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Schär S, Mürner-Lavanchy I, Schmidt SJ, Koenig J, Kaess M. Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis. Front Neuroendocrinol 2022; 66:100987. [PMID: 35202606 DOI: 10.1016/j.yfrne.2022.100987] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.
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Affiliation(s)
- Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany; Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
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Community violence exposure and cortisol awakening responses in adolescents who are overweight/obese. Psychoneuroendocrinology 2020; 121:104842. [PMID: 32892064 DOI: 10.1016/j.psyneuen.2020.104842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 08/08/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Community violence exposure has been identified as a salient environmental stressor associated with dysregulated cortisol awakening response (CAR), which may act to exacerbate hypothalamic-pituitary-adrenal (HPA) axis dysregulation observed in adolescents who are overweight/obese. PURPOSE To perform an exploratory cross-sectional analysis examining the association between community violence exposure and CAR in adolescents who are overweight/obese. METHODS One-hundred adolescents (ages: 13-19 years; 65% female; average BMI percentile: 93.80 ± 4.13) were included in this analysis. Community violence exposure was measured using the Survey of Children's Exposure to Community Violence. Salivary cortisol collected across three days at awakening and 30 min post-awakening was used to calculate CAR area under the curve (AUC). RESULTS Community violence exposure was associated with a lower CAR AUC when controlling for baseline cortisol, sex, BMI, pubertal development, race and perceived stress (β = -0.04 ± 0.02; p = 0.04). CONCLUSION Findings from this study identified cross-sectional association between community violence and HPA dysregulation in adolescents who were overweight/obese. If long-term exposure to community violence does indeed accelerate HPA dysregulation in adolescents at increased weight status, policymakers and interventionists should consider implementing programs that limit adolescent violence exposure.
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Boggero IA, Hostinar CE, Haak EA, Murphy MLM, Segerstrom SC. Psychosocial functioning and the cortisol awakening response: Meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies. Biol Psychol 2017; 129:207-230. [PMID: 28870447 DOI: 10.1016/j.biopsycho.2017.08.058] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/05/2017] [Accepted: 08/29/2017] [Indexed: 01/13/2023]
Abstract
Cortisol levels rise immediately after awakening and peak approximately 30-45min thereafter. Psychosocial functioning influences this cortisol awakening response (CAR), but there is considerable heterogeneity in the literature. The current study used p-curve and meta-analysis on 709 findings from 212 studies to test the evidential value and estimate effect sizes of four sets of findings: those associating worse psychosocial functioning with higher or lower cortisol increase relative to the waking period (CARi) and to the output of the waking period (AUCw). All four sets of findings demonstrated evidential value. Psychosocial predictors explained 1%-3.6% of variance in CARi and AUCw responses. Based on these effect sizes, cross-sectional studies assessing CAR would need a minimum sample size of 617-783 to detect true effects with 80% power. Depression was linked to higher AUCw and posttraumatic stress to lower AUCw, whereas inconclusive results were obtained for predictor-specific effects on CARi. Suggestions for future CAR research are discussed.
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Affiliation(s)
- Ian A Boggero
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY 40506, United States.
| | - Camelia E Hostinar
- Department of Psychology, University of California, Davis, 103 Young Hall, Davis, CA 95616, United States.
| | - Eric A Haak
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY 40506, United States.
| | - Michael L M Murphy
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA 15213, United States.
| | - Suzanne C Segerstrom
- Department of Psychology, University of Kentucky, 125 Kastle Hall, Lexington, KY 40506, United States.
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Hoffmann EV, Duarte CS, Fossaluza V, Milani ACC, Maciel MR, Mello MF, Mello AF. Mental health of children who work on the streets in Brazil after enrollment in a psychosocial program. Soc Psychiatry Psychiatr Epidemiol 2017; 52:55-63. [PMID: 27866219 DOI: 10.1007/s00127-016-1316-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the mental health status of children working on the streets in Sao Paulo City, Brazil, two years after their participation in a psychosocial program, and to identify factors associated with their mental health status. METHODS From a total sample of 126 children working on the streets, 107 (85%) were re-evaluated two years after the initiation of a psychosocial program which aimed to cease their work on the streets. The focus was the presence of mental health problems, defined based on a screening instrument (Strengths and Difficulties Questionnaire). Logistic regression models tested factors related to the probability that a child would not present mental health problems at follow-up. RESULTS The likelihood of a child presenting mental health problems was higher at baseline compared to the two-year follow-up (67.5 and 56.1%, respectively). Absence of mental health problems two years after a psychosocial intervention was significantly correlated with the following baseline factors: lower level of caregiver's psychiatric symptoms as measured by the SRQ (Self-Report Questionnaire) (AOR = 0.84, p = 0.0065), absence of child physical neglect (AOR = 0.38, p = 0.0705) and parental Protestant religion affiliation, compared to other religions (AOR = 4.06; p = 0.0107). CONCLUSIONS Different factors are related to the absence of mental health problems of children working on the streets after enrollment in a two-year psychosocial program. Our findings suggest that interventions that aim to improve child mental health should consider the detection of psychiatric symptoms in caregivers, provide treatment when it is needed, and also assess other problems such as neglect in the family setting.
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Affiliation(s)
- Elis Viviane Hoffmann
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil.
| | - Cristiane S Duarte
- Division of Child and Adolescent Psychiatry, Columbia University-NYSPI, New York, NY, USA
| | - Victor Fossaluza
- Department of Mathematics and Statistics, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - Ana Carolina C Milani
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Mariana R Maciel
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Marcelo F Mello
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
| | - Andrea F Mello
- Programa de Atendimento e Pesquisa em Violência (PROVE), Department of Psychiatry, Universidade Federal de São Paulo, Rua: Borges Lagoa, 570-10° andar, Vila Clementino, São Paulo, SP, Cep: 04038-000, Brazil
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