Possible role of cortisol and dehydroepiandrosterone in human development and psychopathology

Affect variability and cortisol in context: The moderating roles of mean affect and stress

Positive and negative affect have been shown to have implications for hormones like cortisol but how moment to moment changes in affect (i.e., affect variability) influence cortisol secretion is less well understood. Additionally, context characteristics such as mean affect and stress may influence the association between affect variability and cortisol output. In the current study, we examined affect, stress, and cortisol data from 113 participants (age range = 25-63, M = 35.63, SD = 11.34; 29% male; 42% White/Caucasian, 37% Asian or Pacific Islander, 13% Hispanic/Latino, 4% Black/African American, 1% Native American, Eskimo, or Aleut, 4% selected "other" for their race/ethnicity). Participants completed ecological momentary assessments assessing positive and negative affect and stress four times per day for five days and provided saliva samples at each time point. Saliva was assayed for cortisol, and area under the curve with respect to ground was computed. In a three-way interaction, both positive affect mean level and stress moderated the association between positive affect variability and cortisol (b = -1.55, t(100) = -3.29, SE = 0.47, p <.01, β = -4.05). When breaking down this three-way interaction, in the context of low stress and high mean positive affect, variability was positively related to total cortisol output. In contrast, in the context of high stress and high mean positive affect, variability was negatively related to total cortisol output. While greater positive affect variability is generally worse for health-relevant outcomes (as prior research has shown and as we show here at low levels of stress), at high levels of stress, fluctuation in affect may be adaptive. For someone experiencing a high stress week, having fluctuations in positive affect may mean that they are adaptively changing to meet their environmental needs especially when they typically report high mean positive affect levels. There were no associations between negative affect variability and cortisol secretion nor did mean negative affect or stress play a moderating role for negative affect variability. This study provides evidence that positive affect variability's association with cortisol secretion throughout the day may vary based on stress and mean positive affect levels.

Variation in diurnal cortisol patterns among the Indigenous Shuar of Amazonian Ecuador

OBJECTIVES

The hypothalamic-pituitary-adrenal (HPA) axis and its primary end product, the glucocorticoid cortisol, are major components of the evolved human stress response. However, most studies have examined these systems among populations in high-income settings, which differ from the high pathogen and limited resource contexts in which the HPA axis functioned for most of human evolution.

METHODS

We investigated variability in diurnal salivary cortisol patterns among 298 Indigenous Shuar from Amazonian Ecuador (147 males, 151 females; age 2-86 years), focusing on the effects of age, biological sex, and body mass index (BMI) in shaping differences in diurnal cortisol production. Saliva samples were collected three times daily (waking, 30 minutes post-waking, evening) for three consecutive days to measure key cortisol parameters: levels at waking, the cortisol awakening response, the diurnal slope, and total daily output.

RESULTS

Age was positively associated with waking levels and total daily output, with Shuar juveniles and adolescents displaying significantly lower levels than adults (p < .05). Sex was not a significant predictor of cortisol levels (p > .05), as Shuar males and females displayed similar patterns of diurnal cortisol production across the life course. Moreover, age, sex, and BMI significantly interacted to moderate the rate of diurnal cortisol decline (p = .027). Overall, Shuar demonstrated relatively lower cortisol concentrations than high-income populations.

CONCLUSIONS

This study expands the documented range of global variation in HPA axis activity and diurnal cortisol production and provides important insights into the plasticity of human stress physiology across diverse developmental and socioecological settings.

Exploratory Clinical Trial of a Depression Diagnostic Software That Integrates Stress Biomarkers and Composite Psychometrics

OBJECTIVE

This study evaluated the clinical effectiveness of Minds.NAVI, a depression screening kit combining psychometric measures and stress hormone biomarkers, in a prospective clinical trial. The objective was to assess its potential as a depression screening tool and investigate the associations between psychological assessments, salivary hormone staging, and depression severity.

METHODS

Thirty-five participants with major depressive disorder and 12 healthy controls (HCs) were included. The Minds.NAVI software, utilizing the PROtective and Vulnerable factors battEry Test (PROVE) and salivary cortisol/dehydroepiandrosterone (DHEA) analysis, was employed. The PROVE test is a comprehensive self-report questionnaire that assesses depressive symptoms, suicide risk, attachment style, adverse childhood experiences, mentalization capacity, and resilience. In addition, salivary cortisol and DHEA levels were measured to evaluate the functional stage of the hypothalamic-pituitary-adrenal (HPA) axis.

