Childhood parental loss and cortisol levels in adult men

Pathways to lifespan health following childhood parental death

The death of a parent is a profoundly stressful form of childhood adversity, increasing the short- and long-term risk of mental health problems. Emerging research suggests it may also disrupt biological regulatory systems and increase the risk of long-term physical health problems. This article presents a theoretical framework of the process by which the experience of parental death during childhood may influence mental and physical health outcomes over time. Drawing from a broad literature on adaptation following childhood parental loss, we focus on risk and protective factors in the childhood environment that are theoretically and empirically linked to emotional and biological regulatory responses to stress later in life, the effects of which may accumulate to impact long-term health.

Stressful life events and daily stressors affect awakening cortisol level in midlife mothers of individuals with autism spectrum disorders

OBJECTIVES

The current study examines the awakening cortisol level in midlife mothers (M = 51.4 years old, SD = 8.4) of individuals (M = 22.1 years old, SD = 7.1) with autism spectrum disorders (ASD) under stressful conditions that are not specific to their son or daughter's ASD symptoms.

METHODS

In addition to completing a set of questionnaires and in-home interviews, 82 mothers from the Adolescents and Adults with Autism Study (AAA) participated in a Daily Diary Study.

RESULTS

Findings from the multilevel models indicated that mothers who previously were exposed to no negative life events in the previous period had an increased awakening cortisol level on days following a greater number and more severe stressors, a normative stress response. In contrast, we observed a flatter cortisol level of daily stressors in mothers who experienced a greater number of negative life events in the previous period.

CONCLUSION

These findings highlight the sustained toll that global and everyday stressors have on awakening cortisol level of midlife and aging mothers of individuals with ASD.

Early life adversity as a risk factor for fibromyalgia in later life

The impact of early life events is increasingly becoming apparent, as studies investigate how early childhood can shape long-term physiology and behaviour. Fibromyalgia (FM), which is characterised by increased pain sensitivity and a number of affective co-morbidities, has an unclear etiology. This paper discusses risk factors from early life that may increase the occurrence or severity of FM in later life: pain experience during neonatal life causes long-lasting changes in nociceptive circuitry and increases pain sensitivity in the older organism; premature birth and related stressor exposure cause lasting changes in stress responsivity; maternal deprivation affects anxiety-like behaviours that may be partially mediated by epigenetic modulation of the genome—all these adult phenotypes are strikingly similar to symptoms displayed by FM sufferers. In addition, childhood trauma and exposure to substances of abuse may cause lasting changes in developing neurotransmitter and endocrine circuits that are linked to anxiety and stress responses.

The salivary alpha amylase over cortisol ratio as a marker to assess dysregulations of the stress systems

Different factors have been associated with changes in the regulation of the two major stress response systems of the human body, the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. Changes in these systems have been associated with various (psycho)pathologies across adulthood, and are thus frequently assessed within the context of allostatic load. Early Life Adversity (ELA) has been identified as one such factor. Individuals with histories of ELA show evidence of elevated basal and reactive salivary alpha amylase (sAA) levels (a marker of SNS activity), blunted cortisol levels (a marker of HPA axis activity), and an asymmetrical relationship between the two variables. However, variable methods used in the past to measure each variable, and the relationship between the two systems, prevent us from drawing firm conclusions. This preliminary study investigated whether the ratio of reactive sAA over reactive cortisol would be more informative to investigate the relationship between the two stress systems than the ratio of cortisol over sAA, or either marker alone, and whether there is a systematic link between this marker and subjective indexes of chronic stress and depression. We studied this in a total of 37 subjects (n=20 with signs of early life adversity and n=17 without) exposed to the Trier social stress test. Using a specific formula to determine the ratio of sAA over cortisol, we found a systematically stronger positive relationship with indexes of chronic stress and depression when compared to cortisol over sAA, or either marker alone. Our findings suggest that the ratio of sAA over cortisol might be a better marker of stress systems dysregulation than the ratio of cortisol over sAA, sAA or cortisol alone. The usefulness of this marker for other chronic stress states as found in allostatic load is discussed.

Adverse adolescent relationship histories and young adult health: cumulative effects of loneliness, low parental support, relationship instability, intimate partner violence, and loss

PURPOSE

To examine the associations between adverse interpersonal relationship histories experienced during adolescence and health in young adulthood in a large, nationally representative sample.

METHODS

Using data from Waves I, II, and III of the National Longitudinal Study of Adolescent Health, multiple adverse relationship experiences were examined, including high loneliness, low perceived parental support, frequent transitions in romantic relationships (relationship instability), exposure to intimate partner violence, and loss by death of important relationship figures. These histories are assessed, both individually and in a relationship risk index, as predictors of self-reported general health and depressive symptoms at Wave III (ages, 18-27), controlling for baseline (Wave I) health and for demographic and health behavior covariates.

RESULTS

Net of baseline health and covariates, each type of relationship risk (experienced between Wave I and Wave III) was related to either depression or general health at Wave III, with the strongest effects seen for exposure to intimate partner violence. In addition, a cumulative relationship risk index examining the extent to which youth experienced high levels of multiple relationship risk factors revealed that each additional adverse relationship experience increased the odds of reporting worse mental and general health at Wave III, with increases occurring in an additive manner.

CONCLUSION

Multiple types of adverse relationship experiences predicted increases in poorer general health and depressive symptoms from adolescence to early adulthood. Consistent with a cumulative risk hypothesis, the more types of adverse relationship a youth experienced, the worse were their young adult health outcomes.

