed that there is a relationship between gender and triglyceride levels (p = 0.006) and HDL (p = 0.034), but no relationship between the ratio of TG/HDL (p = 0.109) and physical activity was found (p = 0.339). CONCLUSION: Efforts should be made to reduce the level of risk adolescent obesity on the risk of metabolic syndrome and cardiovascular disease, including increase physical activity. Physical activity is important to maintain the physical and mental of obese adolescents.

scholarly journals CTRP3 and serum triglycerides in children aged 7-10 years

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0241813
Author(s):  
Arsham Alamian ◽  
Jo-Ann Marrs ◽  
W. Andrew Clark ◽  
Kristy L. Thomas ◽  
Jonathan M. Peterson
Keyword(s):  
Molecular Weight ◽  
Metabolic Diseases ◽  
Human Subjects ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Oligomeric State ◽  
Serum Samples ◽  
Serum Triglycerides ◽  
Cross Sectional ◽  
The Relationship

Introduction The prevalence of obesity-related disorders has been steadily increasing over the past couple of decades. Diseases that were once only detected in adults are now prevalent in children, such as hyperlipidemia. The adipose tissue-derived hormonal factor C1q TNF Related Protein 3 (CTRP3) has been linked to triglyceride regulation especially in animal models. However, the relationship between circulating CTRP3 levels and obesity-related disorders in human subjects is controversial. CTRP3 can circulate in different oligomeric complexes: trimeric (<100 kDa), middle molecular weight (100–300 kDa), and high molecular weight (HMW) oligomeric complexes (>300 kDa). Previous work has identified that it is not the total amount of CTRP3 present in the serum, but the specific circulating oligomeric complexes that appear to be indicative of the relationship between CTRP3 and serum lipids levels. However, this work has not been examined in children. Therefore, the purpose of this study was to compare the levels of different oligomeric complexes of CTRP3 and circulating lipid levels among young children (aged 7–10 years). Methods Morphometric data and serum samples were collected and analyzed from a cross-sectional population of 62 children of self-identified Hispanic origin from a community health center, between 2015 and 2016. Serum analysis included adiponectin, insulin, leptin, ghrelin, glucagon, C-reactive peptide, triglyceride, cholesterol, IL-6, TNF, and CTRP3. Correlation analyses were conducted to explore the relationships between CTRP3 and other biomarkers. Results Total CTRP3 concentrations were significantly positively correlated with total cholesterol and HDL cholesterol. Whereas, HMW CTRP3 was not significantly associated with any variable measured. Conversely, the middle molecular weight (MMW) CTRP3 was negatively correlated with triglycerides levels, and very low-density lipoprotein (VLDL), insulin, and body mass index (BMI). The negative correlations between MMW CTRP3 and triglycerides and VLDLs were particularly strong (r2 = -0.826 and -0.827, respectively). Conclusion Overall, these data indicate that the circulating oligomeric state of CTRP3 and not just total CTRP3 level is important for understanding the association between CTRP3 and metabolic diseases. Further, this work indicates that MMW CTRP3 plays an important role in triglyceride and VLDL regulation which requires further study.

scholarly journals Vitamin D Deficiency Associated With Markers of Cardiovascular Disease in Children With Obesity

2018 ◽  
Vol 5 ◽  
pp. 2333794X1775177 ◽  
Author(s):  
Marisa Censani ◽  
Hoda T. Hammad ◽  
Paul J. Christos ◽  
Tiffany Schumaker
Keyword(s):  
Cardiovascular Disease ◽  
Vitamin D ◽  
Cardiovascular Risk ◽  
Vitamin D Deficiency ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Pediatric Endocrinology ◽  
Cross Sectional ◽  
Lipid Parameters

