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Minimally-Invasive Methods for Examining Biological Changes in Response to Chronic Stress: A Scoping Review


Salomon, Rebecca E.; Tan, Kelly R.; Vaughan, Ashley; Adynski, Harry; & Muscatell, Keely A. (2020). Minimally-Invasive Methods for Examining Biological Changes in Response to Chronic Stress: A Scoping Review. International Journal of Nursing Studies, 103, 103419. PMCID: PMC7067628


BACKGROUND: Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations.
OBJECTIVE: To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress.
DESIGN, DATA SOURCES, AND METHODS: The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded.
RESULTS: Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors.
CONCLUSIONS: Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

International Journal of Nursing Studies


Salomon, Rebecca E.
Tan, Kelly R.
Vaughan, Ashley
Adynski, Harry
Muscatell, Keely A.