Larger amygdala but no change in hippocampal volume in 10-year-old children exposed to maternal depressive symptomatology since birth

Maternal separation and poor maternal care in animals have been shown to have important effects on the developing hippocampus and amygdala. In humans, children exposed to abuse/maltreatment or orphanage rearing do not present changes in hippocampal volumes. However, children reared in orphanages present enlarged amygdala volumes, suggesting that the amygdala may be particularly sensitive to severely disturbed (i.e., discontinous, neglectful) care in infancy. Maternal depressive symptomatology has been associated with reductions in overall sensitivity to the infant, and with an increased rate of withdrawn, disengaged behaviors. To determine if poor maternal care associated with maternal depressive symptomatology has a similar pattern of association to the volumes of the hippocampus and amygdala in children, as is the case for severely disturbed infant care (orphanage rearing), we measured hippocampal and amygdala volumes as well as stress hormone (glucocorticoid) levels in children exposed (n = 17) or not (n = 21) to maternal depressive symptomatology since birth. Results revealed no group difference in hippocampal volumes, but larger left and right amygdala volumes and increased levels of glucocorticoids in the children of mothers presenting depressive symptomatology since birth. Moreover, a significant positive correlation was observed between mothers' mean depressive scores and amygdala volumes in their children. The results of this study suggest that amygdala volume in human children may represent an early marker of biological sensitivity to quality of maternal care.

Spousal loss predicts alterations in diurnal cortisol activity through prospective changes in positive emotion

OBJECTIVE

The objective of this study was to examine the role of spousal bereavement and positive emotion in naturally occurring levels of daily cortisol.

METHODS

Analyses were conducted using data from the Midlife in the United States survey and the National Study of Daily Experiences. Baseline assessments of extraversion, neuroticism, trait positive emotion, and trait negative emotion were obtained, as were reports of demographic and health behavior covariates. Salivary cortisol levels were measured at wakeup, 30 min after awakening, before lunch, and at bedtime on each of 4 successive days.

RESULTS

Multilevel growth curve analyses indicated that independent of age, gender, education, extraversion, neuroticism, negative emotion, medication use, and smoking, spousal bereavement was associated with lower levels of cortisol at wakeup and a flattening of the diurnal cortisol rhythm. Mediation analyses revealed that prospective changes in positive emotion accounted for the impact of bereavement on diurnal cortisol slopes.

CONCLUSION

The current prospective study is among the first to provide evidence for a role for positive emotion as a mechanism by which bereavement influences hypothalamic-pituitary-adrenal axis dysregulation in older adults.

Childhood parental loss and bipolar spectrum in obese bariatric surgery candidates

BACKGROUND

Early adverse experiences such as sexual, verbal, or physical abuse and parental neglect have been associated with a higher risk of weight or eating problems in adulthood, and death or prolonged separation from parents during childhood has been implicated as a correlate of adult psychiatric disorders that are widely represented in obese subjects seeking bariatric surgery.

OBJECTIVE

The aim of this study was to examine the rate of childhood parental loss in obese bariatric surgery candidates and explore its association with a psychiatric diagnosis and clinical and weight/eating-related characteristics.

METHODS

The current and lifetime psychiatric diagnoses of 120 consecutive bariatric patients undergoing pre-surgical psychiatric consultation were assessed using a modified version of the Structured Clinical Interview for DSM-IV (SCID-CV), and information relating to parental death or separation before the age of 17 years was collected using a semi-structured interview. The rate of childhood parental loss was compared with that of an always slender population sharing the same psychiatric diagnosis.

RESULTS

91.7% of the obese subjects were diagnosed as having a bipolar spectrum disorder. Overall, 28% of the patients reported a childhood parental death or separation. Early parental loss was not equally distributed in the different diagnostic subgroups, being more frequent in those with bipolar II disorders; the always slender subjects with bipolar II disorders showed a lower rate of early parental loss.

CONCLUSIONS

The study findings confirm the association between obesity and bipolar disorders and suggest that early parental loss may play a role in the development of obesity in bipolar II subjects.

Positive parenting during childhood moderates the impact of recent negative events on cortisol activity in parentally bereaved youth

RATIONALE

Early parental loss has been associated with neuroendocrine dysregulation in youth; however, the form of cortisol dysregulation varies widely. Identifying risk and protective factors that influence physiological regulation has important implications for understanding the development of mental health problems in parentally bereaved youth.

OBJECTIVES

The current study investigated the prospective effects of positive parenting on the relation between recent negative life events and cortisol activity in adolescents/young adults several years after bereavement.

METHODS

Positive parenting was assessed an average of 18.5 months following parental death. Six years later, adolescents/young adults (N = 55) reported on exposure to recent negative life events, and salivary cortisol was assessed before and after a conflict discussion task with their caregiver. The interaction between positive parenting and exposure to recent negative events was used to predict total cortisol output and response to the task.

RESULTS

Multilevel modeling and the probing of the interaction effect demonstrated that total cortisol output increased with greater exposure to recent negative events among those with lower levels of past positive parenting. These relations were significant over and above current internalizing and externalizing symptoms.

CONCLUSIONS

The current results highlight the need to consider the interactive influence of proximal and distal factors on neuroendocrine functioning for youth exposed to early parental loss.

Increased cortisol awakening response and afternoon/evening cortisol output in healthy young adults with low early life parental care

RATIONALE

Growing evidence from animal and human studies suggests a profound and long-lasting influence of early life experiences--ranging from variations in parenting behavior to severe adversity--on hypothalamic-pituitary-adrenal axis function.

OBJECTIVES

The aim of the current investigation was to examine the association between naturally occurring variations in early life parental care and the cortisol awakening response (CAR), afternoon/evening cortisol output and key psychological variables in a sample of healthy young adults.

METHODS

Fifty-eight (19 male and 39 female) participants between 18 and 30 years of age completed psychological questionnaires and collected saliva at awakening, 30 min thereafter and at 3 p.m., 6 p.m., and 9 p.m. on three non-consecutive weekdays.

RESULTS

Participants with low (compared to high) parental care experiences exhibited an increased CAR, increased afternoon/evening cortisol output, decreased self-esteem, and increased depressive symptomatology and anxiety.