RESULTS

Minds.NAVI exhibited 100% sensitivity, 91.7% specificity, and 97.9% accuracy in distinguishing depression from HCs within an exploratory small group. Salivary stress hormone phases showed changes with depression stage (p=0.030), and the proportion of patients with "adrenal exhaustion stage" was higher in the moderate/severe depression group (p=0.038). Protective/vulnerable factors differed significantly between controls and depressed groups (p<0.001). Cortisol awakening response inversely correlated with depressive symptom severity (r=-0.31, p=0.034).

CONCLUSION

This study suggested possible clinical effectiveness of Minds.NAVI, a depression screening tool that integrates psychometric measures and stress hormone biomarkers. The findings support the potential association between depression, chronic stress, and HPA axis hyporesponsiveness.

DHEA: a neglected biological signal that may affect fetal and child development

BACKGROUND

The stress-sensitive maternal hypothalamic-pituitary-adrenal (HPA) axis through the end-product cortisol, represents a primary pathway through which maternal experience shapes fetal development with long-term consequences for child neurodevelopment. However, there is another HPA axis end-product that has been widely ignored in the study of human pregnancy. The synthesis and release of dehydroepiandosterone (DHEA) is similar to cortisol, so it is a plausible, but neglected, biological signal that may influence fetal neurodevelopment. DHEA also may interact with cortisol to determine developmental outcomes. Surprisingly, there is virtually nothing known about human fetal exposure to prenatal maternal DHEA and offspring neurodevelopment. The current study examined, for the first time, the joint impact of fetal exposure to prenatal maternal DHEA and cortisol on infant emotional reactivity.

METHODS

Participants were 124 mother-infant dyads. DHEA and cortisol were measured from maternal hair at 15 weeks (early gestation) and 35 weeks (late gestation). Observational assessments of positive and negative emotional reactivity were obtained in the laboratory when the infants were 6 months old. Pearson correlations were used to examine the associations between prenatal maternal cortisol, prenatal maternal DHEA, and infant positive and negative emotional reactivity. Moderation analyses were conducted to investigate whether DHEA might modify the association between cortisol and emotional reactivity.

RESULTS

Higher levels of both early and late gestation maternal DHEA were linked to greater infant positive emotional reactivity. Elevated late gestation maternal cortisol was associated with greater negative emotional reactivity. Finally, the association between fetal cortisol exposure and infant emotional reactivity was only observed when DHEA was low.

CONCLUSIONS

These new observations indicate that DHEA is a potential maternal biological signal involved in prenatal programming. It appears to act both independently and jointly with cortisol to determine a child's emotional reactivity. Its role as a primary end-product of the HPA axis, coupled with the newly documented associations with prenatal development shown here, strongly calls for the inclusion of DHEA in future investigations of fetal programming.

Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that exhibits striking sex differences in symptoms, prevalence, and associated problems across development. Etiological factors and mechanisms underlying these sex differences remain one of the most understudied aspects of this disorder. The current paper seeks to provide a novel theoretical framework for understanding this phenomenon by reviewing evidence that females with ADHD may experience a "double whammy" of organizational and activational pubertal hormonal effects. We propose a novel theory of activational effects of cyclical circulating ovarian hormones on ADHD with increasing risk at times of rapid declines in estrogen. These declines may decrease executive function and trait control at two points of the cycle characterized by biphasic affective risk: (1) increases in approach/risk-taking behaviors at mid-cycle (periovulatory) and (2) increases in avoidance/negative affect perimenstrually. Low estrogen and control may then interact with increases in positive and negative affect, respectively, to increase hyperactivity-impulsivity symptoms post-ovulation and inattention symptoms perimenstrually. These interactions may be exacerbated by organizational pubertal effects on relatively overdeveloped limbic circuitry and adolescent-specific social pressures magnified in females with ADHD.

The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits

Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.

Within-person associations of cortisol, dehydroepiandrosterone, and testosterone hair hormone concentrations and psychological distress in pregnant and non-pregnant women

