Persistent Heightened Cortisol Awakening Response and Adolescent Internalizing Symptoms: A 3-year Longitudinal Community Study

An atypical Cortisol Awakening Response (CAR) has been related to adult anxiety and depression, but little is known about the association between long-term atypical CAR and adolescent anxiety and depression. This study aimed to longitudinally identify subgroups of adolescents with distinct levels of CAR (i.e., adolescents with and without persistent atypical CAR) and to examine their development of anxiety and depressive symptoms over 3 successive years. A community sample of 184 Dutch adolescents (M _age?=?14.99 at T₁, 57 % boys) completed annual salivary cortisol assessments at home at time of awakening, and 30 and 60 min post-awakening (i.e., CAR) for 3 successive years. Adolescents also reported annually on their anxiety and depressive disorder symptoms. Latent Class Growth Analysis suggested two subgroups of adolescents with respect to CAR: a “low” group with stable low levels of AUC_g (Area Under the Curve with respect to the ground) over time and a “high” group with high and increasing levels of AUC_g over time. Controlling for sex, the high and low CAR groups significantly differed in depressive symptoms only, but none of the anxiety disorder symptoms. More specifically, adolescents in the high CAR group showed significantly higher mean levels of depressive symptoms over time compared to adolescents in the low CAR group. These results suggest that persistent heightened CAR is a more consistent, yet modest, correlate of adolescent depressive symptoms than anxiety disorder symptoms.     

Cortisol Awakening Response as an Index of Mental Health and Well-Being in Adolescents

Physiological measures provide a useful complement to self-report indices of mental health and well-being. The cortisol awakening response (CAR) has been associated with mental distress, but less consistently so with positive functioning. In this study, the utility of two CAR indices as a measure of the full spectrum of mental health and well-being in a sample of healthy adolescents was explored. Forty-seven adolescents (14M, 33F; mean age 13.89, SD = .73) completed questionnaires on mental distress and positive functioning, and provided three saliva samples for cortisol analysis as well as demographic and life event information. Correlational analyses revealed that both absolute CAR (CARi) and area under the curve during awakening (CAR_AUC) indices correlated positively with measures of mental distress, and inversely with measures of positive functioning. When the significant life events score was controlled, moderate to strong effects were maintained with negative and positive affect, mental well-being, satisfaction with life and perceived social support from significant others. These findings provide the first data confirming that CAR is a reliable index of positive functioning in healthy adolescents.     

Adolescent Personality: Associations With Basal,Awakening, and Stress‐Induced Cortisol Responses

The purpose of the present study was to investigate the associations between personality facets and hypothalamic‐pituitary‐adrenal (HPA) axis functioning. Previous studies have mainly focussed on stress‐induced HPA‐axis activation. We hypothesized that other characteristics of HPA‐axis functioning would have a stronger association with personality based on the neuroendocrine literature. Data (n = 343) were used from the TRacking Adolescents' Individual Lives Survey (TRAILS), a large prospective cohort study of Dutch adolescents. We studied the association between facets of Neuroticism, Extraversion, and Conscientiousness and basal cortisol, the cortisol awakening response (CAR), and four measures of stress‐induced HPA‐axis activity. Basal cortisol levels were related to facets of all three personality traits. The CAR and stress‐induced cortisol were not related to personality. Possibly due to its more trait‐like nature, basal cortisol seems more informative than stress‐induced cortisol when investigating trait‐like characteristics such as personality facets.     

Self-reported health and cortisol awakening response in parents of people with asperger syndrome: The role of trait anger and anxiety,coping and burden

Caring for offspring with autism spectrum disorders entails high levels of stress for a long period of time and is associated with several types of health complaints. Few studies have focused on specific effects of particular disorders in the spectrum. This study was carried out with the aim of evaluating the global health of parents of people with Asperger syndrome (N?=?53) compared to those of typically developing children (N?=?54) through self-reported measures (medication consumption and somatic symptoms) and biological markers (cortisol awakening response [CAR]). Additionally, we analysed various psychological variables as potential predictors of caregiver health. We found that caregivers take more medication and have worse self-reported health than controls, but there were no significant differences in CAR between the groups. However, after controlling for negative affect, differences between groups in CAR reached significance. With regards to predictor variables, anxiety trait, cognitive-coping style, burden and anger temperament were significantly associated with caregiver’s self-reported health. These findings underline the need to develop interventions that foster improvements in the health of caregivers, reduce their burden and enhance their quality of life.     