CONCLUSIONS

We suggest that the elevated CAR and afternoon/evening cortisol levels might reflect a biological correlate of adversity-induced vulnerability for psychopathology. This study is first to show an association between the retrospective perception of early life parental care and cortisol circadian rhythms in healthy young adults.

Adverse childhood experiences (ACEs), genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents

Epidemiological and clinical data show frequent associations between adverse childhood experiences (ACEs) and substance abuse susceptibility particularly in adolescents. A large body of evidences suggests that the possible dysregulation of neuroendocrine responses as well as neurotransmitters function induced by childhood traumatic experiences and emotional neglect could constitute one of the essential biological changes implementing substance abuse vulnerability. Moreover, genotype variables and its environment interactions have been associated with an increased risk for early onset substance abuse. In this paper we present several data that support the hypothesis of the involvement of hypothalamus-pituitary-adrenal (HPA) axis in mediating the combined effect of early adverse experiences and gene variants affecting neurotransmission. The presented data also confirm the relationship between basal plasma levels of cortisol and ACTH, on the one hand, and retrospective measures of neglect during childhood on the other hand: the higher the mother and father neglect (CECA-Q) scores are, the higher the plasma levels of the two HPA hormones are. Furthermore, such positive relationship has been proved to be particularly effective and important when associated with the "S" promoter polymorphism of the gene encoding the 5-HTT transporter, both in homozygote and heterozygote individuals.

Prospective effects of post-bereavement negative events on cortisol activity in parentally bereaved youth

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the association between adverse childhood experiences, such as parental death, and mental and physical health problems. Recent research indicates that children who experience the death of a parent exhibit HPA axis dysfunction; however, the mechanisms underlying this association have not been explored. It is theorized that physiological dysregulation may result from exposure to stressful life events subsequent to parental death. The current study examined the prospective relations between negative events following parental death and cortisol activity in parentally bereaved youth. A greater number of post-bereavement negative events predicted significantly lower levels of cortisol activity 6 years later; this association remained significant after controlling for current externalizing symptoms and recent negative events. Results suggest that higher exposure to stressful events following childhood parental loss may result in long-term attenuated cortisol activity.

Life-course socioeconomic trajectories and diurnal cortisol regulation in adulthood

Although the health risk of socioeconomic disadvantage over the life-course is fairly established, the mechanisms are less studied. One candidate pathway is long-term dysregulation of cortisol. This study assesses whether socioeconomic trajectories from adolescence to adulthood influences the regulation of cortisol in mid-adulthood, and further investigates the importance of adolescence as a critical period and of accumulation of socioeconomic disadvantage. Participants were drawn from a 27-year prospective cohort study (n=732, 68% of the original cohort). Information on socioeconomic status (SES) was collected at the ages of 16 (based on parental occupation), 21, 30 and 43 (based on own occupation) years, and at 43 years participants collected one-day salivary cortisol samples at awakening, after 15min, before lunch and at bedtime. We found that the cortisol awakening response (CAR) differed with respect to SES trajectory; those with stable low or early low/upwardly mobile SES tended to display higher CAR than those with early high/downwardly mobile, highly mobile or stable high trajectories. Further analyses revealed that early low SES was related to higher CAR, and in women low SES was related to lower bedtime cortisol, independently of later SES and potential confounders. We found no support for a linear effect of accumulation of socioeconomic disadvantage. In conclusion, our study gives support for an independent effect of low socioeconomic status early in life, on the regulation of cortisol in adulthood.

Early environment affects neuroendocrine regulation in adulthood

Animal and human research indicates that the early environment can exert effects on hypothalamic pituitary adrenal (HPA) axis functioning across the lifespan. Using data from the National Study of Midlife Development in the United States and the National Study of Daily Experience substudy, we identified curvilinear relations between adult reports of parental affection in childhood and adult diurnal cortisol rhythms. Reports of both very affectionate and very unaffectionate parental relations in childhood were associated with flatter diurnal rhythms, suggesting potential dysregulation of the HPA axis at both extremes of family environment. Participants in the bottom tertile showed more signs of HPA axis dysregulation than those in the top tertile. We discuss processes that may underlie these effects, with reference to the theory of allostatic load.

Shaping adult phenotypes through early life environments

A major question in the biology of stress and environmental adaptation concerns the neurobiological basis of how neuroendocrine systems governing physiological regulatory mechanisms essential for life (metabolism, immune response, organ function) become harmful. The current view is that a switch from protection to damage occurs when vulnerable phenotypes are exposed to adverse environmental conditions. In accordance with this theory, sequelae of early life social and environmental stressors, such as childhood abuse, neglect, poverty, and poor nutrition, have been associated with the emergence of mental and physical illness (i.e., anxiety, mood disorders, poor impulse control, psychosis, and drug abuse) and an increased risk of common metabolic and cardiovascular diseases later in life. Evidence from animal and human studies investigating the associations between early life experiences (including parent-infant bonding), hypothalamus-pituitary-adrenal axis activity, brain development, and health outcome provide important clues into the neurobiological mechanisms that mediate the contribution of stressful experiences to personality development and the manifestation of illness. This review summarizes our current molecular understanding of how early environment influences brain development in a manner that persists through life and highlights recent evidence from rodent studies suggesting that maternal care in the first week of postnatal life establishes diverse and stable phenotypes in the offspring through epigenetic modification of genes expressed in the brain that shape neuroendocrine and behavioral stress responsivity throughout life.