Prenatal hair cortisol concentration is inconsistently associated with maternal psychological distress. However, prior studies have not often measured hair cortisol and maternal psychological distress prospectively over time, examined within-person associations, nor concurrently considered the complex hormonal milieu in which cortisol operates during pregnancy. We addressed these limitations and tested associations against a similar non-pregnant comparison group. Participants included 68 women (34 pregnant and 34 non-pregnant; Mage = 29.14 and 83 % White) from the Midwestern United States. Pregnant women were assessed each trimester, at 12, 26, and 38 weeks and non-pregnant women were assessed three times on the same schedule. At each assessment, participants completed measures of psychological distress and provided hair samples. The first 3 cm (from the scalp) of hair was assayed using enzyme immune-assay kits to reflect cumulative levels within the given trimester/3-month time period of cortisol, dehydroepiandrosterone (DHEA) and testosterone. Within-person associations of hair cortisol and ratio of hair cortisol-to-DHEA and cortisol-to-testosterone with psychological distress were assessed using multilevel models. There were positive within-person associations of hair cortisol with cumulative psychological distress (γ = 0.01, s.e. = 0.003, p = .049), anxiety (γ = 0.09, s.e. = 0.04, p = .046), and pregnancy-related anxiety symptoms (γ = 0.10, s.e. = 0.05, p = .041) in the pregnant sample such that on occasions when hair cortisol was higher than average so were psychological distress symptoms. No within-person associations of hair cortisol were supported in non-pregnant women although there was a negative within-person association, such that on occasions of having lower testosterone level than typical, depression symptoms were higher. There were no within-person associations of psychological distress and cortisol-to-DHEA ratio or cortisol-to-testosterone ratio in either the pregnant or non-pregnant sample. At the between person-level for pregnant women, lower cortisol levels were associated with higher perceived stress (γ = -0.28, s.e. = 0.09, p = .003) and depression symptoms (γ = -0.11, s.e. = 0.06, p = .039), whereas higher cortisol levels were associated with higher psychological distress (γ = 0.03, s.e. = 0.01, p = .010), state anxiety (γ = 0.33, s.e. = 0.13, p = .010), and depression symptoms (γ = 0.23, s.e. = 0.09, p = .017) in non-pregnant women. Modeling hair cortisol at the within-person and between-person level revealed differential findings in pregnant and non-pregnant women. Hair cortisol concentration, psychological distress, pregnancy, hormone coupling, within-person associations.

Functional near-infrared spectroscopy is a sensitive marker of neurophysiological deficits on executive function tasks in young adults with a history of child abuse

Previous research has shown the utility of imaging measures of neural activity in identifying deficits in cognitive functioning in individuals with a history of child abuse. The purpose of the present study was to measure differences that may exist between individuals who reported physical, emotional, or sexual abuse as children (n = 37) vs. those who did not (n = 47) using Functional Near Infrared Spectroscopy (fNIRS) during the completion of cognitive tasks of executive function. The results showed a significantly higher rate and number of errors of commission on the Conners CPT test in the child abuse group compared to the control group. The analyses also showed a statistically significant decrease in oxyhemoglobin (oxy-Hb) concentration in the left rostral prefrontal cortex in the child abuse group compared to the no-abuse group during the Wisconsin Card Sorting Test (WCST). A similar, albeit non-significant, trend toward decreased oxy-Hb concentration was observed in the child abuse group in the right dorsolateral prefrontal cortex (dlPFC) on the OSPAN and Connors CPT. The results suggest that the latter group may show subtle neurological deficits that persist into adulthood that may not manifest on traditional measures of cognitive function. These findings have implications for the development of remediation and treatment strategies in this population.

DHEAS and nutritional status among Sidama, Ngandu, and Aka children: Effects of cortisol and implications for adrenarche

OBJECTIVE

Adrenarche, the biological event marked by rising production of dehydroepiandrosterone and its sulfate (DHEAS), may represent a sensitive period in child development, with important implications for adolescence and beyond. Nutritional status, particularly BMI and/or adiposity, has long been hypothesized as a factor in DHEAS production but findings are inconsistent, and few studies have examined this among non-industrialized societies. In addition, cortisol has not been included in these models. We here evaluate effects of height- (HAZ), weight- (WAZ), and BMI- (BMIZ) for-age on DHEAS concentrations among Sidama agropastoralist, Ngandu horticulturalist, and Aka hunter-gatherer children.

METHODS

Heights and weights were collected from 206 children aged 2-18 years old. HAZ, WAZ, and BMIZ were calculated using CDC standards. DHEAS and cortisol assays were used to determine biomarker concentrations in hair. Generalized linear modeling was used to examine effects of nutritional status on DHEAS concentrations, as well as cortisol, controlling for age, sex, and population.

RESULTS

Despite the prevalence of low HAZ and WAZ scores, the majority (77%) of children had BMI z-scores >-2.0 SD. Nutritional status has no significant effect on DHEAS concentrations, controlling for age, sex, and population. Cortisol, however, is a significant predictor of DHEAS concentrations.

CONCLUSIONS

Our findings do not support a relationship between nutritional status and DHEAS. Instead, results suggest an important role for stress and ecology in DHEAS concentrations across childhood. Specifically, effects of environment via cortisol may be influential to patterning of DHEAS. Future work should investigate local ecological stressors and their relationship to adrenarche.

