1
|
Wang R, Kogler L, Derntl B. Sex differences in cortisol levels in depression: A systematic review and meta-analysis. Front Neuroendocrinol 2024; 72:101118. [PMID: 38176541 DOI: 10.1016/j.yfrne.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Higher prevalence of depression in females might be associated with sex-specific cortisol levels. Evidence exists that cortisol levels differ between healthy females and males, however a sex-specific association in depression has not been systematically assessed. Thus, the current study quantifies the existing literature on different cortisol parameters, i.e., basal cortisol, hair cortisol, cortisol awakening response (CAR), and cortisol stress reactivity comparing depressed females and males as well as sex-specific comparisons with healthy controls. Following an extensive literature research, fifty original articles were included. Depressed females had significantly higher hair cortisol, higher CAR, and lower cortisol stress reactivity compared to depressed males. In comparison with sex-matched controls, female patients had significantly higher evening basal cortisol, higher CAR and lower cortisol stress reactivity, and male patients had significantly higher general, morning and evening basal cortisol. Overall, sex as a fundamental driver of cortisol levels in depression needs to be taken into account.
Collapse
Affiliation(s)
- Rui Wang
- Department of Psychiatry and Psychotherapy, Women's Mental Health & Brain Function, Tübingen Center for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Lydia Kogler
- Department of Psychiatry and Psychotherapy, Women's Mental Health & Brain Function, Tübingen Center for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany; German Center for Mental Health (DZPG), partner site Tübingen, 72076 Tübingen, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Women's Mental Health & Brain Function, Tübingen Center for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany; German Center for Mental Health (DZPG), partner site Tübingen, 72076 Tübingen, Germany; LEAD Graduate School and Research Network, University of Tübingen, Germany
| |
Collapse
|
2
|
Vansoeterstede A, Cappe E, Lichtlé J, Boujut E. A systematic review of longitudinal changes in school burnout among adolescents: Trajectories, predictors, and outcomes. J Adolesc 2023; 95:224-247. [PMID: 36385709 DOI: 10.1002/jad.12121] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION School burnout (SBO) is a public health issue with possible long-term consequences that occurs among developing adolescents. To design prevention policies, SBO's causes and consequences must be established. Moreover, a better understanding of its development might help identify key moments for interventions. Longitudinal studies can reveal whether SBO changes or remains stable over time and can track how its different dimensions develop. They can also clarify the distinction between the predictors and outcomes of SBO. METHODS This systematic review follows PRISMA guidelines and aims to synthesize knowledge about the development of SBO and its predictors and outcomes. We queried databases for articles published between January 2002 and February 2021 that use a quantitative assessment of SBO and have longitudinal designs using students in secondary education. RESULTS Forty-three articles representing 48 studies were included in this review. The most-documented risk factors are female gender and high school academic track. Exhaustion is the first dimension of SBO to develop. The most-documented risk factors are female gender and high school academic track. Relationships with parents serve as a protective factor. Outcomes of SBO include lower engagement at school, impaired identity development, and lower satisfaction with life. Complex relationships are found between SBO, problematic use of internet, problematic use of social media, and depressive symptoms. The three are likely to be caused by SBO but probably develop in vicious cycles. CONCLUSION More research on the organizational factors influencing SBO in diverse educational systems is needed.
Collapse
Affiliation(s)
- Aline Vansoeterstede
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France
| | - Emilie Cappe
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France.,Institut universitaire de France (IUF), Paris, France
| | - Jérôme Lichtlé
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France
| | - Emilie Boujut
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France
| |
Collapse
|
3
|
Zwolińska W, Dmitrzak-Węglarz M, Słopień A. Biomarkers in Child and Adolescent Depression. Child Psychiatry Hum Dev 2023; 54:266-281. [PMID: 34590201 PMCID: PMC9867683 DOI: 10.1007/s10578-021-01246-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Despite the significant prevalence of Major Depressive Disorder in the pediatric population, the pathophysiology of this condition remains unclear, and the treatment outcomes poor. Investigating tools that might aid in diagnosing and treating early-onset depression seems essential in improving the prognosis of the future disease course. Recent studies have focused on searching for biomarkers that constitute biochemical indicators of MDD susceptibility, diagnosis, or treatment outcome. In comparison to increasing evidence of possible biomarkers in adult depression, the studies investigating this subject in the youth population are lacking. This narrative review aims to summarize research on molecular and biochemical biomarkers in child and adolescent depression in order to advocate future directions in the research on this subject. More studies on depression involving the youth population seem vital to comprehend the natural course of the disease and identify features that may underlie commonly observed differences in treatment outcomes between adults and children.
Collapse
Affiliation(s)
- Weronika Zwolińska
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Szpitalna St. 27/33, 60-572, Poznan, Poland.
| | - Monika Dmitrzak-Węglarz
- grid.22254.330000 0001 2205 0971Department of Psychiatric Genetics, Medical Biology Center, Poznan University of Medical Sciences, Rokietnicka St. 8, 60-806 Poznan, Poland
| | - Agnieszka Słopień
- grid.22254.330000 0001 2205 0971Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Szpitalna St. 27/33, 60-572 Poznan, Poland
| |
Collapse
|
4
|
Zajkowska Z, Gullett N, Walsh A, Zonca V, Pedersen GA, Souza L, Kieling C, Fisher HL, Kohrt BA, Mondelli V. Cortisol and development of depression in adolescence and young adulthood - a systematic review and meta-analysis. Psychoneuroendocrinology 2022; 136:105625. [PMID: 34920399 PMCID: PMC8783058 DOI: 10.1016/j.psyneuen.2021.105625] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the development of major depressive disorder (MDD) in adulthood. Less work has focused on the role of the HPA axis in depression in adolescence and young adulthood globally. The aim of this study was to conduct a systematic review and meta-analysis of worldwide research investigating the relationship between cortisol, a measure of HPA axis activity, and MDD in adolescence and young adulthood. METHOD We searched MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, Web of Science, Lilacs, African Journals Online, and Global Health for studies which examined the relationship between cortisol and MDD in global youth (10-24 years old). RESULTS Twenty-six studies were included in the systematic review and 14 were eligible for the meta-analysis, but only one study included young adults in their sample. Results from the meta-analysis demonstrated that elevated morning, but not evening, cortisol levels was prospectively associated with later MDD development in adolescence and young adulthood. However, morning cortisol levels did not significantly differ between healthy controls and individuals with MDD in cross-sectional studies. Afternoon cortisol and cortisol stress response also did not differ between adolescents with MDD and healthy controls. Qualitative synthesis of the three studies examining nocturnal cortisol showed higher nocturnal cortisol was both longitudinally and cross-sectionally associated with MDD in adolescence. CONCLUSION Our findings suggest elevated morning cortisol precedes depression in adolescence. Despite this, we did not find any differences in other cortisol measures in association with MDD in cross-sectional studies. Taken together, these findings suggest that elevated morning and nocturnal cortisol are risk factors for depression in adolescence rather than a biomarker of existing MDD. This supports a role for the hyperactivity of the HPA axis in the development of MDD in adolescence. Most of the studies were from high-income-countries (HICs) and thus further work would need to be conducted in low- and middle-income countries (LMICs) to understand if our findings are generalisable also to these populations.