Stress hormone regulation: biological role and translation into therapy

Stress is defined as a state of perturbed homeostasis following endangerment that evokes manifold adaptive reactions, which are summarized as the stress response. In the case of mental stress, the adaptive response follows the perception of endangerment. Different peptides, steroids, and biogenic amines operate the stress response within the brain and also after they have been released into circulation. We focus in this review on the biological roles of corticosteroids, corticotrophin-releasing hormone (CRH), and arginine vasopressin (AVP), and we evaluate the effects of treatments directed against the actions of these hormones. CRH and AVP are the central drivers of the stress hormone system, but they also act as neuromodulators in the brain, affecting higher mental functions including emotion, cognition, and behavior. When released toward the pituitary, these central neuropeptides elicit corticotrophin into the periphery, which activates corticosteroid release from the adrenal cortex. These stress hormones are essential for the adequate adaptation to stress, but they can also evoke severe clinical conditions once persistently hypersecreted. Depression and anxiety disorders are prominent examples of stress-related disorders associated with an impaired regulation of stress hormones. We summarize the effects of drugs acting at specific targets of the stress hormone axis, and we discuss their potential use as next-generation antidepressant medications. Such treatments require the identification of patients that will optimally benefit from such specific interventions. These could be a first step into personalized medicine using treatments tailored to the specific pathology of the patients.

Neonatal maternal separation disrupts regulation of sleep and breathing in adult male rats

STUDY OBJECTIVES

Neonatal maternal separation (NMS) disrupts development of cardiorespiratory regulation. Adult male rats previously subjected to NMS are hypertensive and show a hypoxic ventilatory response greater than that of controls. These results have been obtained in awake or anesthetised animals, and the consequences of NMS on respiratory control during normal sleep are unknown. This study tested the following.

HYPOTHESES

NMS augments respiratory variability across sleep-wake states, and NMS-related enhancement of the hypoxic ventilatory response occurs during sleep.

METHODS

Two groups of adult rats were used: controls (no treatment) and rats subjected to NMS. Ventilatory activity, coefficient of variation, and hypoxic ventilatory response were compared between groups and across sleep-wake states.

SUBJECTS

Male Sprague Dawley rats-NMS: n=11; controls: n=10. Pups subjected to NMS were isolated from their mother for 3 hours per day from postnatal days 3 to 12. Controls were undisturbed.

MEASUREMENTS AND RESULTS

At adulthood, sleep-wake states were monitored by telemetry, and ventilatory activity was measured using whole-body plethysmography. Sleep and breathing were measured for 2.5 hours (in the morning) while the rats were breathing room air. Data were analysed in 20-second epochs. Rats were then exposed to a brief (90-sec) hypoxic episode (nadir = 12% O2) to measure the hypoxic ventilatory response. The coefficient of variability for tidal volume and breathing frequency decreased during sleep but remained more elevated in NMS rats than in controls. During non-rapid eye movement sleep, the breathing-frequency response to hypoxia of NMS rats was significantly greater than that of controls.

CONCLUSION

Neonatal maternal separation results in persistent disruption of respiratory control during sleep.

Do social disadvantage and early family adversity affect the diurnal cortisol rhythm in infants? The Generation R Study

Dysregulation of diurnal cortisol secretion patterns may explain the link between adversities early in life and later mental health problems. However, few studies have investigated the influence of social disadvantage and family adversity on the hypothalamic-pituitary-adrenal (HPA) axis early in life. In 366 infants aged 12-20 months from the Generation R Study, a population-based cohort from fetal life onwards, parents collected saliva samples from their infant at 5 moments over the course of 1 day. The area under the curve (AUC), the cortisol awakening response (CAR) and the diurnal cortisol slope were calculated as different composite measures of the diurnal cortisol rhythm. Information about social disadvantage and early adversity was collected using prenatal and postnatal questionnaires. We found that older infants showed lower AUC levels; moreover, infants with a positive CAR were significantly older. Both the AUC and the CAR were related to indicators of social disadvantage and early adversity. Infants of low income families, in comparison to high income families, showed higher AUC levels and a positive CAR. Infants of mothers who smoked during pregnancy were also significantly more likely to show a positive CAR. Furthermore, infants of mothers experiencing parenting stress showed higher AUC levels. The results of our study show that effects of social disadvantage and early adversity on the diurnal cortisol rhythm are already observable in infants. This may reflect the influence of early negative life events on early maturation of the HPA axis.

Assessing salivary cortisol in large-scale, epidemiological research

Salivary cortisol measures are increasingly being incorporated into large-scale, population-based, or epidemiological research, in which participants are selected to be representative of particular communities or populations of interest, and sample sizes are in the order of hundreds to tens of thousands of participants. These approaches to studying salivary cortisol provide important advantages but pose a set of challenges. The representative nature of sampling, and large samples sizes associated with population-based research offer high generalizability and power, and the ability to examine cortisol functioning in relation to: (a) a wide range of social environments; (b) a diverse array individuals and groups; and (c) a broad set of pre-disease and disease outcomes. The greater importance of high response rates (to maintain generalizability) and higher costs associated with this type of large-scale research, however, requires special adaptations of existing ambulatory cortisol protocols. These include: using the most efficient sample collection protocol possible that still adequately address the specific cortisol-related questions at hand, and ensuring the highest possible response and compliance rates among those individuals invited to participate. Examples of choices made, response rates obtained, and examples of results obtained from existing epidemiological cortisol studies are offered, as are suggestions for the modeling and interpretation of salivary cortisol data obtained in large-scale epidemiological research.