Accelerated epigenetic aging at birth interacts with parenting hostility to predict child temperament and subsequent psychological symptoms

In an effort to elucidate new factors that may contribute to developmental psychopathology, the current study examined whether accelerated epigenetic aging at birth related to children's differential susceptibility to the effects of aversive parenting on early emerging mental health risk. Using data from a multiethnic birth cohort, the interaction between Horvath's methylation age in umbilical cord blood and hostile parenting behaviors was examined in relation to perceptions of infant's temperament at 6 months and to children's psychological symptoms at 3 years in 154 families. Results broadly revealed that children with higher levels of accelerated methylation aging evinced more unpredictable temperaments and more psychological symptoms if their mothers reported more hostile parenting, but showed fewer difficulties if mothers engaged in less hostile parenting; children with lower levels of accelerated methylation age did not show associations between hostility and temperament or psychological symptoms. Effects were not accounted for by gestational age at birth, demographic factors, or the distribution of cell subtypes. These findings suggest that accelerated epigenetic age may function as a form of differential susceptibility, signaling increased risk for psychopathology in more aversive contexts but decreased risk in less aversive early environments. Taken together, they point to a novel biological process to consider within risk for psychopathology.

Measuring stress: a review of the current cortisol and dehydroepiandrosterone (DHEA) measurement techniques and considerations for the future of mental health monitoring

Psychological stress and its inevitable trajectory toward mental health deteriorations such as clinical and major depression has become an unprecedented global burden. The diagnostic procedures involved in the characterization of mental illnesses commonly follow qualitative and subjective measures of stress, often leading to greater socioeconomic burdens due to misdiagnosis and poor understanding of the severity of such illnesses, further fueled by the stigmatization surrounding mental health. In recent years, the application of cortisol and stress hormone measurements has given rise to an alternative, quantifiable approach for the psychological evaluation of stress and depression. This review comprehensively evaluates the current state-of-the-art technology for measuring cortisol and dehydroepiandrosterone (DHEA) and their applications within stress monitoring in humans. Recent advancements in these fields have shown the importance of measuring stress hormones for the characterization of stress manifestation within the human body, and its relevance in mental health decline. Preliminary results from studies considering multimodal approaches toward stress monitoring have showcased promising developments, emphasizing the need for further technological advancement in this field, which consider both neurochemical and physiological biomarkers of stress, for global benefit.

Childhood violence exposure and externalizing behaviors: A systematic review of the role of physiological biomarkers

Childhood exposure to violence has been consistently linked to externalizing behaviors like delinquency and aggression. Growing evidence indicates that physiological biomarkers from the parasympathetic and sympathetic nervous systems (PNS and SNS) and hypothalamic-pituitary-adrenal (HPA) axis may moderate or mediate the relation between childhood violence exposure and externalizing behaviors. We conducted a systematic review to synthesize recent findings on physiological biomarkers as mediators and/or moderators of this association across the life course, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search yielded 3878 articles, of which 44 met inclusion criteria (describing a total of 46 independent studies). We found consistent evidence for blunted HPA-axis reactivity as a mediator of the relation between childhood violence exposure and subsequent externalizing behaviors, and for non-reciprocal PNS/SNS activation as moderators exacerbating this relation. However, the results of the majority of included studies that demonstrated significant moderating effects of physiological biomarkers varied by participant sex, type of childhood violence exposure, and type of stimuli used to induce physiological reactivity. The observed mixed findings are consistent with some theories that emphasize that both high and low stress reactivity can be adaptive depending on one's early environment. These findings highlight the need for systematic explorations of heterogeneity, theory-driven research questions, and longitudinal studies that span multiple developmental periods and multiple biological systems. Clinical implications include the need to assess physiological biomarkers in treatment and intervention studies and the potential to target interventions based on both autonomic functioning and environmental contexts.

Applying minimally invasive biomarkers of chronic stress across complex ecological contexts

Chronic stress is both theoretically and methodologically challenging to operationalize through biomarkers. Yet minimally invasive, field-friendly biomarkers of chronic stress are valuable in research linking biology and culture, seeking to understand differential patterns of human development across ecological contexts, and exploring the evolution of human sociality. For human biologists, a central question in measurement and interpretation of biomarkers is how stress-responsive physiological systems are regulated across diverse human ecologies. This article aims to describe a conditional toolkit for human biologists interested in the study of chronic stress, highlighting a mix of longstanding and novel biomarkers, with special focus on hair/fingernail cortisol, latent herpesvirus antibodies, allostatic load indices, and serial/ambulatory data collection approaches. Future trends in chronic stress biomarker research, including epigenetic approaches, are briefly considered. This overview considers: (1) challenges in separating a distinctly psychosocial dimension of chronic stress from adversity more broadly; (2) essential characteristics of human ecology that shape interpretation; (3) retrospective vs. longitudinal sampling; (4) the role of age, developmental effects, and local biologies; (5) different timescales of chronicity; and (6) the role of culture.