Collapse
Affiliation(s)
- Zuzanna Zajkowska
- King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Nancy Gullett
- King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Annabel Walsh
- King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Valentina Zonca
- King’s College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK,Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Gloria A. Pedersen
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, 2120L St NW, Ste 600, Washington, DC 20037, USA
| | - Laila Souza
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 – 400N, Porto Alegre, RS 90035–903, Brazil
| | - Christian Kieling
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350 – 400N, Porto Alegre, RS 90035–903, Brazil
| | - Helen L. Fisher
- King’s College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK,ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, 2120L St NW, Ste 600, Washington, DC 20037, USA
| | - Valeria Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK.
| |
Collapse
|
5
|
Zajkowska Z. In(s) and out(s) of adolescent depression - Trajectories of development and recovery. Brain Behav Immun Health 2021; 18:100382. [PMID: 34816138 PMCID: PMC8591391 DOI: 10.1016/j.bbih.2021.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 10/28/2022] Open
Abstract
While the role of biological markers in understanding major depressive disorder (MDD) in adults have been studied extensively, less has been done to identify the biomarkers of MDD development and recovery in adolescence. With the majority of mental health disorders starting in adolescence, identifying biomarkers of transition and recovery from MDD early in life is critical for developing effective prevention strategies. Considering most of the child and adolescent populations come from low-and-middle-income countries (LMICs), it is vital to focus on adolescent populations in these settings. With most studies coming from high-income countries (HICs), evidence suggests that elevated morning cortisol levels including cortisol awakening response (CAR), increased peripheral inflammation and brain abnormalities such as cortico-limbic dysregulation or blunted activity in reward related regions in response to positive information are associated with MDD and being at-risk for MDD development in adolescence. We also find that some of the biological mechanisms of recovery from MDD, mainly normalisation in the cortico-limbic dysregulation, are reported following psychological therapy, suggesting shared pathways leading to MDD vulnerability and recovery. Although, only a few studies include adolescent populations. Understanding molecular mechanisms through which psychological interventions are effective, as well as molecular markers of transition to depression in individuals at-risk, are important to inform effective prevention and intervention strategies.
Collapse
Affiliation(s)
- Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
6
|
Salihoğlu S, Doğan SC, Kavakçı Ö. Effects of childhood psychological trauma on rheumatic diseases. Eur J Rheumatol 2019; 6:126-129. [PMID: 31364980 DOI: 10.5152/eurjrheum.2019.18184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 04/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The etiology of rheumatic diseases is unclear, but it is thought that environmental factors added to immunogenetic mechanisms in chronic inflammatory diseases play a role. Many inflammatory disorders, autoimmune diseases, and painful conditions have been shown to be associated with the psychological trauma of childhood. The aim of the present study was to investigate childhood psychological trauma that is considered to be one of the environmental factors that initiate inflammation on patients with rheumatic diseases. METHODS In our study, a total of 440 patients (220 patients who have rheumatic diseases as the case group and 220 patients who have no rheumatic disease as the control group) were examined. The Childhood Trauma Questionnaire-28 (CTQ-28) was administered and was completed by the patients. This was a cross-sectional study design. RESULTS No statistically significant differences were found between the case and control groups with respect to age, gender, marital status, and educational level. The CTQ-28 scale was found to be significantly higher in patients with rheumatic diseases (ankylosing spondylitis, rheumatoid arthritis, and connective tissue disease) in our study. CONCLUSION We think that childhood psychiatric traumas are effective in the etiopathogenesis of rheumatic diseases. To make this relationship more understandable, multidisciplinary research and long-term follow-up studies are needed to examine neuroendocrine, genetic, and epidemiological factors.
Collapse
Affiliation(s)
- Salih Salihoğlu
- Department of Physical Medicine and Rehabilitation, Medicana Sivas Hospital, Sivas, Turkey
| | - Sevil Ceyhan Doğan
- Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Önder Kavakçı
- Department of Psychiatry, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| |
Collapse
|
7
|
Roberts AG, Lopez-Duran NL. Developmental influences on stress response systems: Implications for psychopathology vulnerability in adolescence. Compr Psychiatry 2019; 88:9-21. [PMID: 30466015 DOI: 10.1016/j.comppsych.2018.10.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/30/2022] Open
Abstract
The adolescent transition is marked by increases in stress exposure and significant maturation of neural and hormonal stress processing systems. Variability in the development of these systems during adolescence may influence the risk for stress-related psychopathology. This paper aims to review the developmental maturation of the HPA axis and related stress regulation systems, and demonstrate how interference in this adaptive developmental process may increase the risk for negative outcomes. We argue that the developmental maturation of the HPA axis aims to improve the regulatory capacity of the axis in order to more adaptively respond to these increases in stress reactivity. Additionally, we review evidence that sex differences in the development of the HPA and related axes may contribute to sex differences in the risk for stress-related psychopathology. Finally, we discuss how contextual factors, such as early trauma and obesity may alter the development of HPA axis during the adolescence transition and how alterations of normative development increase the risk for stress-related disorders.
Collapse
|
8
|
Abstract
BACKGROUND In adults, hypothalamus-pituitary-adrenal (HPA) axis activity shows sexual dimorphism, and this is thought to be a mechanism underlying sex-specific disease incidence. Evidence is scarce on whether these sex differences are also present in childhood. In a meta-analysis, we recently found that basal (non-stimulated) cortisol in saliva and free cortisol in 24-h urine follow sex-specific patterns. We explored whether these findings could be extended with sex differences in HPA axis reactivity. METHODS From inception to January 2016, PubMed and EMBASE.com were searched for studies that assessed HPA axis reactivity in healthy girls and boys aged ≤18 years. Articles were systematically assessed and reported in the categories: (1) diurnal rhythm, (2) cortisol awakening response (CAR), (3) protocolled social stress tests similar or equal to the Trier Social Stress Test for children (TSST-C), (4) pharmacological (ACTH and CRH) stress tests, and (5) miscellaneous stress tests. RESULTS Two independent assessors selected 109 out of 6158 records for full-text screening, of which 81 studies (with a total of 14,591 subjects) were included. Studies showed that girls had a tendency towards a more variable diurnal rhythm (12 out of 29 studies), a higher CAR (8 out of 18 studies), and a stronger cortisol response to social stress tests (9 out of 21 studies). We found no evidence for sex differences in cortisol response after a pharmacological challenge or to miscellaneous stress tests. DISCUSSION Sex differences in HPA axis reactivity appear to be present in childhood, although evidence is not unequivocal. For a better evaluation of sex differences in HPA axis reactivity, standardization of protocols and reports of stress tests is warranted.
