Whitney, Sydney2021-09-232021-09-232021-09-232021-09-15http://hdl.handle.net/10012/17498Background: Elevated stress levels have been linked to a variety of health concerns, including mental disorders, making stress an important topic of research and clinical assessment. The human stress response involves the coordination of psychological and physiological processes. Psychological measures of stress, such as questionnaires, have traditionally been used to quantify stress levels, but physiological measures, such as hair cortisol concentration (HCC) are becoming increasingly popular. However, the relationship between psychological and physiological measures of stress remains unclear, and studies examining their association have yielded inconsistent results thus far. Objectives: This thesis explored the relationship between measures of perceived stress and HCC in a clinical sample of youth with mental disorder and their parents. The specific objectives of this study were to: (1) estimate the agreement between measures of perceived stress and HCC, (2) model and compare the sociodemographic and psychosocial risk factors for elevated levels of perceived stress and HCC, and (3) model and compare the magnitude of the association between mental disorder and perceived stress and HCC, respectively. Methods: Data came from a cross-sectional study of youth receiving mental health services and their parents. Perceived stress was measured with the Perceived Stress Scale for youth and the Parental Stress Scale for parents; physiological stress was measured with HCC. Bland-Altman analysis, limits of agreement, and intraclass correlation coefficients (ICC) were used to estimate agreement between perceived stress and HCC for youth and parents. Logistic and linear regression models were used to explore risk factors for elevated perceived stress and HCC and to compare the association between each measure of stress and mental disorder. Method of variance estimates recovery was used to compare the association between risk factors and perceived stress and HCC, respectively. Results: Agreement between perceived stress and HCC was low in both the youth and parent subgroups (ICC = 0.31 and 0.15, respectively) and Bland-Altman plots revealed that there may be systematic differences between the measures. Several sociodemographic and psychosocial factors were found to be associated with perceived stress and HCC, however, these factors had larger measures of association with perceived stress. Higher levels of perceived stress were associated with increased odds of major depressive disorder (OR = 1.33 [90% CI 1.12, 1.57]), generalized anxiety disorder (OR = 1.10 [90% CI 1.01, 1.19]), and separation anxiety (OR = 1.14 [90% CI 1.03, 1.25]) in youth and both depression and anxiety in parents (β = 0.53 [90% CI 0.35, 0.71] and β = 0.45 [90% CI 0.26, 0.64], respectively), while HCC was associated with increased odds of generalized anxiety disorder in youth (OR = 1.14 [90% CI 1.01, 1.28]) and depression in parents (β = 0.27 [90% CI 0.06, 0.48]). Conclusion: These findings provide preliminary evidence that agreement between measures of psychological and physiological stress is low and that each measure may have different relationships with various risk factors as well as mental disorders. This suggests that both measures should be used to comprehensively evaluate the stress response. Additional work is needed to confirm the low agreement observed in this study and to continue to examine how psychological and physiological stress are relation to sociodemographic, psychosocial, and clinical factors.enMaster Thesis