Effects of childhood trauma on HPA-axis reactivity in women free of lifetime psychopathology

Exposure to childhood trauma may induce persistent changes in Hypothalamic-Pituitary-Adrenal (HPA)-axis functioning even in the absence of current psychopathology. Because previous studies did not systematically exclude subjects with lifetime psychiatric morbidity, prevalent psychopathology may have confounded the association. In this study we investigated whether women exposed to childhood trauma, but without a history of psychiatric disorders, show alterations in HPA-axis functioning. We included 10 women exposed to significant childhood trauma and 12 non-exposed women. All women were between 29 and 64 years old,mentally and physically healthy, and without current or lifetime psychopathology. HPA-axis functioning was assessed as 1) basal activity with salivary cortisol patterns over 8 time points on two consecutive sampling days and 2) plasma cortisol and adrenocorticotropic hormone (ACTH) reactivity over 7 time points after the combined dexamethasone/corticotropin-releasing hormone (dex/CRH) challenge test. Basal salivary cortisol output did not differ between trauma-exposed compared to non-exposed women. Significantly blunted plasma cortisol and ACTH responses in response to dex/CRH administration were found in the trauma exposed compared to the non-exposed women (F(1,20)=5.08, p=0.04 and F(1,20)=5.23, p=0.03 respectively). Adjusting for age, body mass index (BMI), oral contraceptive use, and menopausal status,somewhat weakened the associations for cortisol as well as ACTH (F(1,16)=3.30, p=0.09) and F(1,16)=2.17, p=0.16 respectively), but for cortisol absolute differences in point estimates were largely unaffected.Although basal cortisol patterns were similar in the two groups, exposure to childhood trauma seemed to be related to a blunted HPA-axis reactivity in women who were free of current or lifetime psychopathology.

Structure provided by parents in middle childhood predicts cortisol reactivity in adolescence among the offspring of parents with bipolar disorder and controls

Recent studies suggest that childhood exposure to adversity influences later functioning of the hypothalamic-pituitary-adrenal (HPA) axis. Parenting style in childhood, a putative moderator of adversity, may be important in determining HPA reactivity in adolescence. As part of a prospective, longitudinal study, saliva was collected at awakening and 30 and 60 min later over 2 days among 27 offspring of parents with bipolar disorder (high risk; 16.7+/-1.5 years) and 26 offspring of parents with no mental disorders (low risk; 16.2+/-1.7 years). In addition, 24 of the high risk and 22 of the low risk adolescents completed the "Trier Social Stress Test" (TSST). Parents had rated their parenting style when their offspring were 6-13 years of age. Low levels of structure (i.e. organization and consistency) provided by parents in middle childhood were predictive of an elevated cortisol response following awakening (beta=-0.36; p<0.05) and during the TSST (beta=-0.33; p<0.05), even while controlling for risk group. These associations were independent of other indices of environmental risk, and of adolescents' mood and behavior. The level of structure provided by parents in childhood predicted independent measures of cortisol reactivity in adolescence, suggesting that parenting style may regulate different aspects of HPA reactivity.

The relation between early life adversity, cortisol awakening response and diurnal salivary cortisol levels in postpartum women

Early life adversity has been associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction in both children and adults. However, in adulthood, most studies have focused on the effects of early adversity on HPA axis stress reactivity rather than the cortisol awakening response or diurnal cortisol profiles. The goal of this study was to examine the cumulative effects of early life adversity on the cortisol awakening response (CAR) and diurnal cortisol profiles in a sample of postpartum women. Ninety women between 2 and 6 months postpartum completed two retrospective reports assessing adverse early life experiences (maltreatment and consistency of care). Eighteen women reported having experienced both parental loss and some form of childhood maltreatment and 36 women reported having experienced one type of early life adversity, either parental loss or maltreatment. HPA axis function was assessed through salivary cortisol collections over two consecutive days for measurement of the cortisol awakening response (n=61) and diurnal cortisol rhythm (n=90). Women who reported experiencing adverse early life experiences exhibited a tendency towards higher levels of awakening cortisol compared to women who reported no adverse early life experiences (p=.07). These higher awakening cortisol levels were sustained throughout the morning in the groups who experienced early adversity, with all groups exhibiting the typical diurnal decline in the afternoon and evening (p<.05). Women reporting early adversity exhibited more heterogeneity in their diurnal cortisol levels across the two collection days (p<.01). Our findings suggest that in a community sample of postpartum women, early adversity is associated with current HPA axis function. These findings may have implications for the nature of mother-infant interactions.

Diurnal cortisol patterns and stress reactivity in child Holocaust survivors reaching old age

OBJECTIVES

Late-life implications of early traumatic stress for the adreno-cortical system were examined in a sample of 133 child survivors of the Holocaust, who were subjected to Nazi persecution during infancy.

METHOD

In a non-convenience sample of child survivors, born between 1935 and 1944, basal circadian cortisol release and cortisol reactivity to a stressor were assessed.

RESULTS

Age, parental loss during the Holocaust, current depression, post-traumatic stress disorder (PTSD) and physical illness were not associated with differences in basal diurnal cortisol levels. Neuro-endocrine effects, however, were found in stress reactivity through elevated cortisol levels in male respondents in the youngest age group (born 1941-1945), and in male respondents suffering from PTSD-related functional impairment.

CONCLUSION

The youngest survivors of Nazi persecution show late-life effects of traumatic stress during early childhood, evidenced by the early onset of differential neuroendocrine pathways to stress-regulating strategies.

Childhood parental loss and adult hypothalamic-pituitary-adrenal function

BACKGROUND

Several decades of research link childhood parental loss with risk for major depression and other forms of psychopathology. A large body of preclinical work on maternal separation and some recent studies of humans with childhood parental loss have demonstrated alterations of hypothalamic-pituitary-adrenal (HPA) axis function that could predispose to the development of psychiatric disorders.

METHODS

Eighty-eight healthy adults with no current Axis I psychiatric disorder participated in this study. Forty-four participants experienced parental loss during childhood, including 19 with a history of parental death and 25 with a history of prolonged parental separation. The loss group was compared with a matched group of individuals who reported no history of childhood parental separation or childhood maltreatment. Participants completed diagnostic interviews and questionnaires and the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test. Repeated measures general linear models were used to test the effects of parental loss, parental care, gender, and age on the hormone responses to the Dex/CRH test.