Collapse
|
9
|
van der Voorn B, Hollanders JJ, Ket JCF, Rotteveel J, Finken MJJ. Gender-specific differences in hypothalamus-pituitary-adrenal axis activity during childhood: a systematic review and meta-analysis. Biol Sex Differ 2017; 8:3. [PMID: 28116043 PMCID: PMC5244584 DOI: 10.1186/s13293-016-0123-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/14/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Gender-specific differences in hypothalamus-pituitary-adrenal (HPA) axis activity have been postulated to emerge during puberty. We conducted a systematic review and meta-analysis to test the hypothesis that gender-specific differences in HPA axis activity are already present in childhood. METHODS From inception to January 2016, PubMed and EMBASE.com were searched for studies that assessed non-stimulated cortisol in serum or saliva or cortisol in 24-h urine in healthy males and females aged ≤18 years. Studies that conform with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement were reported. Standardized mean differences (95% CIs) were calculated and analyzed using fixed-effect meta-analysis stratified for age: <8 years (prepubertal) and 8-18 years (peri-/postpubertal). For comparison, we ran the same analyses using random-effects models. RESULTS Two independent assessors selected 413 out of 6158 records (7%) for full-text screening, of which 79 articles were included. Of these, 58 (with data on 16,551 subjects) were included in the meta-analysis. Gender differences in cortisol metabolism differed per age group. Boys aged <8 years had 0.18 (0.06; 0.30) nmol/L higher serum and 0.21 (0.05; 0.37) nmol/L higher salivary cortisol levels, while between 8 and 18 years, boys had 0.34 (0.28; 0.40) nmol/L lower serum and 0.42 (0.38; 0.47) nmol/L lower salivary cortisol levels. In 24-h urine, cortisol was consistently higher in boys, being 0.34 (0.05; 0.64) and 0.32 (0.17; 0.47) μg/24 h higher in the <8- and 8-18-year groups, respectively. However, gender-differences in serum cortisol <8 years and between 8 and 18 years were absent when using random-effects models. CONCLUSIONS Gender differences in cortisol metabolism are already present in childhood, with higher salivary cortisol in boys aged <8 years compared to girls. This pattern was reversed after the age of 8 years. In contrast, the gender-specific difference in cortisol production as assessed through 24-h urine did not change with age. Although differences were small, and analyses of gender differences in serum cortisol were inconclusive, they might contribute to gender-specific origins of health and disease.
Collapse
Affiliation(s)
- Bibian van der Voorn
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Jonneke J Hollanders
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit, De Boelelaan 1103, 1081 HV Amsterdam, The Netherlands
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Pediatric Endocrinology, VU University Medical Center, Postbus 7057, 1007 MB Amsterdam, The Netherlands
| |
Collapse
|
10
|
Cameron CA, McKay S, Susman EJ, Wynne-Edwards K, Wright JM, Weinberg J. Cortisol Stress Response Variability in Early Adolescence: Attachment, Affect and Sex. J Youth Adolesc 2017; 46:104-120. [PMID: 27468997 PMCID: PMC5518686 DOI: 10.1007/s10964-016-0548-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic-pituitary-adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls' attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.
Collapse
Affiliation(s)
- Catherine Ann Cameron
- University of British Columbia, Vancouver, BC, Canada.
- University of New Brunswick, Fredericton, NB, Canada.
| | - Stacey McKay
- University of New Brunswick, Fredericton, NB, Canada
| | | | | | - Joan M Wright
- University of New Brunswick, Fredericton, NB, Canada
| | | |
Collapse
|
11
|
Lopez-Duran NL, McGinnis E, Kuhlman K, Geiss E, Vargas I, Mayer S. HPA-axis stress reactivity in youth depression: evidence of impaired regulatory processes in depressed boys. Stress 2015; 18:545-53. [PMID: 26115161 PMCID: PMC5403248 DOI: 10.3109/10253890.2015.1053455] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Given the link between youth depression and stress exposure, efforts to identify related biomarkers have involved examinations of stress regulation systems, including the hypothalamic-pituitary-adrenal (HPA) axis. Despite these vast efforts, the underlying mechanisms at play, as well as factors that may explain heterogeneity of past findings, are not well understood. In this study, we simultaneously examined separate components of the HPA-axis response (e.g. activation intensity, peak levels, recovery) to the Socially Evaluated Cold-Pressor Test in a targeted sample of 115 youth (age 9-16), recruited to overrepresent youth with elevated symptoms of depression. Among youth who displayed a cortisol response to the task, depression symptoms were associated with higher peak responses but not greater rate of activation or recovery in boys only. Among those who did not respond to the task, depression symptoms were associated with greater cortisol levels throughout the visit in boys and girls. Results suggest that depression symptoms are associated with a more prolonged activation of the axis and impaired recovery to psychosocial stressors primarily in boys. We discussed two potential mechanistic explanations of the link between depression symptoms and the duration of activation: (1) inhibitory shift (i.e. point at which the ratio of inhibitory and excitatory input into the axis shifts from greater excitatory to greater inhibitory input) or (2) inhibitory threshold (i.e. level of cortisol exposure required to activate the axis' feedback inhibition system).
Collapse
Affiliation(s)
| | - Ellen McGinnis
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Kate Kuhlman
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Elisa Geiss
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Ivan Vargas
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| | - Stefanie Mayer
- a Department of Psychology , University of Michigan , Ann Arbor , MI , USA
| |
Collapse
|
12
|
Chen LS, Tzeng WY, Chuang JY, Cherng CG, Gean PW, Yu L. Roles of testosterone and amygdaloid LTP induction in determining sex differences in fear memory magnitude. Horm Behav 2014; 66:498-508. [PMID: 25066484 DOI: 10.1016/j.yhbeh.2014.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/17/2014] [Accepted: 07/18/2014] [Indexed: 01/30/2023]
Abstract
Women are thought to form fear memory more robust than men do and testosterone is suspected to play a role in determining such a sex difference. Mouse cued fear freezing was used to study the sex-related susceptibility and the role of testosterone in fear memory in humans. A 75-dB tone was found to provoke weak freezing, while 0.15-mA and 0.20-mA footshock caused strong freezing responses. No sex differences were noticed in the tone- or footshock-induced (naïve fear) freezing. Following the conditionings, female mice exhibited greater tone (cued fear)-induced freezing than did male mice. Nonetheless, female mice demonstrated indistinctive cued fear freezing across the estrous phases and ovariectomy did not affect such freezing in female mice. Orchidectomy enhanced the cued fear freezing in male mice. Systemic testosterone administrations and an intra-lateral nucleus of amygdala (LA) testosterone infusion diminished the cued fear freezing in orchidectomized male mice, while pretreatment with flutamide (Flu) eradicated these effects. Long-term potentiation (LTP) magnitude in LA has been known to correlate with the strength of the cued fear conditioning. We found that LA LTP magnitude was indeed greater in female than male mice. Orchidectomy enhanced LTP magnitude in males' LA, while ovariectomy decreased LTP magnitude in females' LA. Testosterone decreased LTP magnitude in orchidectomized males' LA and estradiol enhanced LTP magnitude in ovariectomized females' LA. Finally, male mice had lower LA GluR1 expression than female mice and orchidectomy enhanced the GluR1 expression in male mice. These findings, taken together, suggest that testosterone plays a critical role in rendering the sex differences in the cued fear freezing and LA LTP. Testosterone is negatively associated with LA LTP and the cued fear memory in male mice. However, ovarian hormones and LA LTP are loosely associated with the cued fear memory in female mice.