Salivary Cortisol Values and Personality Features of Atopic Dermatitis Patients: A Prospective Study

BACKGROUND

Atopic dermatitis (AD) patients commonly experience psychological stress and impaired psychosocial functioning.

OBJECTIVE

The aim of this study was to compare patients' salivary cortisol levels with AD severity and other associated stress-related psychological measures/parameters.

METHODS

This prospective study analyzed salivary cortisol levels (enzyme-linked immunosorbent assay) in 84 AD patients (42 symptomatic patients and 42 asymptomatic patients). Each subject filled out the Perceived Stress Scale (PSS), Brief Illness Perception Questionnaire, and the Crown-Crisp Experiential Index, which concerns personality features.

RESULTS

Increased cortisol values were found in both groups and were not dependent on disease severity (Scoring Atopic Dermatitis [SCORAD]) and PSS. Patients with severe AD had significantly lower cortisol levels than those with moderate and mild AD (P = 0.042). The PSS levels were not dependent on SCORAD but correlated with the perceived effect of AD on emotional states (Illness Perception Questionnaire 8), personality traits, anxiety, and depression (P < 0.001).

CONCLUSIONS

The severity of perceived stress in AD patients is not adequately measured by salivary cortisol levels nor SCORAD; it does, however, correlate with the impact of AD on patients' emotional states and personality features (anxiety, depression). All AD patients, regardless of disease severity, should be assessed for impacts of stress, and a multidisciplinary approach should address mental wellness.

Adolescent cortisol and DHEA responses to stress as prospective predictors of emotional and behavioral difficulties: A person-centered approach

BACKGROUND

Well-orchestrated cortisol and DHEA stress responsivity is thought to support efficacious stressor management (i.e., coping) and reduce risk for psychopathology during adolescence. Evidence of these relations, however, is lacking empirically. This longitudinal investigation had three aims: 1) to identify within-adolescent profiles of joint cortisol-DHEA responsivity, 2) examine profiles as prospective predictors of adolescents' later emotional and behavioral difficulties, and 3) examine whether distraction coping helped buffer such prospective risk in each profile.

METHOD

At Time 1, boys (n = 110) and girls (n = 105) between 11 and 16 years of age with varied levels of risk for psychopathology completed a lab-based socio-evaluative stressor and questionnaires (e.g., coping, internalizing and externalizing problems). Emotional and behavioral adjustment was assessed again at Time 2 (2 years later).

RESULTS

Multi-trajectory modeling of adolescents' cortisol and DHEA within the context of the stressor revealed three groups: Normative (n = 107; 49.8%), Hyperresponsive (n = 64; 29.8%), Hyporesponsive (n = 44; 20.5%). Relative to Normative, Hyperresponsive and Hyporesponsive adolescents were more and less advanced in pubertal status, respectively. Hyperresponsive adolescents, but not Hyporesponsive, reported greater emotional and behavioral problems at Time 2, relative to Normative adolescents. Links between distraction coping and Time 2 adjustment varied across the groups. Specifically, distraction coping was associated with fewer Time 2 emotional and behavioral problems for Normative adolescents. However, the converse was true for Hyporesponsive adolescents, with distraction associated with greater Time 2 emotional and behavioral problems. Distraction was not associated with Time 2 emotional and behavioral problems for Hyperresponsive adolescents (i.e., elevated levels irrespective of distraction coping utilization).

CONCLUSION

Our results strengthen inference about the role neuroendocrine coordination plays in risk for psychopathology. Findings also help to clarify inconsistent distraction coping-psychopathology linkages, illustrating different patterns of cortisol-DHEA responsivity that support as well as thwart the use of this potentially efficacious strategy.