RESULTS

Parental loss was associated with increased cortisol responses to the test, particularly in men. The effect of loss was moderated by levels of parental care; participants with parental desertion and very low levels of care had attenuated cortisol responses. Adrenocorticotropic hormone responses to the Dex/CRH test did not differ significantly as a function of parental loss.

CONCLUSIONS

These findings are consistent with the hypothesis that early parental loss induces enduring changes in neuroendocrine function.

Cortisol and ACTH responses to the Dex/CRH test: influence of temperament

Temperament and personality traits such as neuroticism and behavioral inhibition are prospective predictors of the onset of depression and anxiety disorders. Exposure to stress is also linked to the development of these disorders, and neuroticism and inhibition may confer or reflect sensitivity to stressors. Several lines of research have documented hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis in some patients with major depression, as well as in children and non-human primates with inhibited temperaments. The present investigation tested the hypothesis that stress-reactive temperaments would be predictive of plasma adrenocorticotropin (ACTH) and cortisol concentrations in the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test. Sixty adults completed diagnostic interviews and questionnaires assessing the temperament domains of novelty seeking and harm avoidance and symptoms of anxiety and depression. All subjects were free of any current or past Axis I psychiatric disorder. The Dex/CRH test was performed on a separate visit. A repeated-measures general linear model (GLM) showed a main effect of harm avoidance in predicting cortisol concentrations in the test (F(1, 58)=4.86, p<.05). The GLM for novelty seeking and cortisol response also showed a main effect (F(1, 58)=5.28, p<.05). Higher cortisol concentrations were associated with higher levels of harm avoidance and lower levels of novelty seeking. A significant interaction of time with harm avoidance and novelty seeking (F(4, 53)=3.37, p<.05) revealed that participants with both high levels of harm avoidance and low levels of novelty seeking had the highest cortisol responses to the Dex/CRH test. Plasma ACTH concentrations did not differ as a function of temperament. The results indicate that temperament traits linked to sensitivity to negative stimuli are associated with greater cortisol reactivity during the Dex/CRH test. Increased adrenocortical reactivity, which previously has been linked to major depression and anxiety disorders, may contribute to the association between temperament/personality traits and these disorders.

Psychobiology of posttraumatic stress disorder in pediatric injury patients: A review of the literature

Research suggests that about a quarter to a third of children with traffic-related injuries develop posttraumatic stress disorder (PTSD). Early symptoms of PTSD have been found to predict poor mental and physical outcome in studies of medically injured children. However, these symptoms are rarely recognized by physicians who provide emergency care for these children. In addition, there is insufficient knowledge about predictors of posttraumatic stress symptoms in this specific pediatric population. Early identification of those children at particular risk is needed to target preventive interventions appropriately. After some introducing remarks on the classification and the nature of posttraumatic stress reactions, current research findings on psychological and biological correlates of PTSD in pediatric injury patients are presented. The particular focus in this paper is on the neurobiological mechanisms that influence psychological responses to extreme stress and the development of PTSD. Continued study of the psychobiology of trauma and PTSD in pediatric injury patients, both in terms of neurobiology and treatment is needed.

Childhood parental loss and adult psychopathology: effects of loss characteristics and contextual factors

The purpose of this study was to determine whether childhood parental death and childhood parental separation are linked to lifetime depressive and anxiety disorders after controlling for related risk factors. Participants were 105 individuals from the community, including a group with separation/desertion from a parent, a group with childhood parental death, and a matched control group whose parents remained married and living together. Participants completed interviews and questionnaires assessing symptoms of anxiety and depression, family psychiatric history, childhood maltreatment, and childhood parental relationships. Participants with separation/desertion and those with parental death were significantly more likely than the control subjects to report the subsequent onset of symptoms of a depressive or anxiety disorder. These effects were not fully explained by parental relationships or childhood maltreatment. However, in the group with parental separation only, family history of depressive and anxiety disorders accounted for the apparent effect of parental separation. These findings indicate that parental death may be a specific risk factor for depressive and anxiety disorders. For parental separation/desertion, our results highlight the overriding influence of risk factors that commonly co-occur with this form of parental loss.

Social buffering of the cortisol response of adult female guinea pigs

When housed in spacious, mixed age/sex colonies, male guinea pigs form small harems of females with which attachment-like social bonds are established. A previous study indicated that the bonded male, but not an unfamiliar male from the same colony, could reduce the plasma cortisol response of a female when exposed to a novel environment. We examined the effect of several classes of social partners on the cortisol response of females maintained under standard laboratory housing conditions. Eight "artificial harems" comprised of one adult male and two adult females were formed in standard group-housing cages 2 weeks prior to the study. Behavior observed in these home cages indicated that interactions between males and females of the triads were overwhelmingly positive in nature. When exposed to a novel environment for 2 h, the presence of either the male or female cage mate reduced the subject female's plasma cortisol response, whereas the presence of an unfamiliar adult male did not. Changes in plasma cortisol levels were not predicted by the frequency of various social behaviors observed in the novel environment. These findings: (1) demonstrate that the buffering effect of male partners on the cortisol response of adult females can be observed in guinea pigs maintained in conventional laboratory housing; (2) indicate that unfamiliar adult males are ineffective at reducing cortisol responses of females under these conditions; and, (3) appear to be the first to show buffering effects by adult female guinea pigs on the cortisol responses of other adult females.

Health outcomes of bereavement

In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the effectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.