Saliva DHEAS changes in patients suffering from psychopathological disorders arising from bullying at work

BACKGROUND: Psychological disorders arising from bullying at work (BW) are common. The relationship between these disorders and putative markers is not well established. AIMS: To measure saliva dehydroepiandrosterone sulphate (DHEAS) and saliva cortisol as putative markers in individuals suffering from BW. METHODS: Forty one subjects suffering from BW were screened for mental distress at the institute of occupational health in Clermont-Ferrand, France. They were compared with 28 psychologically healthy controls (group C). The conditions causing BW were recorded. The hospital anxiety and depression (HAD) scale, the Beech questionnaire and the visual analogic scale (VAS) of stress were used to determine the psychological consequences of BW. Saliva samples were collected at awakening (7am), 30 and 60min after awakening, and then every 2h until bed time (11pm). RESULTS: The BW group had significantly higher scores on the HAD scale, higher stress on the VAS, and a higher score on the Beech questionnaire. They also had a significantly higher saliva concentration of DHEAS. There was no significant difference between groups in cortisol levels at any time, nor in area under the curve (AUC) and cortisol awakening response (CAR). There was a significant positive correlation between HAD and VAS scores and DHEAS levels, but not between cortisol levels or AUC or CAR. CONCLUSION: In contrast to saliva cortisol levels, saliva DHEAS levels are modified after psychological distress arising from BW. This discrepancy probably arises from the stability conferred by the very long half life of DHEAS of about 15h.     

The cortisol awakening response and the big five personality dimensions

The present study investigated the association between the big five personality dimensions and the cortisol awakening response (CAR), a physiological parameter reflective of HPA axis activity. One hundred and seven participants completed the big five inventory (BFI; John, Donahue, & Kentle, 1991) and collected salivary cortisol samples at 0, 30, and 60 min after awakening on a weekday morning. The cortisol awakening response under the curve (CARauc) and the cortisol awakening response with respect to increase (CARi) were used as outcome variables in the statistical analyses. Hierarchical linear regression analyses were conducted using the data of 92 participants. Gender and age were included as covariates in block one of the regressions, followed by the personality dimensions in block two. Extraversion emerged as a significant predictor of CARauc. No other personality dimensions were significantly predictive of CARauc or CARi. Interestingly, gender emerged as the strongest predictor in the CARauc, with females exhibiting greater cortisol release across the awakening period than males. Our results suggest that extraversion and gender may be particularly important variables to consider in the regulation of the HPA axis.     

C-reactive protein polymorphisms are associated with the cortisol awakening response in basal conditions in human subjects

Cortisol affects the acute-phase response, but it is unknown whether C-reactive protein (CRP), an acute-phase reactant, also affects hypothalamus?pituitary?adrenal axis activity. In the present study, associations were explored between CRP haplotypes with plasma CRP concentrations and basal salivary cortisol level. We included 266 physically healthy Caucasian subjects (103 females and 163 males) aged between 18 and 65 years of whom 94 had a psychiatric disorder in a genetic association study. Six tag single-nucleotide polymorphisms capturing the common genetic variation of the CRP gene were genotyped (i.e. rs2808628, rs2808630, rs1205, rs1800947, rs1417938, and rs3091244) to yield common CRP haplotypes. Plasma CRP concentrations, the salivary cortisol awakening response (CAR) (0, 30, 45, and 60?min after awakening), and the diurnal cortisol decline (11:00, 15:00, 19:00, and 23:00 h) were assessed for 2 days. rs2808628, rs1205, rs1417938, and rs3091244 showed expected associations not only with CRP concentrations, but also with salivary cortisol levels during the CAR. Five well-characterized CRP haplotypes were arranged in ascending order according to increasing CRP levels. There was an inverse linear association between CRP haplotypes and cortisol levels during the CAR, but no association with the diurnal cortisol decline. Hence, genetic variants in the CRP gene that are associated with lifetime plasma CRP levels were also associated with salivary cortisol levels after awakening, in basal, non-inflammatory conditions.     

