Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior

Early father involvement moderates biobehavioral susceptibility to mental health problems in middle childhood

OBJECTIVE

To study how early father involvement and children's biobehavioral sensitivity to social contexts interactively predict mental health symptoms in middle childhood.

METHOD

Fathers' involvement in infant care and maternal symptoms of depression were prospectively ascertained in a community-based study of child health and development in Madison and Milwaukee, WI. In a subsample of 120 children, behavioral, autonomic, and adrenocortical reactivity to standardized challenges were measured as indicators of biobehavioral sensitivity to social context during a 4-hour home assessment in 1998, when the children were 7 years of age. Mental health symptoms were evaluated at age 9 years using parent, child, and teacher reports.

RESULTS

Early father involvement and children's biobehavioral sensitivity to context significantly and interactively predicted symptom severity. Among children experiencing low father involvement in infancy, behavioral, autonomic, and adrenocortical reactivity became risk factors for later mental health symptoms. The highest symptom severity scores were found for children with high autonomic reactivity that, as infants, had experienced low father involvement and mothers with symptoms of depression.

CONCLUSIONS

Among children experiencing minimal paternal caretaking in infancy, heightened biobehavioral sensitivity to social contexts may be an important predisposing factor for the emergence of mental health symptoms in middle childhood. Such predispositions may be exacerbated by the presence of maternal depression.

Daytime cortisol and stress reactivity in the offspring of parents with bipolar disorder

The hypothalamic-pituitary-adrenal (HPA) axis is compromised in major depression and bipolar disorder (BD). It is not known however whether HPA abnormalities predate the onset of these disorders. Preliminary data indicated that the adolescent offspring of parents with BD (high-risk), as compared to adolescents of parents with no mental disorder (low-risk), had higher levels of daytime salivary cortisol. The present study re-examined the cortisol increase after awakening and basal cortisol levels in a larger sample, and tested the hypothesis that high-risk offspring are more reactive to psychosocial stress than low-risk offspring. Saliva samples were collected from 58 adolescents, 29 high-risk (14 male/15 female, 16.8 years) and 29 (14 male/15 female, 16.6 years) low-risk, in their natural environment during at least two days. Twenty-five high-risk (13 male/12 female) and 25 low-risk (13 male/12 female) youth completed a child adaptation (15 years) or the standard version of the "Trier Social Stress Test". Consistent with our previous finding, high-risk offspring had higher daytime levels of cortisol in their natural environment than low-risk offspring, and the difference was unrelated to clinical symptoms or other known confounds. Irrespective of risk status, female participants had higher daytime levels of cortisol than male participants. In contrast, there were no group differences in the cortisol response to the laboratory psychosocial stressor. The offspring of parents with BD show evidence of increased daytime basal HPA functioning with normal reactivity to psychosocial stress.

Measuring cortisol in human psychobiological studies

The steroid cortisol is an extensively studied and important variable in developmental and other behavioral studies. Cortisol has been assayed by various methods using a range of substrates including blood, saliva, and urine. Cortisol in blood exists in two forms. While most is bound to carrier proteins, a small portion exists in a soluble free form. The informed choice of cortisol fraction and measurement method is critical for research. Such choices should be influenced by understanding the characteristics of the various cortisol fractions, along with their binding proteins' biological functions and relationship to the hypothalamic-pituitary-adrenal (HPA) axis. The goal of this paper is to familiarize researchers with key points for evaluating the choice of total and free cortisol in research as well reviewing various options for measuring free cortisol. These points are raised with special emphasis on their significance during pregnancy and the post-partum. Such information may prove useful in informing researcher's cortisol-related protocols and in the interpretation of cortisol data.

Saliva cortisol and response to dexamethasone in children of depressed parents

BACKGROUND

Major depression (MDD) is heritable, and children of depressed parents are at higher risk for the development of depression. However, depression in a parent might also act as a stressor leading to increased activation of neuroendocrine stress circuits. To address this question we examined saliva cortisol in children whose parents have a history of MDD.

METHODS

We recruited 15 families with one parent with MDD (26 prepubertal children) and 16 control families without history of parental MDD (32 prepubertal children). All parents and children underwent Structured Clinical Interview for DSM-IV and Kiddie Schedule For Affective Disorders And Schizophrenia interviews, respectively. Families were asked to collect morning, afternoon, and bedtime saliva samples for 4 days for 2 weeks. At bedtime of the 3rd day, dexamethasone was administered. Two doses, standard and low, were used in each family.

RESULTS

The majority of children demonstrated no psychiatric diagnosis. Children with MDD parents showed higher cortisol basally and higher cortisol after both 25 mg and 5 mg dexamethasone. However, this effect occurred predominantly in children whose parents were currently depressed. There were strong correlations for cortisol between parents and children (r = 52 in depressed; r = 499 in control).

CONCLUSIONS

Elevated cortisol and impaired feedback seemed to reflect an environmental effect of MDD in a parent.

A review of the psychosocial effects of false-positive results on parents and current communication practices in newborn screening

As more states adopt expanded newborn screening for metabolic disorders, the overall number of false positives increases. False-positive screening results have been associated with increased anxiety and stress in parents of infants who require follow-up testing, even after the infant's good health is confirmed. This article reviews the literature on the negative impact of false-positive newborn screening results on parents, along with a review of current communication practices for follow-up screening. The results of this review suggest that parental stress and anxiety can be reduced with improved education and communication to parents, specifically at the time of follow-up screening. Communication strategies with sample materials are proposed.