Adult studies have reported associations of low 25-hydroxyvitamin D (25OHD) with dyslipidemia and cardiovascular disease; however, there are scarce pediatric data regarding relationships between vitamin D status and specific lipid markers affecting cardiovascular risk. In this cross-sectional study of children evaluated at university-based pediatric endocrinology clinics, 178 patients meeting criteria for overweight or obesity had 25OHD levels assessed over a 2-year period; 60 of 178 had non-HDL (high-density lipoprotein) cholesterol and fasting lipid parameters performed. Patients with 25OHD <20 ng/mL had significantly higher non-HDL cholesterol (134.76 ± 47.32 vs 108.85 ± 31.14, P < .03), triglyceride (TG)/HDL ratio (3.09 ± 2.26 vs 1.82 ± 1.18, P = .03), total cholesterol (TC)/HDL ratio (4.23 ± 1.23 vs 3.40 ± 1.05, P < .01), TC (184.15 ± 40.19 vs 158.89 ± 30.10, P < .01), and TG (134.76 ± 47.32 vs 78.93 ± 37.46, P < .03) compared with 25OHD ≥20 ng/mL. Vitamin D deficiency was significantly associated with increase in atherogenic lipids and markers of early cardiovascular disease. These findings suggest that vitamin D deficiency may have negative effects on lipid parameters with increase in cardiovascular risk.

Relative risk of cardiovascular disease is higher in women with type 2 diabetes, but not in those with prediabetes, as compared with men

2020 ◽  
Author(s):  
Elena Succurro ◽  
Teresa Vanessa Fiorentino ◽  
Sofia Miceli ◽  
Maria Perticone ◽  
Angela Sciacqua ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Longitudinal Study ◽  
Relative Risk ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Normal Glucose

<b>Objective</b>: Most, but not all studies suggested that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in prediabetic women compared to men. <p><b>Research Design and Methods</b>: In a cross-sectional study, in 3540 normal glucose tolerant (NGT), prediabetic, and diabetic adults, we compared the RR for prevalent non-fatal CVD between men and women. In a longitudinal study including 1658 NGT, prediabetic, and diabetic adults, we compared the RR for incident major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events after 5.6 years follow-up. </p> <p><b>Results:</b> Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total, LDL and HDL cholesterol, triglycerides, fasting glucose, hsCRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in diabetic women (RR 9.29; 95% CI 4.73-18.25; <i>P</i><0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; <i>P</i><0.0001), but no difference in RR for CVD was observed comparing prediabetic women and men. In the longitudinal study, we found that diabetic, but not prediabetic women have higher RR (RR 5.25; 95% CI 3.22-8.56; <i>P</i><0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; <i>P</i><0.0001).</p> <p><b>Conclusions:</b> This study suggests that diabetic, but not prediabetic, women have higher RR for prevalent and incident major adverse outcomes than men. </p>

Risk factors for cardiovascular diseases and development of prehypertension

2018 ◽  
pp. 37-43
Author(s):  
В.В. Шерстнев ◽  
М.А. Грудень ◽  
В.П. Карлина ◽  
В.М. Рыжов ◽  
А.В. Кузнецова ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Serum Levels ◽  
Left Ventricular ◽  
Optimal Blood Pressure

