Stress as a potential mediator

Title	Stress as a potential mediator in the association between exposome and mental health and cognitive development in children and adolescents.
Source	Christin Belke, Dirk Schreckenberg, Sarah Benz, Julia Kuhlmann, Angel Dzhambov, Peter Lercher, Maria Klatte, Larissa Leist, Natalie Vincens, Kerstin Persson Waye, Sonja Jeram, Gordana Ristovska, Igor Spiroski, Katja Kanninen, Arto Alatalo, Jenny Selander, Charlotta Eriksson, Arzu Arat, Kim White, Irene van Kamp. (Submitted, under review)
Level of evidence	Literature review
What	Scoping literature review on the role of the potential mediation role of stress in the association between multiple environmental exposures and mental health and cognitive development in children and adolescents
Findings	The results show mediating effects of psychological stress due to both specific single exposures or cumulative exposures, into a risk index constructed mainly on mental health.  We did not find evidence for the mediation effects of physiological stress, as measured by cortisol and adrenaline levels.
Recommendations	Further studies into the mediating role of stress are needed, in particular for under 7s. Overall psychological stress should be considered while evaluating the effect of exposome on mental health and cognitive development. Bi-directionality between stress and the outcomes needs to be taken into account.