Environmental influences on family similarity in afternoon cortisol levels: twin and parent-offspring designs

Modest genetic effects on morning, but not late-day, cortisol levels have been established. Environmental demands may influence basal cortisol levels later in the day. Thus, we anticipated that individuals in the same family would have similar afternoon cortisol levels to the extent that they share aspects of their environment. We examined afternoon basal cortisol levels measured across 3 consecutive days in mothers and fathers and in multiple offspring in two separate large and longitudinal studies. Study I involved 321 families with singletons while study II involved 233 families with twins. Modest family similarity was apparent for afternoon basal cortisol levels in both studies. Spouses' cortisol levels were also correlated. Data from study II demonstrated that family resemblance in afternoon cortisol was accounted for by underlying shared environmental factors, but not underlying genetic factors. Shared environment accounted for 62% of the variation in twin afternoon basal cortisol levels and 14% of the variation in parent afternoon basal cortisol levels. We used pooled data from the two studies to examine whether parental depression, socioeconomic status (SES), and offspring sex and age impacted cortisol levels. Female offspring had higher cortisol levels than males, and cortisol decreased with age until about 9 years of age, after which cortisol increased with age. Family similarity persisted after accounting for parental depression, SES, time of day, and offspring sex and age, which suggests that the shared family environment influences parent and offspring stress hormone levels throughout the childhood years.

Changes in maternal depressive symptoms across the postpartum year at well child care visits

OBJECTIVE

To describe the incidence, continuation, and resolution of symptoms during the postpartum year in urban women experiencing high depressive symptom levels at one or more well child care visits.

METHODS

As part of a prior study of postpartum depressive symptoms, demographic data and the Edinburgh Postnatal Depression Scale (EPDS) were systematically collected from pediatric records of a clinic that routinely screens mothers with the EPDS at each first-year well child care visit. To explore the course of depressive symptoms throughout the postpartum year in this pilot study, we included only data from the records that had at least one EPDS > or = 10 (N = 100), a score indicating a high likelihood for clinically significant depressive symptoms.

RESULTS

Among 49 women who completed the EPDS at least once before 3 months and between 3 and 11 months postpartum, 33% had high symptom levels throughout the year, 41% improved after the first 3 months, and 26% developed high symptom levels after the first 3 months.

CONCLUSIONS

Postpartum depressive symptoms persist in many women throughout the postpartum year. Routine screening throughout the year might better identify both a subgroup of women who develop new symptoms during the year, as well as the women whose symptoms persist.

Environmental factors in the development of Type 1 diabetes

Environmental factors appear to play an important role in the pathogenesis of childhood-onset type 1 diabetes (T1D). The most important factors are thought to be infectious, dietary, perinatal, and psychosocial. Enteroviruses (especially Coxsackie B virus), breastfeeding, the early presence or lack of certain foods, birth weight, childhood over-nutrition, maternal islet autoimmunity, and negative stress events have been shown to be related to the prevalence of T1D. However, clear conclusions to date are limited because most studies lacked power to detect exposure/disease associations, were not prospective or long-term, did not start in infancy, had imprecise or infrequent exposure estimates, had confounding exposures, and failed to account for genetic susceptibility. In addition to the identification of specific antigenic triggers, several more general hypotheses, including the accelerator and hygiene hypotheses, are testable approaches worth pursuing.

Corticotropin releasing factor (CRF) receptor signaling in the central nervous system: new molecular targets

Corticotropin-releasing factor (CRF) and the related urocortin peptides mediate behavioral, cognitive, autonomic, neuroendocrine and immunologic responses to aversive stimuli by activating CRF(1) or CRF(2) receptors in the central nervous system and anterior pituitary. Markers of hyperactive central CRF systems, including CRF hypersecretion and abnormal hypothalamic-pituitary-adrenal axis functioning, have been identified in subpopulations of patients with anxiety, stress and depressive disorders. Because CRF receptors are rapidly desensitized in the presence of high agonist concentrations, CRF hypersecretion alone may be insufficient to account for the enhanced CRF neurotransmission observed in these patients. Concomitant dysregulation of mechanisms stringently controlling magnitude and duration of CRF receptor signaling also may contribute to this phenomenon. While it is well established that the CRF(1) receptor mediates many anxiety- and depression-like behaviors as well as HPA axis stress responses, CRF(2) receptor functions are not well understood at present. One hypothesis holds that CRF(1) receptor activation initiates fear and anxiety-like responses, while CRF(2) receptor activation re-establishes homeostasis by counteracting the aversive effects of CRF(1) receptor signaling. An alternative hypothesis posits that CRF(1) and CRF(2) receptors contribute to opposite defensive modes, with CRF(1) receptors mediating active defensive responses triggered by escapable stressors, and CRF(2) receptors mediating anxiety- and depression-like responses induced by inescapable, uncontrollable stressors. CRF(1) receptor antagonists are being developed as novel treatments for affective and stress disorders. If it is confirmed that the CRF(2) receptor contributes importantly to anxiety and depression, the development of small molecule CRF(2) receptor antagonists would be therapeutically useful.

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.

Expanded newborn screening for biochemical disorders: the effect of a false-positive result

BACKGROUND

Newborn screening programs now identify children with >30 biochemical genetic disorders. False-positive identifications may increase as disorders are added to screening panels. Concerns arise regarding the potential impact on parental stress, family relationships, and perceptions of the child's health.

METHODS

Parents of 173 infants with false-positive screening results for a biochemical genetic disorder in the expanded newborn screening panel were compared with parents of 67 children with normal screening results. Parents completed an interview that elicited information about demographic features, child and parental health, and understanding of newborn screening. Parents also completed the parenting stress index.

RESULTS

Parents in the false-positive group attained higher total scores on the PSI than did parents in the normal-screened group, scoring higher on the parent-child dysfunction subscale and the difficult child subscale. Only approximately one third of parents in the false-positive group reported knowing the correct reason for repeat screening. Mothers who reported knowing the correct reason for their child's repeat screening test experienced less total stress than did mothers who were misinformed, were not informed, or did not remember.

CONCLUSIONS

False-positive screening results may affect parental stress and the parent-child relationship. Improved communication with parents regarding the need for repeat screening tests may reduce the negative impact of false-positive results.