Collapse
Affiliation(s)
- Li-Shen Chen
- Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 70101, Taiwan, ROC
| | - Wen-Yu Tzeng
- Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 70101, Taiwan, ROC
| | - Jia-Ying Chuang
- Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 70101, Taiwan, ROC
| | - Chianfang G Cherng
- Department of Health Psychology, Chang Jung Christian University, Tainan 71101, Taiwan, ROC
| | - Po-Wu Gean
- Department of Pharmacology, National Cheng Kung University College of Medicine, Tainan 70101, Taiwan, ROC
| | - Lung Yu
- Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 70101, Taiwan, ROC; Institute of Behavioral Medicine, National Cheng Kung University College of Medicine, Tainan 70101, Taiwan, ROC.
| |
Collapse
|
13
|
Ghaziuddin N, King CA, Welch K, Ghaziuddin M. Depressed suicidal adolescent males have an altered cortisol response to a pharmacological challenge. Asian J Psychiatr 2014; 7:28-33. [PMID: 24524706 PMCID: PMC5731465 DOI: 10.1016/j.ajp.2013.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/02/2013] [Accepted: 10/06/2013] [Indexed: 11/17/2022]
Abstract
Dysregulation of the HPA axis and the dysfunction of the central serotonin (5HT) system are the most replicated biomarkers of depression and suicidal ideation and behavior. However, few studies have examined the two systems simultaneously. In this study, cortisol response was measured in depressed adolescents, following the administration of a central serotonin receptor agonist, meta-chlorphenylpiprazine (mCPP). Adolescents with major depression (MDD; n = 44; males = 15, females = 29; mean age ± SD = 15.5 ± 1.5) were divided into two groups: non-suicidal or those who reported passive suicidal ideation (n = 21), and those who had either threatened suicide or engaged in suicidal acts (n = 23). Sequential infusions of normal saline and mCPP were administered, and serial blood samples were collected for cortisol response. A differential time by group pattern of cortisol response following mCPP was found in the entire group (F(6,242) = 2.6, p=0.018). However, this was mostly attributed to males (F(6,73) = 2.3, p = 0.043) who had threatened or engaged in suicidal acts and displayed a higher cortisol response at 10 and 25 min after the infusion of mCPP, which was not affected by the severity of depression. This differential pattern of cortisol secretion in response to a serotonergic agonist may be a biomarker for more severe forms of suicidal ideation and behavior in adolescent males.
Collapse
Affiliation(s)
- Neera Ghaziuddin
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Cheryl A King
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Kathleen Welch
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Mohammad Ghaziuddin
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109, United States.
| |
Collapse
|
14
|
Guerry JD, Hastings PD. In search of HPA axis dysregulation in child and adolescent depression. Clin Child Fam Psychol Rev 2012; 14:135-60. [PMID: 21290178 PMCID: PMC3095794 DOI: 10.1007/s10567-011-0084-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis in adults with major depressive disorder is among the most consistent and robust biological findings in psychiatry. Given the importance of the adolescent transition to the development and recurrence of depressive phenomena over the lifespan, it is important to have an integrative perspective on research investigating the various components of HPA axis functioning among depressed young people. The present narrative review synthesizes evidence from the following five categories of studies conducted with children and adolescents: (1) those examining the HPA system’s response to the dexamethasone suppression test (DST); (2) those assessing basal HPA axis functioning; (3) those administering corticotropin-releasing hormone (CRH) challenge; (4) those incorporating psychological probes of the HPA axis; and (5) those examining HPA axis functioning in children of depressed mothers. Evidence is generally consistent with models of developmental psychopathology that hypothesize that atypical HPA axis functioning precedes the emergence of clinical levels of depression and that the HPA axis becomes increasingly dysregulated from child to adult manifestations of depression. Multidisciplinary approaches and longitudinal research designs that extend across development are needed to more clearly and usefully elucidate the role of the HPA axis in depression.
Collapse
Affiliation(s)
- John D Guerry
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | |
Collapse
|
15
|
Stroud LR, Papandonatos GD, Williamson DE, Dahl RE. Sex differences in cortisol response to corticotropin releasing hormone challenge over puberty: Pittsburgh Pediatric Neurobehavioral Studies. Psychoneuroendocrinology 2011; 36:1226-38. [PMID: 21489699 PMCID: PMC3270708 DOI: 10.1016/j.psyneuen.2011.02.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 02/26/2011] [Accepted: 02/28/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Consistent sex differences in regulation of the hypothalamic pituitary adrenocortical (HPA) axis have been shown in animal models and emerge over puberty. However, parallel work in humans is lacking despite implications for elucidating the emergence of sex differences in depression over puberty. We investigated sex differences in HPA response to corticotropin releasing hormone (CRH) challenge over puberty in a carefully screened normative sample. METHODS Participants were 68 healthy children (41% girls), ages 6-16, with no personal or family history of psychiatric disorder. Pubertal maturation was determined by Tanner staging. Following 24h of adaptation, 9-10 plasma cortisol samples were collected over 30-40 min pre-infusion baseline, 1 μg/kg CRH infusion, and 90-180 min post-infusion recovery. Thirty-seven participants completed 2+ CRH challenges allowing inclusion of cross-sectional and longitudinal data in all analyses. The influence of gender and pubertal maturation on parameters of cortisol response to CRH challenge was investigated using nonlinear mixed model methodology. RESULTS Girls showed increasing total cortisol output following CRH challenge over puberty, while boys showed little change in total cortisol output over puberty. Increased cortisol output in girls was explained by slower reactivity and recovery rates leading to prolonged time to reach peak cortisol and delayed return to baseline over puberty. Girls also showed increasing baseline cortisol over puberty, while boys showed declining baseline over puberty. CONCLUSION Results reveal subtle normative sex differences in the influence of pubertal maturation on HPA regulation at the pituitary level. This normative shift may tip the balance towards stress response dysregulation in girls at high risk for depression, and may represent one potential mechanism underlying elevated rates of depression among pubescent girls.
Collapse
Affiliation(s)
- Laura R. Stroud
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI
| | | | - Douglas E. Williamson
- Departments of Psychiatry, Epidemiology & Biostatistics, University of Texas Health Sciences Center at San Antonio, School of Medicine, San Antonio, TX
| | - Ronald E. Dahl
- Departments of Psychiatry and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
16
|
Brand S, Wilhelm FH, Kossowsky J, Holsboer-Trachsler E, Schneider S. Children suffering from separation anxiety disorder (SAD) show increased HPA axis activity compared to healthy controls. J Psychiatr Res 2011; 45:452-9. [PMID: 20870248 DOI: 10.1016/j.jpsychires.2010.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/26/2010] [Accepted: 08/27/2010] [Indexed: 01/03/2023]
Abstract
RESEARCH QUESTIONS Separation anxiety disorder (SAD) is one of the most common mental disorders in childhood, and one of the earliest emerging. Little is known about the association between SAD and the hypothalamic-pituitary-adrenocortical (HPA) axis activity. Therefore, the present study aimed at investigating this association in children suffering from separation anxiety compared to healthy controls. METHODS A total of 31 children with diagnosed SAD (mean age: 8.45; 17 females, 14 males) and 25 healthy controls (HC; mean age: 9.74; 12 females, 13 males) took part in the study. All participants underwent psycho-physiological testing for HPA axis challenge. Testing consisted of a separation and a social exposure paradigm. Saliva samples to assess HPA axis-related cortisol secretion were gathered in parallel. RESULTS Compared to healthy controls, children with SAD showed greatly increased HPA axis activity, as reflected by an increased cortisol secretion throughout the entire period of investigation. The rise of cortisol was already observed in anticipation of, but not following the separation paradigm. No gender-related differences of cortisol secretion were observed. CONCLUSIONS Separation anxiety disorder (SAD) in children is reflected in greatly increased HPA axis activity. Compared to healthy controls, children with SAD showed increased cortisol values from the beginning of, and throughout, the entire investigation. This pattern of results suggests that both the anticipation of a separation and a persistent hyperactivity of the HPA axis system leads to an increased cortisol secretion.