The cortisol awakening response in caregivers of schizophrenic offspring shows sensitivity to patient status

Abstract

Taking care of offspring during a prolonged period of time is probably one of the most stressful life experiences for parents. The present study compares the cortisol awakening response (CAR) in 38 long-term caregivers (mothers and fathers of schizophrenic relatives) with a control group of 32 non-caregivers. Factors such as general stress, caregiver burden, patient severity, and institutionalization were studied. Although a blunted CAR was observed in caregivers in comparison with controls, this difference was not significant. Among caregivers, the absence of institutionalization for the patient is associated with a lack of CAR in caregivers in comparison with caregivers of institutionally supported patients. General stress, caregiver burden, and patient severity themselves did not favor significant changes in CAR. CAR shows greater sensitivity to institutional support than patient severity and perceived stress. Further research is needed to explain the impact of these factors on health and the psychological factors involved.     

Does the level of physical exercise affect physiological and psychological responses to psychosocial stress in women?

ObjectivesTo test the Cross-Stressor Adaptation hypothesis for females by examining whether physically exercising young women show reduced physiological and psychological stress responses to a psychosocial stressor.DesignForty-seven healthy young women with different levels of physical exercise (17 not or rarely exercising, 15 moderately exercising, 15 vigorously exercising) underwent the Trier Social Stress Test for Groups (TSST-G); physiological and psychological stress responses during and after stress induction were compared.MethodANOVAs with repeated measures were used to compare stress reactivity and recovery between the three exercise groups. Heart rate and salivary free cortisol were used as indicators of physiological stress response, state anxiety, mood, and calmness as indicators of psychological stress response. For physiological stress reactivity, the areas under the curve with respect to the ground (AUC_G) were compared.ResultsIn all three exercise groups, experimentally induced stress led to a significant rise in heart rate, cortisol, and state anxiety; mood and calmness significantly decreased. As hypothesized, the pattern of the physiological stress response differed for the three exercise groups, with lowered reactivity in the more active groups. However, the psychological stress response partly went in the opposite direction: Exercising participants reported a higher mood decrease, suggesting a dissociation of the physiological and psychological stress responses.ConclusionsThe findings suggest that the Cross-Stressor Adaptation hypothesis is also valid for young women; however, only with regard to physiological stress response. The unexpected findings for psychological stress response need to be further explored in experimental studies.     

Daily and trait rumination: diurnal cortisol patterns in adolescent girls

Rumination is a maladaptive form of emotion regulation associated with psychopathology. Research with adults suggests that rumination covaries with diurnal cortisol rhythms, yet this has not been examined among adolescents. Here, we examine the day-to-day covariation between rumination and cortisol, and explore whether trait rumination is associated with alterations in diurnal cortisol rhythms among adolescent girls. Participants (N?=?122) provided saliva samples 3 times per day over 3 days, along with daily reports of stress and rumination, questionnaires assessing trait rumination related to peer stress, and diagnostic interviews assessing depression and anxiety. Greater rumination than usual during the day was associated with lower cortisol awakening responses the following morning, but this effect was not significant after accounting for wake time and an objective measure of adherence to the saliva sampling protocol. Trait rumination was associated with lower average cortisol levels at waking and flatter diurnal slopes, accounting for wake time, protocol compliance, and other factors. These patterns may help to explain why rumination is related to the development of psychopathology.     