Women's Mental Health Research: The Emergence of a Biomedical Field

This review surveys the field of women's mental health, with particular emphasis on its evolution into a distinct area of biomedical research. The field employs a biomedical disease model but it also emphasizes social and cultural influences on health outcomes. In recent years, its scope has expanded beyond studies of disorders occurring in women at times of reproductive transitions and it now encompasses a broader study of sex and gender differences. Historical and conceptual influences on the field are discussed. The review also surveys gender differences in the prevalence and clinical manifestations of mental disorders. Epidemiological findings have provided a rich resource for theory development, but without research tools to test theories adequately, findings of gender differences have begged the question of their biological, social, and cultural origins. Clinical depression is used to exemplify the usefulness of a sex/gender perspective in understanding mental illness; and major theories proposed to account for gender differences are critically evaluated. The National Institutes of Health (NIH) is the primary federal funding source for biomedical women's mental health research. The review surveys areas of emphasis in women's mental health research at the NIH as well as some collaborative activities that represent efforts to translate research findings into the public health and services arenas. As new analytic methods become available, it is anticipated that a more fundamental understanding of the biological and behavioral mechanisms underlying sex and gender differences in mental illness will emerge. Nonetheless, it is also likely that integration of findings predicated on different conceptual models of the nature and causes of mental illness will remain a challenge. These issues are discussed with reference to their impact on the field of women's mental health research.

Maternal programming of defensive responses through sustained effects on gene expression

There are profound maternal effects on individual differences in defensive responses and reproductive strategies in species ranging literally from plants to insects to birds. Maternal effects commonly reflect the quality of the environment and are most likely mediated by the quality of the maternal provision (egg, propagule, etc.), which in turn determines growth rates and adult phenotype. In this paper we review data from the rat that suggest comparable forms of maternal effects on defensive responses stress, which are mediated by the effects of variations in maternal behavior on gene expression. Under conditions of environmental adversity maternal effects enhance the capacity for defensive responses in the offspring. In mammals, these effects appear to 'program' emotional, cognitive and endocrine systems towards increased sensitivity to adversity. In environments with an increased level of adversity, such effects can be considered adaptive, enhancing the probability of offspring survival to sexual maturity; the cost is that of an increased risk for multiple forms of pathology in later life.

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.

Maternal and environmental factors influence the hypothalamic–pituitary–adrenal axis response to corticotropin-releasing hormone infusion in offspring of mothers with or without mood disorders

Individuals with melancholic major depression exhibit basal hypercortisolism and an attenuated ACTH response to exogenous corticotropin-releasing hormone (CRH) infusion. Given the greater incidence of depression in children of depressed parents, we examined the ACTH and cortisol responses to ovine CRH (oCRH) infusion in 63 adolescent offspring of mothers with major depression, bipolar illness, or no psychiatric illness. Psychiatric and observational assessments of these families had been conducted over the course of 10 years preceding this study. We examined the children's responses to CRH in relation to maternal characteristics and family environment and found the following: (a) cortisol responses were negatively related to chronic family stress and (b) offspring of depressed mothers with an avoidant personality disorder showed an exaggerated ACTH response. In addition, adolescents in late puberty (Tanner 4 and 5) had lower ACTH and cortisol responses to oCRH infusion than those in early puberty. Further, offspring with early histories of mood problems, and those who developed major depressive disorder as young adults, did not exhibit basal hypercortisolism but did show an attenuated ACTH response to CRH. Our results add to the growing body of literature showing the influence of maternal characteristics and environmental factors on hypothalamic-pituitary-adrenal axis patterns in children.

Psychological stress and the risk of diabetes-related autoimmunity: a review article

The beta cell stress hypothesis suggests that any phenomenon that induces insulin resistance, and thereby extra pressure on the beta cells, should be regarded as a risk factor for type 1 diabetes (T1D). Psychological stress decreases insulin sensitivity and increases insulin resistance and may hence be important in the development/onset of T1D. The aim of the current review article was to evaluate existing empirical evidence concerning an association between psychological stress and development/onset of T1D as well as diabetes-related autoimmunity. Ten retrospective case-control studies were found. Nine studies showed a positive association between stress and development/onset of T1D in children, adolescents or adults. One study did not find an association between stress and development/onset of T1D. An association between stress and diabetes-related autoimmunity was found at 1 and 2-3 years of age in a large epidemiological study of the general population. The hypothesis that psychological stress (via beta cell stress or direct influence on the immune system) may contribute to the induction or progression of diabetes-related autoimmunity has gained some strong initial support, but is in need of further empirical verification. It seems much clearer that stress can precipitate manifest T1D, although the biological mechanisms are still not known.

Childcare as a stabilizing influence on HPA axis functioning: A reevaluation of maternal occupational patterns and familial relations

The influence of family relations, maternal occupational characteristics, and childcare1The UK terms "childcare," childcare centres' and "nurseries" are used throughout this paper to define group care for children prior to starting their first year of formal schooling at age 4 years and are used synonymously with the American terms "day-care" and "preschool." This form of group care is provided in a formal setting, outside the family home and excludes "childminding" (i.e., childcare that may be group based and offered at the home of the care provider/childminder). In the UK, this form of childcare is offered from zero to 4 years old. Children are separated according to their age into small groups usually consisting of 10-15 children. In the present study, all children were in the preschool-aged group (3-4 years old). Where childcare of a different or more generic form is referred to, then this has been made clear in the context or stated in the text. utilization on preschool children's cortisol production were investigated in 56 mother-child dyads. Family characteristics and maternal employment, childcare and child temperament were reported by mothers. Morning and evening levels of children's salivary cortisol were obtained. Children in highly expressive or reserved families exhibited higher cortisol levels compared to children in moderately expressive families. Elevated levels of cortisol were detected in children of mothers reporting low levels of job role quality or high levels of emotional exhaustion. Frequent childcare use was found to protect children against the physiological effects of low maternal job role quality and emotional exhaustion. Findings underscore the pervasive role of the family as set within an external support system and highlight the potential physiological impact of these interacting contexts for children. Further research is needed to fully understand current findings and to develop appropriate psycho-physiological interventions.