Collapse
Affiliation(s)
- Serge Brand
- Psychiatric Hospital of the University of Basel, Depression and Sleep Research Unit, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| | | | | | | | | |
Collapse
|
17
|
Tyrka AR, Kelly MM, Graber JA, DeRose L, Lee JK, Warren MP, Brooks-Gunn J. Behavioral adjustment in a community sample of boys: links with basal and stress-induced salivary cortisol concentrations. Psychoneuroendocrinology 2010; 35:1167-77. [PMID: 20223598 PMCID: PMC2922420 DOI: 10.1016/j.psyneuen.2010.02.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 11/20/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been observed in association with internalizing symptoms and is thought to be involved in the pathogenesis of depression and some anxiety disorders. This study examined basal and stress-induced cortisol concentrations in relation to internalizing and externalizing symptoms in a racially mixed community sample of 102 8-11-year-old boys. Afternoon basal cortisol concentrations were positively correlated with measures of internalizing behavior problems, social problems, and emotionality. Greater change in cortisol across a home-visit challenge task was also significantly associated with internalizing behaviors and social problems, as well as attention and thought problems. The implications of these findings and how they may relate to the pathogenesis of emotional and behavioral problems are discussed.
Collapse
Affiliation(s)
- Audrey R. Tyrka
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI,Address Correspondence to: Audrey R. Tyrka, M.D., Ph.D., Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906. TEL: (401) 455-6520. FAX: (401) 455-6534.
| | - Megan M. Kelly
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
| | - Julia A. Graber
- Department of Psychology, University of Florida, Gainesville, FL
| | - Laura DeRose
- Department of Developmental Psychology, Adelphi University, Garden City, NY
| | - Janet K. Lee
- Mood Disorders Research Program and Laboratory for Clinical Neuroscience, Butler Hospital, Providence, RI
| | | | - Jeanne Brooks-Gunn
- College of Physicians & Surgeons, Columbia University, NY, NY,National Center for Children and Families, Teachers College, Columbia University, NY, NY
| |
Collapse
|
18
|
Lopez-Duran NL, Kovacs M, George CJ. Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: a meta-analysis. Psychoneuroendocrinology 2009; 34:1272-83. [PMID: 19406581 PMCID: PMC2796553 DOI: 10.1016/j.psyneuen.2009.03.016] [Citation(s) in RCA: 295] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/09/2009] [Accepted: 03/24/2009] [Indexed: 01/03/2023]
Abstract
Research findings on the hypothalamic-pituitary-adrenal (HPA) axis and pediatric depression reflect a variety of methodological approaches that tap different facets of HPA-axis functions. Partly owing to the methodological heterogeneity of studies, descriptive reviews of this area have produced inconsistent conclusions. Therefore, we conducted formal meta-analyses of pertinent studies in order to advance our understanding of HPA-axis dysregulation in pediatric depression. We examined: (a) 17 published studies of HPA-axis response to the dexamethasone suppression test (DST) in depressed youth (DST; N=926) and (b) 17 studies of basal HPA-axis functioning (N=1332). We also examined descriptively studies that used corticotropin-releasing hormone (CRH) infusion, and those that used psychological probes of the HPA-axis. The global standardized mean effect size difference in HPA-axis response to the DST between depressed and non-depressed youth was 0.57, z=4.18, p<0.01. The global standardized mean difference effect size in basal HPA-axis functioning was 0.20, z=4.53, p<0.01. Age, sex, timing of sampling, dexamethasone dosage, or type of control group was not a significant source of variability for the DST or basal studies. In addition, when compared to non-depressed peers, depressed youth have a normative response to CRH infusion but an overactive response to psychological stressors. In conclusion, the HPA-axis system tends to be dysregulated in depressed youth, as evidenced by atypical responses to the DST, higher baseline cortisol values, and an overactive response to psychological stressors. This pattern of dysregulation suggests anomalies within the axis's negative feedback system and CRH production, but intact pituitary and adrenal sensitivity.
Collapse
Affiliation(s)
- Nestor L. Lopez-Duran
- Send all correspondence to Nestor L. Lopez-Duran Ph.D. University of Pittsburgh. Western Psychiatric Institute and Clinic. 3811 O'Hara St. Pittsburgh, PA 15213. Telephone 1.412.246.5714. Fax: 1.412.246.5455.
| | | | | |
Collapse
|
19
|
Locke RL, Davidson RJ, Kalin NH, Goldsmith HH. Children's context inappropriate anger and salivary cortisol. Dev Psychol 2009; 45:1284-97. [PMID: 19702392 PMCID: PMC2776065 DOI: 10.1037/a0015975] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Some children show emotion that is not consistent with normative appraisal of the context and can therefore be defined as context inappropriate (CI). The authors used individual growth curve modeling and hierarchical multiple regression analyses to examine whether CI anger predicts differences in hypothalamic-pituitary-adrenal axis activity, as manifest in salivary cortisol measures. About 23% of the 360 children (ages 6-10 years, primarily 7-8) showed at least 1 expression of CI anger in situations designed to elicit positive affect. Expression of anger across 2 positive assessments was less common (around 4%). CI anger predicted the hypothesized lower levels of cortisol beyond that attributed to context appropriate anger. Boys' CI anger predicted lower morning cortisol and flatter slopes. Results suggest that this novel approach to studying children's emotion across varying contexts can provide insight into affective style.
Collapse
Affiliation(s)
- Robin L Locke
- Department of Psychology, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747-2300, USA.
| | | | | | | |
Collapse
|
20
|
Natsuaki MN, Klimes-Dougan B, Ge X, Shirtcliff EA, Hastings PD, Zahn-Waxler C. Early pubertal maturation and internalizing problems in adolescence: sex differences in the role of cortisol reactivity to interpersonal stress. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2009; 38:513-24. [PMID: 20183638 PMCID: PMC3061854 DOI: 10.1080/15374410902976320] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An accumulating body of literature has shown a link between early pubertal maturation and internalizing problems, particularly among girls. Our knowledge is, however, limited with regard to what accounts for this association. Based on a hypothesis that early maturing girls have heightened stress sensitivity that increases the risk of internalizing problems, the present investigation examined the roles of pubertal timing and salivary cortisol reactivity to interpersonal stressors in adolescents' internalizing problems. Results from 110 boys and 106 girls (ages 11-16) indicated that early maturing adolescents had increased internalizing symptoms. Early maturing girls' higher levels of internalizing problems were at least partially attributed to their heightened sensitivity to interpersonal stress. Finally, girls' cortisol reactivity to interpersonal challenge was more strongly associated with internalizing problems than boys' reactivity.