Worse than sticks and stones? Bullying is associated with altered HPA axis functioning and poorer health

Adolescents (N = 107; M = 12.23 years, SD = 1.09 months) participated in a two-part study examining peer victimization, neuroendocrine functioning, and physical health. In phase 1, adolescents completed questionnaires assessing peer victimization and health. They returned for phase 2 which consisted of two sessions. In session 1, adolescents learned to collect salivary cortisol samples; they collected four samples over 2 non-sports school days. In session 2, adolescents completed the Trier Social Stress Test (TSST) in which they prepared and delivered a speech while cortisol was collected. Peer victimization predicted poor health outcomes and a flattened cortisol awakening response (CAR); this CAR was linked with health problems. During the TSST, victims reported more stress and exhibited altered cortisol levels. Higher cortisol immediately after the stressor and lower cortisol 30 min after the stressor were associated with more health problems. This study provides evidence that the relationship between peer victimization and poor physical health may be explained by differences in neuroendocrine functioning.     

Differences between diurnal patterns of salivary cortisol and dehydroepiandrosterone in healthy female adolescents

The adrenal hormones cortisol and dehydroepiandrosterone (DHEA) share a common secretagogue: adrenocorticotropic hormone; however, secretion of these hormones can be dissociated suggesting subtle individual regulation at the level of the adrenal gland. We examined differences in the diurnal patterns of cortisol and DHEA secretion in healthy adolescent girls, with the aim of informing the possibility of exploiting these differences to aid interpretation of data from clinical populations in which these patterns can become dysregulated. Fifty-six healthy females aged 10-18 years provided saliva samples at 0 and 30 min (morning samples) and 12 h post-awakening on 2 consecutive weekdays. For morning salivary cortisol in relation to morning DHEA concentrations, correlational analysis revealed only a trend (p = 0.054). Similarly, the association between evening cortisol and DHEA was characterised as a trend (p = 0.084). Mean morning DHEA concentrations showed more day-to-day consistency than equivalent cortisol samples (r = 0.829 for DHEA and 0.468 for cortisol; z = 3.487, p < 0.0005). Unlike the cortisol pattern, characterised by a marked awakening response (cortisol awakening response, CAR), a significant rise in DHEA concentration post-awakening was not evident. Finally, there was a strong association between morning and evening concentrations of DHEA, not found for cortisol. The study shows differences in cortisol and DHEA secretion in the post-awakening period and informs work that seeks to examine correlates of dysregulated hypothalamic-pituitary-adrenal axis function. Parallel examination of both hormones enables enhanced interpretation of aberrant patterns of the CAR, i.e. an exploration of whether dysregulation affects both hormones (reflecting overall steroidogenic capacity) or cortisol alone (CAR-specific mechanisms).     

Blunted cortisol response to awakening in mild to moderate depression: regulatory influences of sleep patterns and social contacts

Cortisol is elevated during severe depression. However, some studies of outpatients suggest reduced cortisol levels, either basal or poststress. More definite evidence of this phenomenon is needed, and correlates that may explain the disparate findings should be identified. Women from the community (37 depressed and 36 nondepressed) completed electronic diaries in order to help researchers assess the cortisol awakening response (CAR), sleep, and social contacts. Depressed women had a blunted CAR compared with nondepressed women. Among the nondepressed but not among depressed women, time of waking, and number of social contacts (especially positive ones) were independently associated with CAR. These psychosocial factors may contribute to a normal CAR, but their regulatory influence may become disrupted during mild to moderate clinical depression.     

Diurnal cortisol rhythm and cognitive functioning in toddlers: The Generation R Study

Little is known about the relationship between diurnal cortisol secretion patterns and cognitive function early in life. This population-based study examined whether diurnal cortisol rhythms and cognitive functioning in toddlers are related. Within the Generation R Study, parents of 364 infants (median age: 14.2 months) collected saliva samples at five moments during one day. We assessed the diurnal cortisol rhythm by calculating the area under the curve (AUC), the cortisol awakening response (CAR), and the diurnal slope. Verbal cognitive functioning and fine motor development was determined at age 18 months. Nonverbal cognitive functioning was assessed at age 30 months. A more positive CAR was associated with a lower risk of delay in language comprehension (OR per 1-SD CAR: 0.62, 95%CI: 0.40–0.98, p = .04), a lower risk of nonoptimal fine motor development (OR per 1-SD slope: 0.74, 95%CI: 0.57–0.96, p = .03), and a lower risk of delay in nonverbal cognitive development (OR per 1-SD CAR: 0.58, 95%CI: 0.38–0.90, p = .02). Also, children with flatter slopes had a lower risk of delay in nonverbal cognitive development (OR per 1-SD slope: 0.51, 95%CI: 0.34–0.76, p = .001). Higher AUC levels were associated with a higher risk of delay in language production. These results show that variations in diurnal cortisol rhythms are already associated with variations in cognitive functioning at a young age. Infants with a diurnal cortisol pattern indicative of less stress and more cortisol reactivity, that is, lower AUC levels and a more positive CAR, show a lower risk of delay in cognitive functioning as toddlers.     