Longitudinal effects of family psychopathology and stress on pubertal maturation and hormone coupling in adolescent twins

Adolescents experience profound neuroendocrine changes, including hormone "coupling" between cortisol, testosterone, and dehydroepiandrosterone. Emerging research has only begun to elucidate the role of hormone coupling, its genetic and environmental etiology, and the extent to which coupling is impacted by gender, puberty, and family context. We included measures on parent and child mental health, parenting stress, and family conflict of 444 twin pairs and their parents across two timepoints, when youth were on average 8 and 13 years old, respectively. Structural equation models examined the impact of family context effects on coupling during adolescence. Biometric twin models were then used to probe additive genetic, shared, and non-shared environmental effects on hormone coupling. Hormones were more tightly coupled for females than males, and coupling was sensitive to parental depression and co-twin psychopathology symptoms and stress exposure in females. The association between family context and coupling varied across specific neuroendocrine measures and was largely distinct from pubertal maturation. Biometric models revealed robust shared and non-shared environmental influences on coupling. We found that family antecedents modify the strength of coupling. Environmental influences account for much of the variation on coupling during puberty. Gender differences were found in genetic influences on coupling.

Beyond Glucocorticoids: Integrating Dehydroepiandrosterone (DHEA) into Animal Welfare Research

Animal welfare researchers are committed to identifying novel measures for enhancing the quality of life of individual animals. Recently, welfare scientists have emphasized the need for tracking multiple indicators of an animal's behavioral, emotional and mental health. Researchers are currently focused on integrating non-invasive physiological biomarkers to gain insight into an individual's welfare status. Most commonly, the animal welfare community has analyzed glucocorticoid hormones and their metabolites as a measure of stress. While glucocorticoids provide valuable information about hypothalamic-pituitary-adrenal (HPA) axis activity, there are limitations to utilizing these hormones as the sole measure of long-term stress and welfare. Other biomarkers, such as dehydroepiandrosterone and its sulfate ester-collectively referred to as DHEA(S)-help provide a more complete picture of HPA activity. DHEA(S) counteracts the effects glucocorticoids by having anti-aging, immune-enhancing and neuroprotective properties. Recent studies have examined the ratio of glucocorticoids to DHEA(S) as a way to better understand how the HPA axis is functioning. There is evidence that this ratio serves as an indicator of immune function, mental health, cognitive performance and overall welfare. We review studies that employed the glucocorticoid:DHEA(S) ratio, outline methodological considerations and discuss how researchers can integrate glucocorticoids, DHEA(S) and the glucocorticoid:DHEA(S) ratio into welfare assessments.

The complex neurobiology of resilient functioning after childhood maltreatment

BACKGROUND

Childhood maltreatment has been associated with significant impairment in social, emotional and behavioural functioning later in life. Nevertheless, some individuals who have experienced childhood maltreatment function better than expected given their circumstances.

MAIN BODY

Here, we provide an integrated understanding of the complex, interrelated mechanisms that facilitate such individual resilient functioning after childhood maltreatment. We aim to show that resilient functioning is not facilitated by any single 'resilience biomarker'. Rather, resilient functioning after childhood maltreatment is a product of complex processes and influences across multiple levels, ranging from 'bottom-up' polygenetic influences, to 'top-down' supportive social influences. We highlight the complex nature of resilient functioning and suggest how future studies could embrace a complexity theory approach and investigate multiple levels of biological organisation and their temporal dynamics in a longitudinal or prospective manner. This would involve using methods and tools that allow the characterisation of resilient functioning trajectories, attractor states and multidimensional/multilevel assessments of functioning. Such an approach necessitates large, longitudinal studies on the neurobiological mechanisms of resilient functioning after childhood maltreatment that cut across and integrate multiple levels of explanation (i.e. genetics, endocrine and immune systems, brain structure and function, cognition and environmental factors) and their temporal interconnections.

CONCLUSION

We conclude that a turn towards complexity is likely to foster collaboration and integration across fields. It is a promising avenue which may guide future studies aimed to promote resilience in those who have experienced childhood maltreatment.

Determination, intercorrelation and intraindividual stability of five steroids in hair, saliva and urine among chinese college students