Impact of saliva collection methods on sIgA and cortisol assays and acceptability to participants

In community-based studies of stress and immunity, saliva samples offer a non-intrusive way of gathering biological data. Cotton-based devices are widely used in cortisol research, but some may affect assay results. We compared assay reliability and perceived acceptability of three saliva collection methods: passive, cotton 'salivettes' and cellulose-cotton tip 'eyespears'. Compared to passive collection, salivettes reduced the concentration of cortisol (p = .001) and sIgA (p = .002). Eyespears did not reduce cortisol or sIgA concentration, and showed less interference in the rank ordering of cortisol (r(eyespear with passive) = .90) and sIgA scores (r(eyespear with passive) = .96) compared to salivettes (r cortisol(salivette with passive) = .79; r sIgA(salivette with passive) = .66). The comfort and acceptability of both cotton-based devices were rated positively. Cotton-cellulose eyespears could offer methodological advantages for collecting saliva to measure cortisol and sIgA levels, and, because they can be held during sampling, may be useful for research with children and the frail elderly.

Mothers' experiences of serious life events increase the risk of diabetes-related autoimmunity in their children

OBJECTIVE

Stressful life events have been shown to constitute a risk factor for type 1 diabetes during childhood. Our aim was to investigate in the general child population (i.e., irrespective of genetic risk for type 1 diabetes) whether mothers' experiences of serious life events, such as divorce and violence, were associated with diabetes-related autoimmunity in their children at age 2.5 years.

RESEARCH DESIGN AND METHODS

The study cohort was comprised of the first 5,986 consecutive children and their families from the prospective population-based All Babies in Southeast Sweden project for whom 2.5-year study data were available. Data were drawn from parental questionnaires that included questions about experiences of serious life events and the blood samples taken from the children when the children were age 2.5 years. The blood samples were analyzed for diabetes-related autoantibodies against tyrosine phosphatase and GAD.

RESULTS

Mothers' experiences of divorce (odds ratio 3.6, 95% CI 1.4-9.6, P < 0.05) and violence (2.9, 1.0-7.8, P < 0.05) were associated with diabetes-related autoimmunity in the children, independent of a family history of type 1 diabetes.

CONCLUSIONS

The results support the beta-cell stress hypothesis and suggest that maternal experiences of serious life events such as divorce and violence seem to be involved in the induction or progression of diabetes-related autoimmunity in children at age 2.5 years, independent of family history of type 1 diabetes.

Trauma, proximity, and developmental psychopathology: the effects of war and terrorism on children

This report summarizes recent literature relevant to the effects of terrorism on children's mental health. The paper addresses three aspects of this topic. In the first section of the paper, data are reviewed concerning the relationships among stress, trauma, and developmental psychopathology. A particular emphasis is placed on associations with indirect forms of trauma, given that terrorism involves high levels of indirect trauma. Second, the paper delineates a set of key principles to be considered when considering ways in which the effects of terrorism on children's mental health can be minimized. Third, data are reviewed from studies in developmental psychobiology. These data are designed to illustrate the mechanisms through which children exhibit unique effects in the wake of traumatic circumstances.

Effects of maternal prenatal stress on infant outcomes: a synthesis of the literature

There is growing evidence that maternal prenatal stress may be hazardous to infant health. Changes in maternal hormonal and immune function as a result of stress may adversely affect the immune function and neurodevelopment of the fetus. Prenatal stress in the mother may produce lasting effects on the (1) infant's health status, (2) development and function of the infant's immune system, and (3) neurocognitive development of the infant. This article provides a synthesis of current human and animal literature on the effects of maternal prenatal stress on the developing fetus and the infant, with the resulting model evolving out of the framework of psychoneuroimmunology. The intent of the authors is an integrative review. The authors examined the following research question: What effect does maternal prenatal stress have on infants' immune development and neurodevelopment? All relevant studies were reviewed with no exclusion criteria. Major databases (CINAHL, MEDLINE, PsychINFO) were searched using a combination of the following key words: prenatal stress, cytokines, thymus, and infant neurodevelopment.

Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children

BACKGROUND

Animal studies suggest that prenatal stress is associated with long-term disturbance in hypothalamic-pituitary-adrenal (HPA) axis function, but evidence in humans is lacking. This study examined the long-term association between prenatal anxiety and measures of diurnal cortisol at age 10 years.

METHODS

Measures of cortisol were collected at awakening, 30 min after awakening, and at 4 pm and 9 pm on 3 consecutive days in a sample of 10-year-olds (n = 74) from the Avon Longitudinal Study of Parents and Children, a prospective longitudinal cohort study of mothers and children on whom measures of anxiety and depression were collected in pregnancy and the postpartum period. Analyses examined the links between symptoms of prenatal anxiety and multiple indicators of cortisol, an index of HPA axis functioning.

RESULTS

Prenatal anxiety was significantly associated with individual differences in awakening and afternoon cortisol after accounting for obstetric and sociodemographic risk (partial correlations were .32 and .25, p < .05). The effect for awakening cortisol remained significant after controlling for multiple postnatal assessments of maternal anxiety and depression.

CONCLUSIONS

This study provides the first human evidence that prenatal anxiety might have lasting effects on HPA axis functioning in the child and that prenatal anxiety might constitute a mechanism for an increased vulnerability to psychopathology in children and adolescents.

Efeitos da depressão materna no desenvolvimento neurobiológico e psicológico da criança

Vários estudos recentes têm demonstrado a repercussão da privação materna no desenvolvimento neurobiológico e psicológico da criança. A depressão pós-parto, quando persistente, pode favorecer a ocorrência de situações de negligência e abuso infantil. Este trabalho tem como objetivo revisar estudos publicados a partir de 1988 que demonstrem alterações no desenvolvimento neurológico, endócrino, mental e comportamental de crianças cujas mães tiveram depressão pós-parto. A importância do meio ambiente inicial foi revisada em estudos pré-clínicos com mamíferos não-humanos, demonstrando que, quando há privação ou estresse no início do desenvolvimento, ocorrem alterações persistentes em estruturas encefálicas, em secreções neuro-hormonais e na densidade de receptores específicos. Também serão descritos alguns aportes teóricos sobre a importância da relação mãe-bebê concordantes com os achados experimentais.