Cortisol and symptoms of psychopathology in Russian and American college students

Cortisol is a key player in the hypothalamus-pituitary-adrenal (HPA) axis response to stress, and has been related to symptoms of depression and other stress-related pathology. The present study investigated the relationship between cortisol and survey measures of stress and psychopathology as well as lifestyle in Russian and American college students. Salivary cortisol was collected upon awakening, 30 min later, at 4 p.m., and at 10 p.m. by Russian and American college students. Survey measures of anxiety and depression, as measured by the Hopkins Symptom Checklist (HSCL-25) were collected as well as scores on the Trauma History Questionnaire (THQ). In addition, measures of drinking-related problems, as measured by the Alcohol Use Disorder Identification Test (AUDIT) and the "Cut down, Annoyed, Guilty, Eye-opener" (CAGE) were also completed. Consistent with the typically observed empirical pattern, cortisol levels increased in the 30 min after awakening and then declined across the day. Women reported more symptoms of anxiety than did men in both Russian and American samples. American students reported more symptoms of depression than did Russian students, though Russian students reported more traumatic life experiences. Americans had higher cortisol levels overall, though Russian students had larger changes in cortisol levels across the day, associated with both greater morning rises and afternoon declines in cortisol. While more Russian students reported smoking, American students reported more problems associated with alcohol use as measured by the AUDIT. The relationship between stress and health, mediating factors of lifestyle and coping, and the impact of social transition in Russia are discussed.     

人类应激内分泌轴功能状态的测量

HPA轴(下丘脑?垂体?肾上腺皮质轴, hypothalamic-pituitary-adrenal cortex axis)是人类重要的应激内分泌轴, 静息与应激条件下HPA轴的机能障碍能引发应激相关疾病, 而HPA轴机能障碍的表现和原因并不明确。皮质醇作为HPA轴的终端产物能直接反映HPA轴活动, 唾液皮质醇优于其他生物样本皮质醇的特性使其成为测量HPA轴活动的最优指标, 因此寻找到合适的唾液皮质醇标识来反映静息与应激条件下的HPA轴调节变化, 能促进理解HPA轴机能障碍与疾病间的神经内分泌通路。近来研究常用的是以皮质醇觉醒反应(cortisol -awakening response, CAR)与特里尔社会应激测试(Trier social stress test, TSST)来分别表示静息与应激条件下的HPA轴活动。未来研究将结合应激反应的生理、心理指标, 进一步考察HPA轴调节的脑网络, 为应激反应提供脑-神经内分泌通路的生物基础。     

Diurnal patterns of salivary cortisol and DHEA in adolescent anorexia nervosa

Although there is well-documented evidence for hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis function in anorexia nervosa (AN), there has been little research into secretory patterns of salivary cortisol and dehydroepiandrosterone (DHEA) in this condition. The cortisol awakening response (CAR), a prominent and discrete feature of the cortisol cycle, has not been extensively explored in adolescent AN. Saliva samples were collected at awakening, 30?min and 12 h post-awakening on two consecutive weekdays from eight female adolescents with clinically diagnosed AN and 41 healthy control (HC) age-matched females. Adolescent AN patients had greater salivary cortisol and DHEA concentrations than HC girls at all points. Increased hormone secretion was unrelated to body mass index. However, despite hypersecretion of both hormones, the circadian pattern including the CAR paralleled that of the HC group. Findings from this preliminary study confirm dysregulation of HPA axis function in adolescent AN as evidenced by hypersecretion of both cortisol and DHEA, which share the common secretagogue adrenocorticotropic hormone. However, the parallel diurnal profiles for AN and HC participants, including the CAR, may indicate hypersecretion per se rather than differential regulation of the diurnal pattern of these two adrenal steroids in AN.     