Collapse
Affiliation(s)
- Misaki N Natsuaki
- Institute of Child Development, University of Minnesota, Twin Cities, Minneapolis, MN 55455, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Fox HC, Sinha R. Sex differences in drug-related stress-system changes: implications for treatment in substance-abusing women. Harv Rev Psychiatry 2009; 17:103-19. [PMID: 19373619 PMCID: PMC2746371 DOI: 10.1080/10673220902899680] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Extensive research indicates that chronic substance abuse disrupts stress and reward systems of the brain. Gender variation within these stress-system alterations, including the impact of sex hormones on these changes, may influence sex-specific differences in both the development of, and recovery from, dependency. As such, gender variations in stress-system function may also provide a viable explanation for why women are markedly more vulnerable than men to the negative consequences of drug use. This article therefore initially reviews studies that have examined gender differences in emotional and biophysiological changes to the stress and reward system following the acute administration of drugs, including cocaine, alcohol, and nicotine. The article then reviews studies that have examined gender differences in response to various types of stress in both healthy and drug-abusing populations. Studies examining the impact of sex hormones on these gender-related responses are also reported. The implications of these sex-specific variations in stress and reward system function are discussed in terms of both comorbid psychopathology and treatment outcome.
Collapse
|
22
|
Hatzinger M, Brand S, Perren S, von Wyl A, von Klitzing K, Holsboer-Trachsler E. Hypothalamic-pituitary-adrenocortical (HPA) activity in kindergarten children: importance of gender and associations with behavioral/emotional difficulties. J Psychiatr Res 2007; 41:861-70. [PMID: 16979188 DOI: 10.1016/j.jpsychires.2006.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/17/2006] [Accepted: 07/24/2006] [Indexed: 10/24/2022]
Abstract
The current cross-sectional study investigated basal and stress-challenged hypothalamic-pituitary-adrenocortical (HPA) system function in 102 five-year old kindergarten children (59 boys, 43 girls) who had been assessed by a comprehensive psychological and behavioral test battery. Baseline HPA system activity was significantly increased in girls when compared to boys (p<0.001). Furthermore, basal HPA system activity predicted a high hormonal release during stress with--again--girls showing higher hormonal responses than boys (p<0.01). Importantly, increased HPA system activity (baseline and stress-challenged) was significantly associated with hyperactivity/impulsivity and emotional problems in boys and with positive emotions in girls (p<0.05). These results suggest an occurrence of neurobiological alterations early in development. The observed neurobiological changes are gender specific already at the age of 5 years. Prospective long-term follow up of the identified subjects with HPA axis alterations will clarify if these markers are predictive for the onset of psychiatric disorders.
Collapse
Affiliation(s)
- Martin Hatzinger
- Psychiatric University Clinics (UPK), Depression Research Unit, Wilhelm Klein-Str. 27, CH-4025 Basel, Switzerland.
| | | | | | | | | | | |
Collapse
|
23
|
Pajer KA. Cardiovascular disease risk factors in adolescents: do negative emotions and hypothalamic-pituitary-adrenal axis function play a role? Curr Opin Pediatr 2007; 19:559-64. [PMID: 17885475 DOI: 10.1097/mop.0b013e3282ef443a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Negative emotions such as depression and hostility/anger are important risk factors for cardiovascular disease in adults, but are often neglected in treatment or prevention programs. Adolescence is a stage of life when negative emotions often first become problematic and is also a time when the pathogenesis of cardiovascular disease appears to accelerate. The literature on negative emotions and cardiovascular disease risk factors in adolescents is reviewed here. RECENT FINDINGS Research indicates that negative emotions are associated with cardiovascular disease risk factors in adolescence. Negative emotions are also associated with several types of hypothalamic-pituitary-adrenal axis dysregulation. Such dysregulation appears to have a facilitatory effect on cardiovascular disease development and progression in adults. Thus, it is possible that negative emotions in adolescents may be risk factors for the development of cardiovascular disease via dysregulation of the hypothalamic-pituitary-adrenal axis. Although this hypothesis has not been directly tested, some studies indirectly support the hypothesis. SUMMARY Negative emotions are associated with cardiovascular disease risk factors in adolescents; it is possible that hypothalamic-pituitary-adrenal axis dysregulation is an important mechanism. This hypothesis merits further research. If the hypothesis is valid, it has significant implications for early prevention of cardiovascular disease.
Collapse
Affiliation(s)
- Kathleen A Pajer
- Department of Pediatrics, Columbus Children's Research Institute, Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
| |
Collapse
|
24
|
Zalsman G, Oquendo MA, Greenhill L, Goldberg PH, Kamali M, Martin A, Mann JJ. Neurobiology of depression in children and adolescents. Child Adolesc Psychiatr Clin N Am 2006; 15:843-68, vii-viii. [PMID: 16952764 DOI: 10.1016/j.chc.2006.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reviews classical and updated studies of the neurobiology of depressive disorders in children and adolescents. Most studies of childhood and adolescent depression and suicide have followed up the observations and methods used in studies in adults. These studies include neuroendocrine studies, which particularly look at the hypothalamic-pituitary-adrenal axis, the serotonergic system, peripheral blood and cerebrospinal fluid biologic markers, genetics, gene-environment interactions and sleep studies, and neuroimaging and postmortem studies, although in these areas the number of studies is limited.
Collapse
Affiliation(s)
- Gil Zalsman
- Department of Psychiatry, Division of Neuroscience, Columbia University, New York, NY 10032, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
Vasa RA, Carlino AR, Pine DS. Pharmacotherapy of depressed children and adolescents: current issues and potential directions. Biol Psychiatry 2006; 59:1021-8. [PMID: 16406250 DOI: 10.1016/j.biopsych.2005.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 10/05/2005] [Accepted: 10/19/2005] [Indexed: 11/29/2022]
Abstract
The recent deliberations by the U.S. Food and Drug Administration (FDA) regarding the relationship between antidepressants and suicidality in children have incited debates about the safety of these medications for the treatment of pediatric depression. In light of these events, this review discusses four issues pertaining to pharmacotherapy for pediatric depression. First, we summarize pertinent data from randomized controlled trials of antidepressants for pediatric depression. These data provide strong support for fluoxetine and modest support for the other antidepressants. Second, we examine the outcome of the FDA meta-analysis of the data on antidepressant-induced suicidality, with specific emphasis on the methodological limitations of this analysis. Third, we consider the collective implications of the antidepressant efficacy and suicidality data on clinical practice. Specifically, we present several compelling arguments that justify the continued use of antidepressants for pediatric depression, despite the inherent limitations of these medications. Finally, we review several pathophysiological factors that might provide insights into treatment response and impact the design of future pharmacotherapy studies of depression. These factors relate to diagnostic heterogeneity, developmental consistency, and psychobiology. Potentially novel pharmacotherapies are also discussed.