The corticotropin-releasing hormone gene and behavioral inhibition in children at risk for panic disorder

BACKGROUND

Behavioral inhibition to the unfamiliar (BI) is a heritable temperamental phenotype involving the tendency to display fearful, avoidant, or shy behavior in novel situations. BI is a familial and developmental risk factor for panic and phobic anxiety disorders. We previously observed an association between BI and a microsatellite marker linked to the corticotropin releasing hormone (CRH) gene in children at risk for panic disorder. To evaluate this further, we genotyped additional families for this marker and a panel of markers encompassing the CRH locus.

METHODS

Sixty-two families that included parents with panic disorder and children who underwent laboratory-based behavioral observations were studied. Family-based association tests and haplotype analysis were used to evaluate the association between BI and polymorphisms spanning the CRH locus.

RESULTS

We examined a set of markers which we found to reside in a block of strong linkage disequilibrium encompassing the CRH locus. The BI phenotype was associated with the microsatellite marker (p=.0016) and three single nucleotide polymorphisms (SNPs), including a SNP in the coding sequence of the gene (p=.023). Haplotype-specific tests revealed association with a haplotype comprising all of the markers (p=.015).

CONCLUSIONS

These results suggest that the CRH gene influences inhibited temperament, a risk factor for panic and phobic anxiety disorders. Genetic studies of anxiety-related temperament represent an important strategy for identifying the genetic basis of anxiety disorders.

Biological sensitivity to context: II. Empirical explorations of an evolutionary–developmental theory

In two studies comprising 249 children and their families, the authors utilized secondary, exploratory data analyses to examine Boyce and Ellis' (this issue) evolutionary-developmental theory of biological sensitivity to context. The theory proposes that individual differences in stress reactivity constitute variation in susceptibility to environmental influence, both positive and negative, and that early childhood exposures to either highly protective or acutely stressful environments result in heightened reactivity. In Study 1, 127 3- to 5-year old children were concurrently assessed on levels of support/adversity in home and preschool environments and on cardiovascular reactivity to laboratory challenges. In Study 2, 122 children were prospectively assessed on familial stress in both infancy and preschool and on autonomic and adrenocortical reactivity to laboratory challenges at age 7. In both studies, a disproportionate number of children in supportive, low stress environments displayed high autonomic reactivity. Conversely, in Study 2, a relatively high proportion of children in very stressful environments showed evidence of heightened sympathetic and adrenocortical reactivity. Consistent with the evolutionary-developmental theory, the exploratory analyses also generated the testable hypothesis that relations between levels of childhood support/adversity and the magnitude of stress reactivity are curvilinear, with children from moderately stressful environments displaying the lowest reactivity levels in both studies.

Biological sensitivity to context: I. An evolutionary–developmental theory of the origins and functions of stress reactivity

Biological reactivity to psychological stressors comprises a complex, integrated, and highly conserved repertoire of central neural and peripheral neuroendocrine responses designed to prepare the organism for challenge or threat. Developmental experience plays a role, along with heritable, polygenic variation, in calibrating the response dynamics of these systems, with early adversity biasing their combined effects toward a profile of heightened or prolonged reactivity. Conventional views of such high reactivity suggest that it is an atavistic and pathogenic legacy of an evolutionary past in which threats to survival were more prevalent and severe. Recent evidence, however, indicates that (a) stress reactivity is not a unitary process, but rather incorporates counterregulatory circuits serving to modify or temper physiological arousal, and (b) the effects of high reactivity phenotypes on psychiatric and biomedical outcomes are bivalent, rather than univalent, in character, exerting both risk-augmenting and risk-protective effects in a context-dependent manner. These observations suggest that heightened stress reactivity may reflect, not simply exaggerated arousal under challenge, but rather an increased biological sensitivity to context, with potential for negative health effects under conditions of adversity and positive effects under conditions of support and protection. From an evolutionary perspective, the developmental plasticity of the stress response systems, along with their structured, context-dependent effects, suggests that these systems may constitute conditional adaptations: evolved psychobiological mechanisms that monitor specific features of childhood environments as a basis for calibrating the development of stress response systems to adaptively match those environments. Taken together, these theoretical perspectives generate a novel hypothesis: that there is a curvilinear, U-shaped relation between early exposures to adversity and the development of stress-reactive profiles, with high reactivity phenotypes disproportionately emerging within both highly stressful and highly protected early social environments.