Цель - исследование взаимосвязи факторов риска сердечно-сосудистых заболеваний и развития предгипертонии. Методика. Проведен сравнительный и корреляционный анализы показателей модифицируемых и немодифицируемых факторов риска сердечно-сосудистых заболеваний у обследованных лиц в возрасте 30-60 лет с «оптимальным» артериальным давлением, (n = 63, АД <120/80 мм рт.ст.) и лиц с предгипертонией (n = 52, АД = 120-139/80-89 мм рт.ст.). Результаты. Показано, что лица с предгипертонией по сравнению с группой лиц, имеющих «оптимальное» артериальное давление характеризуются статистически значимо повышенным содержанием холестерина и холестерина липопротеидов низкой плотности, интеллектуальным характером трудовой деятельности, а также значимыми сочетаниями факторов риска: повышенный уровень холестерина липопротеидов низкой плотности с интеллектуальным характером трудовой деятельности; повышенное содержание креатинина с уровнем триглициридов; наследственная отягощенность по заболеваниям почек и интеллектуальным характером трудовой деятельности; наследственная отягощенность по сахарному диабету и гипертрофия левого желудочка сердца. У лиц с предгипертонией документированы перестройки структуры взаимосвязи (количество, направленность и сила корреляций) между показателями факторов риска в сравнении с лицами, имеющими «оптимальное» артериальное давление. Заключение. Выявленные особенности взаимосвязей факторов риска сердечно-сосудистых заболеваний при предгипертонии рассматриваются как проявление начальной стадии дизрегуляционной патологии и нарушения регуляции физиологических систем поддержания оптимального уровня артериального давления. The aim of the study was to investigate the relationship between risk factors for cardiovascular disease and development of prehypertension. Methods. Comparative and correlation analyses of modifiable and non-modifiable risk factors for cardiovascular disease were performed in subjects aged 30-60 with «optimal» blood pressure (n = 63, BP <120/80 mm Hg) and prehypertension (n = 52, BP = 120-139 / 80-89 mm Hg). Results. The group with prehypertension compared with the «optimal» blood pressure group had significantly increased serum levels of low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol, sedentary/intellectual type of occupation, and significant combinations of risk factors. The risk factor combinations included an increased level of LDL cholesterol and a sedentary/intellectual occupation; increased serum levels of creatinine and triglycerides; hereditary burden of kidney disease and a sedentary/intellectual occupation; hereditary burden of diabetes mellitus and cardiac left ventricular hypotrophy. In subjects with prehypertension compared to subjects with «optimal» blood pressure, changes in correlations (correlation number, direction, and strength) between parameters of risk factors were documented. Conclusion. The features of interrelationships between risk factors for cardiovascular disease observed in prehypertension are considered a manifestation of early dysregulation pathology and disordered regulation of physiological systems, which maintain optimal blood pressure.

Mediation of Coping Strategies among Patients with Advanced Cancer

2021 ◽  
pp. 105477382110032
Author(s):  
Nurul Huda ◽  
Yun-Yen ◽  
Hellena Deli ◽  
Malissa Kay Shaw ◽  
Tsai-Wei Huang ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Coping Strategies ◽  
Advanced Cancer ◽  
Well Being ◽  
Cross Sectional ◽  
Correlational Research ◽  
Resampling Procedure ◽  
Relationship Of ◽  
Anxiety Depression ◽  
The Relationship

The purpose of this study was to test the mediating effects of coping on relationships of psychological distress and stress with anxiety, depression, and quality of life. A cross-sectional and correlational research study was used to recruit a sample of 440 patients with advanced cancer in Indonesia. A bootstrap resampling procedure was used to test the significance of the total and specific indirect effects of coping. Data analysis showed that problem-focused coping (PFC) mediated relationships of psychological distress and stress on depression, anxiety and functional well-being. PFC also mediated the relationship between stress and social well-being. Emotional-focused coping (EFC) mediated the relationship of stress with physical and emotional well-being. EFC also mediated the relationships between psychological distress and physical well-being. Thus, proper assessments and interventions should be tailored and implemented for patients in order to facilitate their use of coping strategies when needed in stressful situations.

Identification of six novel susceptibility loci for dyslipidemia by longitudinal exome-wide association studies in Japanese

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Oguri ◽  
K Kato ◽  
H Horibe ◽  
T Fujimaki ◽  
J Sakuma ◽  
...  
Keyword(s):  
Serum Lipid ◽  
Ldl Cholesterol ◽  
Association Studies ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Genome Wide Association ◽  
Genome Wide Association Studies ◽  
Susceptibility Loci ◽  
Cross Sectional ◽  
Genome Wide