Timing of Early Maternal Mental Health and Child Cortisol Regulation

Maternal mental health problems can negatively impact children's physiological stress regulation. Yet, little is known of their long‐term effects, especially related to the timing of maternal symptoms. We examined how maternal mental health problems during pregnancy versus in the early postpartum period predict children's cortisol levels and diurnal patterns at 10–12 years. Participants were a selection (N = 102) of an original sample of 805 Finnish families, who were followed from the second trimester of pregnancy (T1) to child's age of 2 months (T2) and 12 months (T3), and again at child's age of 10–12 years (T4). Based on the timing of psychological distress and depressive symptoms (T1–T3), the mothers could be assigned to three distinct mental health trajectory groups: mothers with prenatal mental health problems (n = 15), mothers with early postpartum mental health problems (n = 15) and mothers without mental health problems (n = 72). Children's cortisol (T4) was measured by saliva samples through five within‐1‐day assessments. The results show that maternal prenatal mental health problems predicted a relatively steep increase of child cortisol from awakening to 1 h later, indicating an intensified cortisol awakening response (CAR). Mothers' early postpartum mental health problems instead predicted a reduced CAR. Both maternal prenatal and postnatal mental health problems thus predicted children's later stress regulation, but in unique ways. We discuss the specific roles of direct biochemical effects during pregnancy and postpartum mother–infant interaction quality as modifiers of the hypothalamic–pituitary–adrenal system. Copyright © 2015 John Wiley & Sons, Ltd.     

Visuo-spatial path learning,stress, and cortisol secretion following military cadets’ first parachute jump: the effect of increasing task complexity

The present field experiment examined how multi-trial visuo-spatial learning and memory performance are impacted by excessive arousal, instigated by a potentially life-threatening event (i.e., a first parachute jump). Throughout a parachute training activity, subjective and neuroendocrine (i.e., cortisol) stress levels were assessed of 61 male military cadets who were randomly assigned to a control (n = 30) or a jump stress condition (n = 31). Post-stress learning and memory capacity was assessed with a 10-trial path-learning task that permitted emergence of learning curves. Pre-activity cortisol concentrations indicated a significant neuroendocrine anticipatory stress response in the stress group. Following parachuting, subjective stress levels and salivary cortisol reactivity differed significantly between groups. Visuo-spatial path-learning performance was impaired significantly after jump stress exposure, relative to the control group. Moreover, examination of the learning curves showed similar learning and memory performance at onset of the trials, with curves bifurcating as the task became more complex. These findings are in accordance with leading theories that acknowledge a moderating effect of task complexity. In sum, the present study extends knowledge concerning anticipatory stress effects, endogenously instigated cortisol reactivity, and the influence of extreme arousal on visuo-spatial path learning.     

Anxiety,hormonal responses,and coping during a judo competition

Competitive situations induced hormonal changes, depending on the outcome, victory or defeat. This study aimed to investigate the salivary testosterone (T) and cortisol (C) and the mental state responses to a real judo championship. Data about individuals’ anxiety levels, strategies of coping, and patterns of behavior were thus collected. The relationship between hormonal changes and psychological variables were also analyzed. Our results showed a C response to competition, which was especially characterized by an anticipatory rise. Depending on outcome, results did not show statistically significant different C responses. The T values noted after the last fight were significantly greater in the losers than those obtained in the winners. Hormonal response did not show a relationship with psychological variables depending on the outcome. Losers showed just before the first fight an elevated cognitive anxiety, accompanied by low self‐confidence. Moreover, they were characterized by type B behavior. Types of coping strategies also differentiated losers from winners. Finally, even if no relationships between hormonal and psychological variables depending on the outcome were found, our results showed that state and trait psychological variables, as well as the coping strategies, must be taken into account to better understand the response to competitive situations. Aggr. Behav. 27:55–63, 2001. © 2001 Wiley‐Liss, Inc.