Collapse
Affiliation(s)
- Roma A Vasa
- Department of Psychiatry, Johns Hopkins University School of Medicine.
| | | | | |
Collapse
|
26
|
Fox HC, Garcia M, Kemp K, Milivojevic V, Kreek MJ, Sinha R. Gender differences in cardiovascular and corticoadrenal response to stress and drug cues in cocaine dependent individuals. Psychopharmacology (Berl) 2006; 185:348-57. [PMID: 16514523 DOI: 10.1007/s00213-005-0303-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 12/20/2005] [Indexed: 11/24/2022]
Abstract
RATIONALE Extensive research suggests that gender may affect neuroendocrine and cardiovascular arousal mechanisms underlying biological responses to stress. OBJECTIVE To examine the impact of gender on response to stress and to drug-cue exposure in treatment-seeking cocaine abusers. METHODS Fifty recently abstinent cocaine dependent individuals (25F/25M), who were matched on cocaine use history, were exposed to a brief guided-imagery procedure that involved imagining a recent personal stressful situation, a personal drug-related situation and neutral-relaxing situation, one imagery per session, presented in random order. Subjective craving and anxiety, cardiovascular measures and plasma adrenocorticotrophic hormone (ACTH), cortisol and prolactin were assessed. RESULTS Males showed significantly higher levels of ACTH, cortisol, and SBP, both at baseline and following all three imagery conditions. Females showed significantly higher basal heart rate and prolactin, although no gender differences were observed following imagery. No gender differences were seen in subjective anxiety or cocaine craving. CONCLUSIONS Results indicate significant gender differences in baseline sensitivity and subsequent variations in hypothalamus-pituitary-adrenal (HPA) and cardiovascular response to imagery challenge. Such gender-specific responses could have implications for the development of pharmacological treatments that address stress and drug-cue-related relapse in cocaine-abusing individuals.
Collapse
Affiliation(s)
- Helen C Fox
- Substance Abuse Center, Connecticut Mental Health Center, Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Ronsaville DS, Municchi G, Laney C, Cizza G, Meyer SE, Haim A, Radke-Yarrow M, Chrousos G, Gold PW, Martinez PE. 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. Dev Psychopathol 2006; 18:173-94. [PMID: 16478558 DOI: 10.1017/s095457940606010x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
Collapse
|
28
|
Cameron JL. Interrelationships between hormones, behavior, and affect during adolescence: complex relationships exist between reproductive hormones, stress-related hormones, and the activity of neural systems that regulate behavioral affect. Comments on part III. Ann N Y Acad Sci 2004; 1021:134-42. [PMID: 15251882 DOI: 10.1196/annals.1308.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Adolescence is a period in life marked by change, encompassing physiological changes associated with pubertal development, changes in social status and the social stresses that an individual faces, and changes in behavioral affect regulation. The interactions between activity in the reproductive axis, the neural systems that regulate stress, hormones produced in response to stress, and neural systems governing behavioral affect regulation are complex and multifaceted. Although our understanding of these interactions remains rudimentary, we do know that stress can suppress activity of the reproductive axis, that reproductive hormones can modulate the activity of neural systems that govern the body's responses to stress, that both reproductive function and stress responsiveness can be altered in depressed individuals, and that the function of some of the key neural systems regulating behavioral affect (i.e., serotonergic, noradrenergic, dopaminergic systems) are modulated by both gonadal steroid hormones and adrenal steroid hormones. This summary reviews the central interactions discussed in this session on the interrelationships between hormones, behavior, and affect during adolescence and identifies key topics that require further investigation in order to understand the role that pubertal changes in reproductive function, interacting with increased exposure to life stresses, play in modulating behavioral affect regulation during the adolescent period.
Collapse
Affiliation(s)
- Judy L Cameron
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| |
Collapse
|
29
|
Gutman DA, Nemeroff CB. Persistent central nervous system effects of an adverse early environment: clinical and preclinical studies. Physiol Behav 2003; 79:471-8. [PMID: 12954441 DOI: 10.1016/s0031-9384(03)00166-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the search for the underlying biological causes of psychiatric disorders, primary roles for both genetics and environment have been clearly established. A family history of mood or anxiety disorders, representing the genetic component, clearly increases the risk for developing these illnesses in adulthood. The pivotal role of early environmental influences in the pathogenesis of these disorders is also supported by an abundance of both clinical and preclinical data. This review will highlight some of the preclinical and clinical literature that suggests early adverse experience may sensitize corticotropin-releasing factor (CRF) circuitry. The neurobiology of depression highlighting the pathophysiological role of CRF is reviewed. Next, some of the preclinical models of early life stress are discussed; along with a review of the relevant clinical literature that suggests that the functional dysregulation of CRF circuitry in response to early life trauma may contribute to adulthood depression. The discussion will be framed in regards to a stress-diathesis model in which early adverse events result in a sensitized stress axis that predisposes individuals to develop mood disorders.
Collapse
Affiliation(s)
- David A Gutman
- Laboratory of Neuropsychopharmacology, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Drive, Suite 4000 WMRB, Atlanta, GA 30322, USA
| | | |
Collapse
|
30
|
Abstract
Early stress is associated with long-term alterations in brain circuits and systems that mediate the stress response. Early stressors have lasting effects on the HPA axis and norepinephrine systems. Other brain systems that are involved include benzodiazepine, opiate, dopaminergic, and various neuropeptide systems. These neurochemical systems modulate function in brain regions, including the hippocampus, amygdala, and prefrontal cortex. Long-term alterations in these brain regions are hypothesized to play a role in the maintenance of PTSD, depression, and other psychiatric symptoms after childhood abuse.
Collapse
Affiliation(s)
- J Douglas Bremner
- Departments of Psychiatry and Radiology, Emory University School of Medicine, 1256 Briarcliff Road, Atlanta, GA 30306, USA.
| |
Collapse
|
31
|
Abstract
BACKGROUND Sex differences in stress responses may be one mechanism underlying gender differences in depression. We hypothesized that men and women would show different adrenocortical responses to different stressors. In particular, we predicted that women would show greater responses to social rejection stressors, whereas men would demonstrate greater responses to achievement stressors. METHODS Following a rest session in which they habituated to the laboratory, 50 healthy volunteers (24 men and 26 women, mean age 19.1, SD = 1.13) were randomly assigned to achievement or rejection stress conditions. The achievement condition involved a mathematical and a verbal challenge; the rejection condition involved two social interaction challenges. Self-reported affect and salivary cortisol were measured throughout each stress session (baseline, stress, and poststress periods). RESULTS There were no sex differences in mood ratings following the stressors; however, cortisol responses showed the predicted gender by condition by time interaction. Men showed significantly greater cortisol responses to the achievement challenges, but women showed greater cortisol responses to the social rejection challenges. CONCLUSIONS Women appear more physiologically reactive to social rejection challenges, but men react more to achievement challenges. Women's greater reactivity to rejection stress may contribute to the increased rates of affective disorders in women.