Hair steroids and their ratios are believed to be reliable biomarkers reflecting the long-term exposure of circulating steroids. Hereinto, two underlying assumptions are that hair biomarkers have consistency with traditional biomarkers in saliva or urine, and good long-term intraindividual stability across a long time. However, these two assumptions have not been well verified for most of hair biomarkers except for hair cortisol. Thus, this study aimed to verify the two issues on eight hair biomarkers: cortisol, cortisone, dehydroepiandrosterone (DHEA), testosterone, progesterone, the ratios of cortisol to cortisone, DHEA and testosterone. The five steroids in hair, saliva and urine were measured with high performance chromatography tandem mass spectrometry. The results revealed that the hair biomarkers had significant correlations with the salivary biomarkers calculated by the mean area under curve (AUC_g) in a matched time span (ps < 0.05) where the coefficients of correlations (r) were >0.3 (r = 0.322-0.616) except cortisone and progesterone (r = 0.177 and 0.212, respectively). It indicated that hair biomarkers had weak to moderate consistency with salivary ones. But only three biomarkers showed the consistency between hair and urine, such as testosterone (r = 0.352, p < 0.01), progesterone (r = 0.228, p < 0.05) and the ratio of cortisol to testosterone (r = 0.502, p < 0.01). Hair biomarkers showed no absolute stability, but moderate to high long-term relative stability across 12 months where interclass correlation coefficients ranged between 0.356 and 0.678 (ps < 0.01). These results implied that the eight biomarkers in hair could retrospectively reflect their cumulative exposure in vivo. Therefore, the hair biomarkers would be considerable reliable long-term biomarkers for psychological and physiological research.

Violence Victimization Predicts Body Mass Index One Decade Later among an Urban Sample of African American Young Adults: Sex as a Moderator and Dehydroepiandrosterone as a Mediator

Psychological stressors such as violence victimization are known contributors to obesity. However, moderators and mediators of this association have not been studied, although they might offer pathways for intervention or prevention. Using a sample of African American young adults, this study tested: (1) the moderating effect of sex on the effect of violence victimization on trajectories of body mass index (BMI), and (2) the mediating effect of dehydroepiandrosterone (DHEA) on this association. This 13-year longitudinal study followed 73 male and 80 female African American young adults who lived in an urban area from 1999 to 2012 when the youth were 20-32 years old. The independent variable was violence victimization measured in 1999 and 2000. The dependent variable was BMI measured in 2002 and 2012. The mediator was DHEA measured in 2001 and 2002. Multilevel path analysis was used to test if males and females differed in violence victimization predicting change in BMI (Model I) and the mediating effect of DHEA change on the above association (Model II). The results of Model I suggested that the change in violence victimization from 1999 to 2000 predicted change in BMI from 2002 to 2012 for females, but not males. Based on Model II, the DHEA change from 2000 to 2001 for females fully mediated the association between violence victimization from 1999 to 2000 and increases in BMI from 2002 to 2012. Our findings suggest that violence victimization in urban areas contributes to the development of obesity among African American female young adults and change in DHEA mediates this link. Violence prevention may have important implications for obesity prevention of African American young women who live in unsafe urban areas. This study also suggests that DHEA may be involved in the violence victimization-obesity link for African American women.

Sex-specific contribution of DHEA-cortisol ratio to prefrontal-hippocampal structural development, cognitive abilities and personality traits

Although dehydroepiandrosterone (DHEA) may exert neuroprotective effects in the developing brain, prolonged or excessive elevations in cortisol may exert neurotoxic effects. The ratio between DHEA and cortisol (DC ratio) has been linked to internalising and externalising disorders, as well as cognitive performance, supporting the clinical relevance of this hormonal ratio during development. However, the brain mechanisms by which these effects may be mediated have not yet been identified. Furthermore, although there is evidence that the effects of cortisol in the central nervous system may be sexually dimorphic in humans, the opposite is true for DHEA, with human studies showing no sex-specific associations in cortical thickness, cortico-amygdalar or cortico-hippocampal structural covariance. Therefore, it remains unclear whether sex moderates the developmental associations between DC ratio, brain structure, cognition and behaviour. In the present study, we examined the associations between DC ratio, structural covariance of the hippocampus with whole-brain cortical thickness, and measures of personality, behaviour and cognition in a longitudinal sample of typically developing children, adolescents and young adults aged 6-22 years (N = 225 participants [F = 128]; 355 scans [F = 208]), using mixed effects models that accounted for both within- and between-subject variances. We found sex-specific interactions between DC ratio and anterior cingulate cortex-hippocampal structural covariance, with higher DC ratios being associated with a more negative covariance between these structures in girls, and a more positive covariance in boys. Furthermore, the negative prefrontal-hippocampal structural covariance found in girls was associated with higher verbal memory and mathematical ability, whereas the positive covariance found in boys was associated with lower cooperativeness and reward dependence personality traits. These findings support the notion that the ratio between DHEA and cortisol levels may contribute, at least in part, to the development of sex differences in cognitive abilities, as well as risk for internalising/externalising disorders, via an alteration in prefrontal-hippocampal structure during the transition from childhood to adulthood.

Body Image Dissatisfaction and the Adrenarchal Transition

BACKGROUND

Puberty marks a transition in risk for body image disturbance and disordered eating. Yet few studies have examined these symptoms across puberty and none have examined links with adrenarche, the earliest phase in the pubertal hormonal cascade.