Chronic corticosterone elevation and sex-specific augmentation of the hypoxic ventilatory response in awake rats

Perinatal stress disrupts normal development of the hypothalamo-pituitary-adrenal (HPA) axis. Adult male (but not female) rats previously subjected to a stress such as neonatal maternal separation (NMS) are characterized by chronic elevation of plasma corticosterone (Cort) levels and an abnormally elevated hypoxic ventilatory response through mechanisms that remain unknown. The present study tested the hypothesis that a chronic increase of plasma Cort levels alone augments the ventilatory response to hypoxia in adult rats. Three groups of Sprague-Dawley male and female rats were used (control, placebo and Cort implants). Rats subjected to chronic Cort elevation received a subcutaneous Cort implant (300 mg) 14 days prior to ventilatory measurements, whereas sham-operated rats received placebo implants. Controls received no treatment. Plasma Cort levels and body weight profiles were measured to assess protocol efficiency. Whole body plethysmography was used to measure ventilatory activity and metabolic indices during normoxia and following a 20 min period of moderate hypoxia (12% O(2)). Male rats implanted with Cort showed a ventilatory response to hypoxia higher than placebo-treated rats; this effect was mainly due to a larger tidal volume response. In females, Cort treatment increased the breathing frequency response but the effect on minute ventilation was not significant. Taken together, these data show that chronic elevation of Cort alone increases the ventilatory response to hypoxia, but in a sex-specific manner. These data raise important questions regarding the mechanisms underlying the sexual dimorphism of this effect and the potential link between HPA axis dysfunction and respiratory disorders related to abnormal ventilatory chemoreflex.

Delayed recall of childhood sexual abuse memories and the awakening rise and diurnal pattern of cortisol

Traumatic stress associated with childhood sexual abuse (CSA) may result in chronic alterations of stress-sensitive neurochemical systems (e.g., the hypothalamic-pituitary-adrenal axis and sympathetic-adrenal medullary activity). Some authors have suggested that these alterations might help explain why some individuals, after a period of inability to remember, demonstrate delayed recall of CSA memories (i.e., "recovered" memories). The present study is the first study that explored morning cortisol responses and circadian cortisol profiles among women with recovered (n=7), repressed (n=8), or continuous (n=6) memories of CSA and women without a history of CSA (n=9). Although there were group differences in current depression and post-traumatic stress symptoms, we found no differences in cortisol awakening response or daytime profile between women reporting recovered, repressed, or continuous memories of CSA as compared to women without a history of CSA. Implications for neurobiological models intended to explain the delayed recall of CSA are discussed.

Childhood neglect and parental care perception in cocaine addicts: relation with psychiatric symptoms and biological correlates

Childhood neglect and poor child-parent relationships have been reported to increase substance use disorders susceptibility. Stressful environmental factors, including emotional neglect, could affect individual personality traits and mental health, possibly inducing stable changes in hypothalamic-pituitary-adrenal (HPA) axis and brain mono-amine function, in turn involved in addictive behavior vulnerability. Therefore, we decided to investigate homovanillic (HVA) and prolactin (PRL) plasma levels, as expression of possible changes in dopamine function, ACTH and cortisol plasma levels, as measures of HPA axis function, and concomitant psychiatric symptoms profile in abstinent cocaine addicts, in relationship to their childhood history of neglect and poor parental care perception.

METHODS

Fifty abstinent cocaine dependent patients, and 44 normal controls, matched for age and sex, were submitted to a detailed psychiatric assessment (DSM IV criteria). All patients and controls completed the Symptoms Check List-90 (SCL-90) and the Buss Durkee Hostility Inventory (BDHI), to evaluate psychiatric symptoms frequency and aggressiveness levels. The Childhood Experience of Care and Abuse-Questionnaire (CECA-Q) and Parental Bonding Instrument (PBI) have been used to retrospectively investigate parent-child relationships. Blood samples were collected to determine HVA, PRL, ACTH and cortisol basal plasma levels.

RESULTS

Cocaine addicted individuals in general showed significantly lower HVA, and higher PRL, ACTH and cortisol basal levels respect to controls. In particular, neuroendocrine changes characterized cocaine addicts with childhood history of neglect and low perception of parental care. Obsessive-compulsive, depression and aggressiveness symptoms have been found related to poor parenting, inversely associated to HVA levels and directly associated to PRL, ACTH and cortisol levels.

CONCLUSIONS

These findings suggest the possibility that childhood experience of neglect and poor parent-child attachment may partially contribute to a complex neurobiological derangement including HPA axis and dopamine system dysfunctions, playing a crucial role in addictive and affective disorders susceptibility.

Long-term effects of early parental loss due to divorce on the HPA axis

We investigated the long-term effects of divorce and early separation from one parent on HPA axis reactivity, in young adults without psychopathology. Participants were 44 young subjects, 22 whose parents divorced before they reached age 10, and 22 controls. Psychiatric symptomatology was measured with the Brief Symptom Inventory (BSI), family perceived stress by the Dyadic Adjustment Scale (DAS), and bonding by the Parental Bonding Instrument (PBI). Assessment of HPA axis function included baseline morning cortisol and ACTH and cortisol response to a CRH stimulation test. No baseline or stimulated group differences were observed for ACTH. Cortisol levels were consistently but insignificantly lower in the divorce group throughout the CRH stimulation reaching statistical significance only at 5 min (p<0.03). Group by time effect reached a trend level (p<0.06). A correlation was found between psychiatric symptomatology and PBI scores; however, both parameters did not correlate with HPA axis activity. A significant correlation was found between DAS scores and ACTH. A regression model revealed a contributing effect for both family stress and child-parent bonding to stimulated ACTH levels. These preliminary findings suggest that even in the absence of adult psychopathology, a history of childhood separation from one parent due to divorce may lead to detectable, albeit mild, long-term alterations in HPA axis activity. Furthermore, they suggest that level of stress at home and parental bonding are important determinants of this effect. It is likely that divorce has significant and sustained effects on children's HPA axis only in the context of a traumatic separation.

Children's cortisol levels and quality of child care provision

BACKGROUND

Cortisol levels are increasingly being used as an indicator of stress levels. Research suggests that children who attend child care demonstrate higher cortisol levels than children in their homes, suggesting that child care acts as a risk factor for poor child outcomes. However, it is also suggested that quality influences outcomes.