Collapse
Affiliation(s)
- Laura R Stroud
- Brown University Centers for Behavioral and Preventive Medicine, Providence, Rhode Island 02903, USA
| | | | | |
Collapse
|
32
|
Hankin BL, Abramson LY. Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. Psychol Bull 2001; 127:773-96. [PMID: 11726071 DOI: 10.1037/0033-2909.127.6.773] [Citation(s) in RCA: 772] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Descriptive epidemiological studies are reviewed, showing that the female preponderance in depression begins to emerge around age 13. A developmentally sensitive, elaborated cognitive vulnerability-transactional stress model of depression is proposed to explain the "big fact" of the emergence of the gender difference in depression. The elaborated causal chain posits that negative events contribute to initial elevations of general negative affect. Generic cognitive vulnerability factors then moderate the likelihood that the initial negative affect will progress to full-blown depression. Increases in depression can lead transactionally to more self-generated dependent negative life events and thus begin the causal chain again. Evidence is reviewed providing preliminary support for the model as an explanation for the development of the gender difference in depression during adolescence.
Collapse
Affiliation(s)
- B L Hankin
- Department of Psychology, University of Illinois at Chicago, 60607, USA.
| | | |
Collapse
|
33
|
Heim C, Nemeroff CB. The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biol Psychiatry 2001; 49:1023-39. [PMID: 11430844 DOI: 10.1016/s0006-3223(01)01157-x] [Citation(s) in RCA: 1796] [Impact Index Per Article: 78.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epidemiologic studies indicate that children exposed to early adverse experiences are at increased risk for the development of depression, anxiety disorders, or both. Persistent sensitization of central nervous system (CNS) circuits as a consequence of early life stress, which are integrally involved in the regulation of stress and emotion, may represent the underlying biological substrate of an increased vulnerability to subsequent stress as well as to the development of depression and anxiety. A number of preclinical studies suggest that early life stress induces long-lived hyper(re)activity of corticotropin-releasing factor (CRF) systems as well as alterations in other neurotransmitter systems, resulting in increased stress responsiveness. Many of the findings from these preclinical studies are comparable to findings in adult patients with mood and anxiety disorders. Emerging evidence from clinical studies suggests that exposure to early life stress is associated with neurobiological changes in children and adults, which may underlie the increased risk of psychopathology. Current research is focused on strategies to prevent or reverse the detrimental effects of early life stress on the CNS. The identification of the neurobiological substrates of early adverse experience is of paramount importance for the development of novel treatments for children, adolescents, and adults.
Collapse
Affiliation(s)
- C Heim
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | |
Collapse
|
34
|
Kaufman J, Martin A, King RA, Charney D. Are child-, adolescent-, and adult-onset depression one and the same disorder? Biol Psychiatry 2001; 49:980-1001. [PMID: 11430841 DOI: 10.1016/s0006-3223(01)01127-1] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper reviews prior research studies examining neurobiological correlates and treatment response of depression in children, adolescents, and adults. Although there are some similarities in research findings observed across the life cycle, both children and adolescents have been found to differ from depressed adults on measures of basal cortisol secretion, corticotropin stimulation post-corticotropin releasing hormone (CRH) infusion, response to several serotonergic probes, immunity indices, and efficacy of tricyclic medications. These differences are proposed to be due to 1) developmental factors, 2) stage of illness factors (e.g., number of episodes, total duration of illness), or 3) heterogeneity in clinical outcome (e.g., recurrent unipolar course vs. new-onset bipolar disorder). Relevant clinical and preclinical studies that provide support for these alternate explanations of the discrepant findings are reviewed, and directions for future research are discussed. To determine whether child-, adolescent-, and adult-onset depression represent the same condition, it is recommended that researchers 1) use the same neuroimaging paradigms in child, adolescent, and adult depressed cohorts; 2) carefully characterize subjects' stage of illness; and 3) conduct longitudinal clinical and repeat neurobiological assessments of patients of different ages at various stages of illness. In addition, careful attention to familial subtypes (e.g., depressive spectrum disorders vs. familial pure depressive disorders) and environmental factors (e.g., trauma history) are suggested for future investigations.
Collapse
Affiliation(s)
- J Kaufman
- Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut 06511, USA
| | | | | | | |
Collapse
|
35
|
Schmeelk KH, Granger DA, Susman EJ, Chrousos GP. Maternal depression and risk for postpartum complications: role of prenatal corticotropin-releasing hormone and interleukin-1 receptor antagonist. Behav Med 1999; 25:88-94. [PMID: 10401538 DOI: 10.1080/08964289909595741] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The pregnancies of 58 healthy adolescents (ages 13 to 19 years) were followed to examine links between symptoms of depression, corticotropin-releasing hormone (CRH), interleukin-1 beta, (IL-1 beta), and IL-1 receptor antagonist (IL-1ra) as possible predictors of maternal and infant outcomes. Maternal psychological adjustment and medical complications during gestation, labor, delivery, and the postpartum period were monitored. Plasma samples collected during gestation were assayed for CRH, IL-1 beta, and IL-1ra. During gestation, symptoms of maternal depression were found to be associated with lower levels of CRH; lower levels of CRH were associated with lower levels of IL-1ra. In addition, lower levels of IL-1ra predicted higher rates of maternal complications after childbirth. IL-1 beta, detected in only 4 mothers, was not associated with any predictor or outcome measures. During gestation, CRH may induce circulating cytokine inhibitors without significantly affecting cytokine production or synthesis. Maternal symptoms of depression during gestation may attenuate the association between CRH and IL-1ra.
Collapse
Affiliation(s)
- K H Schmeelk
- Department of Biobehavioral Health at Pennsylvania State University, University Park, USA
| | | | | | | |
Collapse
|
36
|
Susman EJ, Schmeelk KH, Worrall BK, Granger DA, Ponirakis A, Chrousos GP. Corticotropin-releasing hormone and cortisol: longitudinal associations with depression and antisocial behavior in pregnant adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38:460-7. [PMID: 10199119 DOI: 10.1097/00004583-199904000-00020] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the concurrent and longitudinal associations between corticotropin-releasing hormone (CRH) and cortisol concentrations and depression and antisocial behavior (conduct disorder symptoms) in pregnant adolescents. METHOD Fifty-nine adolescents were evaluated in early pregnancy (9-21 weeks' gestation), late pregnancy (32-34 weeks' gestation), and the postpartum period (4-5 weeks postpartum). Symptoms of depression and conduct disorder were obtained from the Diagnostic Interview Schedule for Children. RESULTS Lower concentrations of CRH were related to a greater number of depression symptoms in early pregnancy (p < .05) and in late pregnancy (p < .05). Lower concentrations of CRH also were related to a greater number of conduct disorder symptoms in early pregnancy (p < .06) and in the postpartum period (p < .05). CONCLUSION The findings support the long-standing hypothesis that stress-related products of the hypothalamic-pituitary-adrenal axis are associated with emotions and behavior during pregnancy.
Collapse
Affiliation(s)
- E J Susman
- Department of Biobehavioral Health, Pennsylvania State University, University Park 16802, USA
| | | | | | | | | | | |
Collapse
|