The stress system in the human brain in depression and neurodegeneration

Corticotropin-releasing hormone (CRH) plays a central role in the regulation of the hypothalamic-pituitary-adrenal (HPA)-axis, i.e., the final common pathway in the stress response. The action of CRH on ACTH release is strongly potentiated by vasopressin, that is co-produced in increasing amounts when the hypothalamic paraventricular neurons are chronically activated. Whereas vasopressin stimulates ACTH release in humans, oxytocin inhibits it. ACTH release results in the release of corticosteroids from the adrenal that, subsequently, through mineralocorticoid and glucocorticoid receptors, exert negative feedback on, among other things, the hippocampus, the pituitary and the hypothalamus. The most important glucocorticoid in humans is cortisol, present in higher levels in women than in men. During aging, the activation of the CRH neurons is modest compared to the extra activation observed in Alzheimer's disease (AD) and the even stronger increase in major depression. The HPA-axis is hyperactive in depression, due to genetic factors or due to aversive stimuli that may occur during early development or adult life. At least five interacting hypothalamic peptidergic systems are involved in the symptoms of major depression. Increased production of vasopressin in depression does not only occur in neurons that colocalize CRH, but also in neurons of the supraoptic nucleus (SON), which may lead to increased plasma levels of vasopressin, that have been related to an enhanced suicide risk. The increased activity of oxytocin neurons in the paraventricular nucleus (PVN) may be related to the eating disorders in depression. The suprachiasmatic nucleus (SCN), i.e., the biological clock of the brain, shows lower vasopressin production and a smaller circadian amplitude in depression, which may explain the sleeping problems in this disorder and may contribute to the strong CRH activation. The hypothalamo-pituitary thyroid (HPT)-axis is inhibited in depression. These hypothalamic peptidergic systems, i.e., the HPA-axis, the SCN, the SON and the HPT-axis, have many interactions with aminergic systems that are also implicated in depression. CRH neurons are strongly activated in depressed patients, and so is their HPA-axis, at all levels, but the individual variability is large. It is hypothesized that particularly a subgroup of CRH neurons that projects into the brain is activated in depression and induces the symptoms of this disorder. On the other hand, there is also a lot of evidence for a direct involvement of glucocorticoids in the etiology and symptoms of depression. Although there is a close association between cerebrospinal fluid (CSF) levels of CRH and alterations in the HPA-axis in depression, much of the CRH in CSF is likely to be derived from sources other than the PVN. Furthermore, a close interaction between the HPA-axis and the hypothalamic-pituitary-gonadal (HPG)-axis exists. Organizing effects during fetal life as well as activating effects of sex hormones on the HPA-axis have been reported. Such mechanisms may be a basis for the higher prevalence of mood disorders in women as compared to men. In addition, the stress system is affected by changing levels of sex hormones, as found, e.g., in the premenstrual period, ante- and postpartum, during the transition phase to the menopause and during the use of oral contraceptives. In depressed women, plasma levels of estrogen are usually lower and plasma levels of androgens are increased, while testosterone levels are decreased in depressed men. This is explained by the fact that both in depressed males and females the HPA-axis is increased in activity, parallel to a diminished HPG-axis, while the major source of androgens in women is the adrenal, whereas in men it is the testes. It is speculated, however, that in the etiology of depression the relative levels of sex hormones play a more important role than their absolute levels. Sex hormone replacement therapy indeed seems to improve mood in elderly people and AD patients. Studies of rats have shown that high levels of cumulative corticosteroid exposure and rather extreme chronic stress induce neuronal damage that selectively affects hippocampal structure. Studies performed under less extreme circumstances have so far provided conflicting data. The corticosteroid neurotoxicity hypothesis that evolved as a result of these initial observations is, however, not supported by clinical and experimental observations. In a few recent postmortem studies in patients treated with corticosteroids and patients who had been seriously and chronically depressed no indications for AD neuropathology, massive cell loss, or loss of plasticity could be found, while the incidence of apoptosis was extremely rare and only seen outside regions expected to be at risk for steroid overexposure. In addition, various recent experimental studies using good stereological methods failed to find massive cell loss in the hippocampus following exposure to stress or steroids, but rather showed adaptive and reversible changes in structural parameters after stress. Thus, the HPA-axis in AD is only moderately activated, possibly due to the initial (primary) hippocampal degeneration in this condition. There are no convincing arguments to presume a causal, primary role for cortisol in the pathogenesis of AD. Although cortisol and CRH may well be causally involved in the signs and symptoms of depression, there is so far no evidence for any major irreversible damage in the human hippocampus in this disorder.

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.

Psychological stress may induce diabetes-related autoimmunity in infancy

OBJECTIVE

In retrospective studies, a number of disparate environmental factors (including experiences of serious life events) have been proposed as trigger mechanisms for type 1 diabetes or the autoimmune process behind the disease. Psychosocial stress in families may affect children negatively due to a link to hormonal levels and nervous signals that in turn influence both insulin sensitivity/insulin need and the immune system. Our aim was to investigate whether psychological stress, measured as psychosocial strain in families, is associated with diabetes-related autoimmunity during infancy.

RESEARCH DESIGN AND METHODS

The first 4,400 consecutive 1-year-old children from a large prospective population-based project participated in the study. Parents completed questionnaires at birth and at 1 year, including various measures of psychosocial stress (e.g., parenting stress) and sociodemographic background. Blood samples drawn from the children at 1 year were analyzed for type 1 diabetes-associated autoantibodies toward tyrosine phosphatase and GAD. Antibodies toward tetanus toxoid were used as non-diabetes-related control antibodies.

RESULTS

Psychosocial factors, i.e., high parenting stress (odds ratio 1.8 [95% CI 1.2-2.9], P < 0.01), experiences of a serious life event (2.3 [1.3-4.0], P < 0.01), foreign origin of the mother (2.1 [1.3-3.3], P < 0.001), and low paternal education (1.6 [1.1-2.3], P < 0.01) were associated with diabetes-related autoimmunity in the child, independent of family history of diabetes.

CONCLUSIONS

Psychological stress, measured as psychosocial strain in the family, seems to be involved in the induction, or progression, of diabetes-related autoimmunity in the child during the 1st year of life.

The programming of individual differences in defensive responses and reproductive strategies in the rat through variations in maternal care

There are profound maternal effects on individual differences in defensive responses and reproductive strategies in species ranging literally from plants to insects to birds. Maternal effects commonly reflect the quality of the environment and are most likely mediated by the quality of the maternal provision (egg, propagule, etc.), which in turn determines growth rates and adult phenotype. In this paper, we review data from the rat that suggest comparable forms of maternal effects on both defensive responses to threat and reproductive behavior and which are mediated by variations in maternal behavior. Ultimately, we will need to contend with the reality that neural development, function and health are defined by social and economic influences.

Vulnerability and presenting symptoms in burning mouth syndrome

OBJECTIVES

To investigate if burning mouth syndrome (BMS) patients have differing health perceptions, medication, and life experiences compared with controls and to examine the role of vulnerability factors and differentiate them from the presenting symptomology in patients with BMS.

STUDY DESIGN

A nonprobability convenience sample of patients presenting with BMS and age- and sex-matched controls were recruited from Queen's University, Belfast, King's College London, and Baylor College of Dentistry, Dallas. Participants completed a questionnaire to assess 9 aspects of their medical and social history, including early and past life experiences. The subjects completed the Hospital Anxiety and Depression Scale to assess current distress.