METHODS

Cortisol levels were measured through samples of saliva taken from children (3-5 years of age) attending long-day care centres in Perth, Western Australia. Quality of the programme was measured using industry national quality assurance indicators designed for child care centres. The analysis employed a 2 (time of collection: average am cortisol, average pm cortisol) by 3 (centre quality: high, satisfactory, unsatisfactory) split plot ANOVA with repeated measures on the time factor.

RESULTS

Cortisol levels of children attending high-quality programmes demonstrated a decline across the child care day. Levels in children attending unsatisfactory programmes demonstrated an increase across the day.

CONCLUSIONS

Although we do not yet know how high, and for how long, cortisol levels need to be elevated for risk of undesirable outcomes to increase, this research signals the importance of emphasizing the need for high-quality care for young children.

Early parental loss and salivary cortisol in young adulthood: The moderating role of family environment

Early family life adversity has been linked with negative physical and psychological health consequences in adulthood, possibly due to alterations in neuroendocrine activity. Young adults from families characterized by parental loss (N = 45) and control participants (N = 43) completed self-report measures of prior abuse and family conflict, and performed a stressful speech task designed to elicit neuroendocrine responses. Higher reported abuse and conflict were associated with increased cortisol for the loss group, but were unrelated to cortisol in the control group. Results indicate alterations in neuroendocrine functioning associated with early parental loss, which are moderated by the quality of the family environment.

Moderation of psychosocial risk factors through dysfunction of the hypothalamic–pituitary–adrenal stress axis in the onset of chronic widespread musculoskeletal pain : Findings of a population-based prospective cohort study

OBJECTIVE

To test the hypothesis that abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP).

METHODS

We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low-dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new-onset CWP.

RESULTS

A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5-47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP.

CONCLUSION

Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.

Developmental determinants of sensitivity and resistance to stress

The purpose of this paper is two fold. First, to revisit the issue of the definition of stress and to highlight the difficulties with the contemporary definitions and, second, to review the literature on the influence of early experiences on the endocrine stress responses and behavior in rodents, sub-human primates and humans. Early experiences, usually involving some manipulation that results in disruption of the mother-infant relationship, have been shown to have long-term influences on the behavioral and endocrine responses to stress. In the rodent, brief periods of separation result in an attenuated adrenal response to stress (reduced secretion of corticosterone). In contrast, longer periods of separation result in an exaggerated response and several behavioral anomalies i.e. increased alcohol consumption, increased startle response etc. However, the effects of disruptions of the mother-infant relationships in primates reveal a pattern of behavioral disturbance but little influence on the endocrine response. Brief maternal separations result in a blunted cortisol response in juvenile squirrel monkeys. The long-term effects of early experiences in humans are very difficult to interpret. It is not possible to determine the length and severity of the experiences, and when in development the experiences were imposed on the child. Despite these limitations, there is a general consensus that adverse early experiences contribute to adult psychopathology.

Decreased cortisol awakening response after early loss experience

Early loss experience (ELE) due to death or separation is a major risk factor for the development of several psychiatric and physical disorders in adulthood. Few studies have focused on the effects of ELE on neuroendocrine systems, which might mediate this risk in part. The goal of this study was to evaluate salivary cortisol responses to awakening in individuals with and without ELE. A total of 95 healthy college students (29 men, 66 women) completed a questionnaire on ELE and were instructed to collect saliva immediately after awakening and 30 min later. Fifty-five of the 95 subjects reported having experienced the separation or divorce of their parents and/or the death of a close relative before the age of 14 years. Subjects with such ELE exhibited decreased salivary cortisol responses to awakening compared to subjects without ELE (net increase: 4.78 nmol/l versus 9.83 nmol/l; t93 = 2.88, p = 0.005). The effect was most pronounced in individuals who experienced multiple types of ELE, while there were no sex differences. In conclusion, ELE appears to be associated with decreased salivary cortisol responses to awakening. Low cortisol awakening responses are believed to reflect altered dynamics of the hypothalamic-pituitary-adrenal (HPA) axis, possibly conferring risk for certain stress-related disorders.

Specificity of autobiographical memories and basal cortisol levels in patients with major depression

This study investigated whether over-general retrieval of autobiographical memories in depression is related to increased basal cortisol levels. Forty-seven individuals with a current diagnosis of major depression were given the autobiographical memory test, in which they were asked to produce specific autobiographical memories following positive, negative and neutral cue words. Salivary cortisol samples were taken at fixed time intervals during testing in the afternoon. Basal cortisol levels did not appear to be markedly elevated and were not significantly correlated with autobiographical memory performance. There were, however, strong negative correlations between memory specificity and decreases of cortisol levels over time of testing. Findings suggest that while specificity of autobiographical memory may be sensitive to cortisol changes, the occurrence of over-general memory in depression is not necessarily due to increased cortisol levels.

Psychological and stress hormone correlates in early life: a key to HPA-axis dysregulation and normalisation

Substantial recent research has focused on examining hormone indicators of psychosocial stress and on how relationships between stress and hormone changes might be linked to chronic illness. Particular attention has been paid to disease progression in cancer and HIV/AIDS. This focus has generated a plethora of research which has contributed both theoretically and clinically to the understanding of disease experience and the rate of disease progression. Measurement of salivary cortisol levels and diurnal variation has substantially advanced research methodology. Applying the unifying concept of allostasis and accumulated lifetime stress, this review attempts to assess the relevance of psychological and stress hormone correlates to disease resistance and health, through an examination of such correlates on the experience and outcomes of stress during childhood. Focus is on the role and importance of naturalistic social stress experiences such as school transition in healthy children, with emphasis on salivary cortisol as an endocrine marker of HPA-axis activation. It is argued that differing research perspectives offer valuable insight into the often assumed but largely unexplored links between early life experience and subsequent physical health outcomes in adulthood. Longitudinal studies incorporating measures of acute physical health outcome and of learning and memory are clearly needed.