{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:44:16Z","timestamp":1792395856018,"version":"4.4.0"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54MD011240\u201005S1"],"award-info":[{"award-number":["U54MD011240\u201005S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>American Indian and Alaska Native (AI\/AN) communities experienced a disproportionate burden of COVID\u201019, including among the highest rates of infection, hospitalization, and mortality in the United States. The pandemic also introduced widespread stressors, and elevated perceived stress is itself a risk factor for adverse physical and mental health outcomes. Little is known about whether COVID\u201019 infection is associated with perceived stress among AI\/AN peoples. We examined the association between self\u2010reported COVID\u201019 infection and perceived stress among urban AI\/AN adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Self\u2010report surveys were initiated by\n                      <jats:italic>N<\/jats:italic>\n                      = 788 patients of 5 geographically dispersed health organizations that primarily served AI\/AN peoples in urban settings between January and May of 2021. COVID\u201019 infection was assessed by participants\u2019 self\u2010report of either a positive test result or having been informed they were infected by a health professional. Stress was measured using the Perceived Stress Scale\u20104 (PSS\u20104). The relationships between COVID\u201019 infection and mean stress were assessed using linear regressions; the relationships between COVID\u201019 infection and specified stress levels were assessed using modified Poisson regressions with results expressed as relative risk (RR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      COVID\u201019 infection was associated with an adjusted\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 0.9 (95% CI: 0.1, 1.8) points higher mean PSS\u20104 score and RR = 3.2 (95% CI: 1.2, 8.5) of high (\u226513) PSS\u20104 score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>COVID\u201019 infection was associated with elevated perceived stress among urban AI\/AN adults; this association was robust to adjustment for comorbid health conditions, social determinants of health, healthcare access, and pandemic\u2010related stressors. Healthcare providers should be aware that AI\/AN people who have been infected with COVID\u201019 are at higher risk of elevated stress, and further research on the downstream health consequences of stress among those infected with COVID\u201019 is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71783","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:26:45Z","timestamp":1789712805000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID\u201019 Infection Is Associated With Higher Stress in Urban American Indian and Alaska Native Peoples: Results From a Cross\u2010Sectional Survey"],"prefix":"10.1002","volume":"16","author":[{"given":"Austin","family":"Henderson","sequence":"first","affiliation":[{"name":"Department of Economics University of Otago  Dunedin New Zealand"},{"name":"Institute For Research and Education to Advance Community Health Elson S Floyd College of Medicine Washington State University  Pullman Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"MacLehose","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Community Health University of Minnesota School of Public Health  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spero M.","family":"Manson","sequence":"additional","affiliation":[{"name":"Centers For American Indian and Alaska Native Health University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dedra","family":"Buchwald","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Washington Medical School  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.2223"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889\u2010024\u201017997\u2010x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41398\u2010020\u201000982\u20104"},{"key":"e_1_2_12_5_1","unstructured":"U.S. Census Bureau.2012.American Indian and Alaska Native Heritage Month: November 2012.Profile America Facts for Features CB12\u2010FF.22.Washington DC: U.S. Census Bureau.https:\/\/www.census.gov\/newsroom\/releases\/archives\/facts_for_features_special_editions\/cb12-ff22.html. 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