RESULTS

Participants with BMS had significantly higher experiences of adverse early life experiences compared with controls. They had statistically significantly higher mean scores for anxiety and depression compared with controls. A hierarchical multiple logistic regression analysis showed that the characteristics of BMS included cancer phobia, gastro-intestinal problems, and chronic fatigue.

CONCLUSION

BMS is a complex disorder. People who experience adverse life experiences may become vulnerable to developing BMS in later life.

Mutual influences on maternal depression and child adjustment problems

Often undetected and poorly managed, maternal depression and child adjustment problems are common health problems and impose significant burden to society. Studies show evidence of mutual influences on maternal and child functioning, whereby depression in mothers increases risk of emotional and behavioral problems in children and vice versa. Biological mechanisms (genetics, in utero environment) mediate influences from mother to child, while psychosocial (attachment, child discipline, modeling, family functioning) and social capital (social resources, social support) mechanisms mediate transactional influences on maternal depression and child adjustment problems. Mutual family influences in the etiology and maintenance of psychological problems advance our understanding of pathways of risk and resilience and their implications for clinical interventions. This article explores the dynamic interplay of maternal and child distress and provides evidence for a biopsychosocial model of mediating factors with the aim of stimulating further research and contributing to more inclusive therapies for families.

Relationship between baseline cortisol, social functioning and depression: a mediation analysis

Both elevated cortisol secretion and low social support have been commonly found in depressed patients, but their respective roles in depression remain unclear. In fact, it may not be a lack of social support but a failure to obtain it that is important. The present study used mediation analysis to study the interrelationships among cortisol, social functioning and depression. Sixty healthy volunteers were recruited from the community. Depression and social functioning were measured by the Beck Depression Inventory and the Social Adaptation Self-evaluation Scale, respectively. Salivary samples were collected to measure the cortisol. Using mediation analysis, it was found that elevated cortisol secretion was a vulnerability factor for low social functioning, leading to higher depression scores. Hypercortisolaemia may be a predisposing factor and may interact with a low level of social functioning leading to depression.

Enhanced evoked responses after early adversity and repeated platform exposure: the neurobiology of vulnerability?

BACKGROUND

There is a long-standing clinical awareness of the significance of adverse early experiences and subsequent stress in the evolution of psychiatric disorder.

METHODS

We investigated the impact of a single episode of preweaning maternal separation on in vivo electrophysiologic responses in the hippocampus of the mature rat after repeated exposure to an open elevated platform.

RESULTS

Only rats that had experienced both maternal separation followed by stressful platform exposure when mature had significantly increased granule cell response to perforant path stimulation, compared with control rats. Rats exposed to either maternal separation or the elevated platform in adulthood alone did not differ significantly from control rats.

CONCLUSIONS

Adverse early experience seems to induce functional changes in the hippocampus that remain latent until activated by stress in adulthood. Such electrophysiologic changes might represent a neural substrate for vulnerability to stress-associated psychopathology.

Integrating neuroscience and psychological approaches in the study of early experiences

Rodent maternal separation and primate rearing environment paradigms demonstrate that early disturbances in caregiving that sensitize stress-responsive neurocircuits may play a role in the etiology of mood disorders. Psychosocial studies document the importance of adverse early experiences in the risk for psychopathology. The time is ripe for integrating the animal neuroscience and human psychosocial research on early experiences and stress. Based on work by the National Institute of Mental Health Early Experience, Stress Neurobiology Prevention Science research network, findings in the human literature that are consistent with those in animal models are reviewed. In addition, however, anomalous findings and the challenge they pose in translating the basic neuroscience findings to human development are also discussed.

Nonhuman primate models to study anxiety, emotion regulation, and psychopathology

This paper demonstrates that the rhesus monkey provides an excellent model to study mechanisms underlying human anxiety and fear and emotion regulation. In previous studies with rhesus monkeys, stable, brain, endocrine, and behavioral characteristics related to individual differences in anxiety were found. It was suggested that, when extreme, these features characterize an anxious endophenotype and that these findings in the monkey are particularly relevant to understanding adaptive and maladaptive anxiety responses in humans. The monkey model is also relevant to understanding the development of human psychopathology. For example, children with extremely inhibited temperament are at increased risk to develop anxiety disorders, and these children have behavioral and biological alterations that are similar to those described in the monkey anxious endophenotype. It is likely that different aspects of the anxious endophenotype are mediated by the interactions of limbic, brain stem, and cortical regions. To understand the brain mechanisms underlying adaptive anxiety responses and their physiological concomitants, a series of studies in monkeys lesioning components of the neural circuitry (amygdala, central nucleus of the amygdala and orbitofrontal cortex) hypothesized to play a role are currently being performed. Initial findings suggest that the central nucleus of the amygdala modulates the expression of behavioral inhibition, a key feature of the endophenotype. In preliminary FDG positron emission tomography (PET) studies, functional linkages were established between the amygdala and prefrontal cortical regions that are associated with the activation of anxiety.

Can premorbid episodes of diminished vagal tone be detected via histological markers in patients with PTSD?

While laboratory methods for estimating genetic susceptibility for adult psychopathology have received much recent attention, laboratory methods for objectively estimating a person's early autonomic nervous system perturbations have been under-researched. Research on heart rate variability suggests that early life episodes of diminished vagal tone may predict poor stress resilience in adults. This article will detail a research method for retrospectively estimating in adults the chronology of diminished vagal tone episodes experienced prior to age 10. This method makes use of the developing enamel matrix, one of very few tissues that cannot recover after being stressed.

Exposure to postnatal depression predicts elevated cortisol in adolescent offspring

BACKGROUND

Animal research shows that early adverse experience results in altered glucocorticoid levels in adulthood, either raised basal levels or accentuated responses to stress. If a similar phenomenon operates in humans, this suggests a biological mechanism whereby early adversity might transmit risk for major depression, glucocorticoid elevations being associated with the development of this disorder.