Abstract Background The circulating concentrations of triglycerides, high density lipoprotein (HDL)-cholesterol, and low density lipoprotein (LDL)-cholesterol have a substantial genetic component. Although previous genome-wide association studies identified various genes and loci related to plasma lipid levels, those studies were conducted in a cross-sectional manner. Purpose The purpose of the study was to identify genetic variants that confer susceptibility to hypertriglyceridemia, hypo-HDL-cholesterolemia, and hyper-LDL-cholesterolemia in Japanese. We have now performed longitudinal exome-wide association studies (EWASs) to identify novel loci for dyslipidemia by examining temporal changes in serum lipid profiles. Methods Longitudinal EWASs (mean follow-up period, 5 years) for hypertriglyceridemia (2056 case, 3966 controls), hypo-HDL-cholesterolemia (698 cases, 5324 controls), and hyper-LDL-cholesterolemia (2769 cases, 3251 controls) were performed with Illumina Human Exome arrays. The relation of genotypes of 24,691 single nucleotide polymorphisms (SNPs) that passed quality control to dyslipidemia-related traits was examined with the generalized estimating equation (GEE). To compensate for multiple comparisons of genotypes with each of the three conditions, we applied Bonferroni's correction for statistical significance of association. Replication studies with cross-sectional data were performed for hypertriglyceridemia (2685 cases, 4703 controls), hypo-HDL-cholesterolemia (1947 cases, 6146 controls), and hyper-LDL-cholesterolemia (1719 cases, 5833 controls). Results Longitudinal EWASs revealed that 30 SNPs were significantly (P&lt;2.03 × 10–6 by GEE) associated with hypertriglyceridemia, 46 SNPs with hypo-HDL-cholesterolemia, and 25 SNPs with hyper-LDL-cholesterolemia. After examination of the relation of identified SNPs to serum lipid profiles, linkage disequilibrium, and results of the previous genome-wide association studies, we newly identified rs74416240 of TCHP, rs925368 of GIT2, rs7969300 of ATXN2, and rs12231744 of NAA25 as a susceptibility loci for hypo-HDL-cholesterolemia; and rs34902660 of SLC17A3 and rs1042127 of CDSN for hyper-LDL-cholesterolemia. These SNPs were not in linkage disequilibrium with those previously reported to be associated with dyslipidemia, indicating independent effects of the SNPs identified in the present study on serum concentrations of HDL-cholesterol or LDL-cholesterol in Japanese. According to allele frequency data from the 1000 Genomes project database, five of the six identified SNPs were monomorphic or rare variants in European populations. In the replication study, all six SNPs were associated with dyslipidemia-related phenotypes. Conclusion We have thus identified six novel loci that confer susceptibility to hypo-HDL-cholesterolemia or hyper-LDL-cholesterolemia. Determination of genotypes for these SNPs at these loci may prove informative for assessment of the genetic risk for dyslipidemia in Japanese. Funding Acknowledgement Type of funding source: None

scholarly journals Perceived discrimination and psychological distress among immigrants to Canada: The mediating role of bicultural identity orientations

2021 ◽  
pp. 136843022199008
Author(s):  
Mustafa Firat ◽  
Kimberly A. Noels
Keyword(s):  
Psychological Distress ◽  
Undergraduate Students ◽  
Structural Equation ◽  
Perceived Discrimination ◽  
The Other ◽  
Equation Modeling ◽  
Bicultural Identity ◽  
Cross Sectional ◽  
Mediating Role ◽  
The Relationship

Bicultural identity orientations have rarely been examined in relation to both perceived discrimination and psychological distress. Furthermore, these constructs have usually been studied in isolation, but their intersection is essential for understanding intercultural relations in multicultural societies. Using cross-sectional data from 1,143 Canadian undergraduate students from immigrant families, this study explored the relationship between perceived discrimination and psychological distress, and how bicultural identity orientations might mediate this relationship. The structural equation modeling results indicated that perceived discrimination was associated with higher levels of psychological distress and hybrid, monocultural, alternating, and conflicted orientations, but lower levels of complementary orientation. Alternating and conflicted orientations were related to higher psychological distress, whereas the other orientations were not. Alternating and conflicted orientations mediated the relationship between perceived discrimination and psychological distress, whereas the other orientations did not. The findings are discussed in light of theories on identity integration, rejection–identification, and acculturation.

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