METHODS

We measured salivary cortisol at 8:00 am and 8:00 pm over 10 days in 13-year-old adolescents who had (n = 48) or had not (n = 39) been exposed to postnatal maternal depression.

RESULTS

Maternal postnatal depression was associated with higher, more variable morning cortisol in offspring, a pattern previously found to predict major depression.

CONCLUSIONS

Early adverse experiences might alter later steroid levels in humans. Because maternal depression confers added risk for depression to children, these alterations might provide a link between early events and later psychopathology.

New developments in the neurobiology of borderline personality disorder

Within the past several years, research on the clinical phenomena and neurobiology of borderline personality disorder has increased substantially. Borderline personality disorder is currently best thought of in terms of dimensions rather than as a categorical disorder. This article reviews the most recent findings on two of the core dimensions--affective dysregulation and impulsivity. Most of the neuropsychologic, physiologic, endocrinologic, and neuroimaging data support the theory that a dual brain pathology, affecting prefrontal and limbic circuits, may underlie this hyperarousal-dyscontrol syndrome.

Prophecies of childhood: how children's social environments and biological propensities affect the health of populations

During the past decade, important steps have been taken globally to improve the status of children. Concurrently, significant advances have been made toward understanding how child development is shaped by transactions between biological and environmental influences. Despite such advances, ongoing adversities in the lives of children worldwide undermine the development of individuals and thus the health of nations. The primary tenets of this paper are that: children continue to suffer a disproportionate share of the world's adversities; exposure to early adversities is not only associated with increased morbidity during childhood, but also across the lifespan; and recent advances in understanding the operation and ontogeny of stress-response systems can help explain how adversity is translated into lifelong effects on health. Acknowledging the long-lasting sequelae of childhood adversity has important implications for public health and society.

Public health context of women's mental health research

As more attention is directed to the mental health care of women, sex and gender differences in research design and in regulatory policies have interfaced with clinical care and public policy. An emphasis on women's mental health issues in the provision of treatment and care as well as the design of large-scale screening strategies to identify and treat women with mental disorders promises to be effective public health approaches to reducing the burden of mental illness in women. The past decade has seen increased emphasis on women's mental health and sex/gender differences in the federal sector and in the research community. Federal regulations (summarized in the NIH Outreach Notebook) call for the inclusion of women and minorities in NIH-funded clinical research. The regulations also place emphasis on gender analysis of the results of clinical trials, in particular phase III trials, the findings of which are likely to influence practice. There has been substantial progress toward the goal of including women in research, but more remains to be done. A 2000 GAO report titled "Women's Health: NIH Has Increased Its Efforts to Include Women in Research" commended NIH for tracking the number of women in clinical research but the report also noted that relatively few NIH-funded studies, including major clinical trials, had reported findings by gender of study participants. This was seen as an impediment to progress in developing gender-based effective treatments. In the past decade, the women's health field has moved beyond an exclusive emphasis on women's reproductive function to one that defines health as a scientific enterprise to identify clinically important sex and gender differences in prevalence, etiology, course, and treatment of illnesses affecting men and women in the population as well as conditions specific to women. Nonetheless, for mental disorders, women's reproductive function and its impact on mental health conditions is still understudied. Based on the epidemiology of mental disorders, the course of mental disorders in women in relation to reproductive transitions remains an important issue for the mental health field because the burden of mental disorders, such as depression and anxiety, fall disproportionately on women of childbearing and childrearing age. The public health emphasis on women's mental health does not lessen the basic scientific opportunities to be had by a focus on gender and sex differences. A 2001 report of the Institute of Medicine titled "Exploring the Biological Contributions to Health: Does Sex Matter?" underscores the benefit to health care of looking for sex differences at the biological level. Basic and clinical neuroscience research is rapidly accruing a knowledge base that will provide information at the level of genes and cells of the influences of biological sex on mental health outcomes in both women and men. A focus on women's mental health and gender/sex differences research promises to yield improvement in treatments and services and thereby to improve the public health as well as to increase fundamental knowledge about the etiology and neurophysiology of mental disorders.

Children, stress, and context: integrating basic, clinical, and experimental prevention research

Findings from the Watamura, Donzella, Alwin, and Gunnar (this issue) study support the growing recognition of the importance of context on physiology and affective and behavioral regulation early in human development. This discussion focuses on the role of context and development on hypothalamic-pituitary-adrenal (HPA) axis regulation in young children. Discussed in this article are the Watamura et al. findings with regard to relevant animal studies, extension of these observations to samples of children at elevated risk for psychopathology, and experimental prevention studies with young children. It is contended that environmental factors operating at key points in development may shape affective and behavioral regulation as well as HPA axis function in children, much as environmental factors have been shown to shape HPA axis regulation in animals.

Exposure to maternal depression and marital conflict: gender differences in children's later mental health symptoms

OBJECTIVE

To investigate effects of the timing of initial exposure to maternal depression and marital conflict on kindergarten children's mental health symptoms.

METHOD

For 406 families (of 570 originally recruited), mothers reported on major depression and marital conflict on multiple occasions in the child's infancy and toddler/preschool periods. Mothers and teachers completed the MacArthur Health and Behavior Questionnaire when children were in kindergarten.

RESULTS

Children evidenced co-occurring internalizing and externalizing symptoms, although the mix was more toward internalizing for girls and externalizing for boys. Symptoms were more severe among children exposed to either adversity, and these effects were additive. Boys exposed to maternal depression in infancy had a preponderance of internalizing behaviors, but if subsequently exposed to marital conflict, the mix toward externalizing behaviors increased to match levels of clinic-referred children. For girls, the preponderance of internalizing symptoms increased to match levels of clinic-referred children when initial exposure to marital conflict occurred in the toddler/preschool period.

CONCLUSIONS

It is important to consider both adversities across developmental periods, to distinguish the symptom severity from directionality, and to consider child gender. Prevention and intervention efforts that consider these findings are warranted.