METHOD

Levels of adrenal androgens (dehydroepiandrosterone, dehydroepiandrosterone sulphate, and testosterone) were measured in a population-based study of 8- to 9-year-old children (516 males and 621 females). Body dissatisfaction was measured using the Kids' Eating Disorder Scale Silhouettes. Covariates included body mass index, age, and socioeconomic status.

RESULTS

There were significant associations between adrenal androgen levels and greater body dissatisfaction in both males and females. Specifically, females with more advanced levels of dehydroepiandrosterone and testosterone relative to peers, and males with more advanced levels of testosterone relative to peers, reported greater body dissatisfaction. However, after adjusting for covariates, hormones levels were no longer associated with body dissatisfaction, and only higher body mass index had a clear association with body dissatisfaction.

CONCLUSIONS

The adrenarchal transition brings a heightened risk for body dissatisfaction. Whether this arises from the neuroendocrine effects of adrenal androgens or as a reaction to the greater body mass that accompanies adrenarche requires further exploration.

Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis

BACKGROUND

Complicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N = 305).

METHODS

Gaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss.

RESULTS

In the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters.

CONCLUSIONS

The network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.

An Entity Theory of Intelligence Predicts Higher Cortisol Levels When High School Grades Are Declining

Grades often decline during the high school transition, creating stress. The present research integrates the biopsychosocial model of challenge and threat with the implicit theories model to understand who shows maladaptive stress responses. A diary study measured declines in grades in the first few months of high school: salivary cortisol (N = 360 students, N = 3,045 observations) and daily stress appraisals (N = 499 students, N = 3,854 observations). Students who reported an entity theory of intelligence (i.e., the belief that intelligence is fixed) showed higher cortisol when grades were declining. Moreover, daily academic stressors showed a different lingering effect on the next day's cortisol for those with different implicit theories. Findings support a process model through which beliefs affect biological stress responses during difficult adolescent transitions.

Breastfeeding and behavior disorders among children and adolescents: a systematic review

OBJECTIVE

This systematic review study aimed to assess the evidence available for the association between breastfeeding and behavior disorders in childhood and adolescence.

METHODS

The search was carried out in the PubMed, Lilacs, and PsycINFO databases up to December 2016. Inclusion criteria were as follows: prospective, retrospective and cross-sectional studies assessing the association between breastfeeding and behavior disorders in childhood or adolescence, using psychometric tests, carried out in humans and published in Portuguese, English, or Spanish. The search was performed in several stages by two independent researchers using pre-established criteria.

RESULTS

Eighteen studies met the inclusion criteria. Breastfeeding for a period equal to or higher than three or four months seemed to be inversely associated with total behavior and conduct disorders in childhood; however, the association remains unclear for other behavior disorders. Only four studies assessed behavior disorders in adolescence, and when an association was found, it was likely to be positive. The duration of breastfeeding seemed to be more important than the exclusive or non-exclusive pattern of breastfeeding.

CONCLUSIONS

Breastfed children for at least three to four months had fewer total behavior and conduct disorders in childhood. Further studies are needed to better understand this association, particularly in adolescence and involving other behavioral profiles.

Hypothalamic-Pituitary-Adrenal Axis Function in Children and Adults with Severe Antisocial Behavior and the Impact of Early Adversity

PURPOSE OF REVIEW

To review recent studies investigating hypothalamic-pituitary-adrenal axis function in children and adolescents with disruptive behavior disorders (DBDs) and adults with antisocial personality disorder. We consider key concepts and methodological issues in cortisol assessment and review studies investigating basal cortisol secretion and stress reactivity in antisocial populations. Lastly, we consider whether cortisol abnormalities predict prognosis or treatment outcomes and the impact of exposure to adversity on hypothalamic-pituitary-adrena (HPA) axis activity.

RECENT FINDINGS

Studies tracking cortisol levels across the day and assessing cortisol awakening responses (CARs) have reported broadly intact, but flatter, diurnal rhythms and lower CARs in children and adolescents with DBDs, whereas findings in antisocial adults have been mixed. Cortisol hyporeactivity to stress is consistently reported in male antisocial populations, whereas no comparable data exist in females. Severe antisocial behavior is associated with cortisol hyporeactivity to stress, and such hyporeactivity predicts poor treatment outcomes. Further research investigating sex differences and the impact of adversity is needed. Harmonization of methods for assessing hypothalamic-pituitary-adrenal axis function and antisocial behavior would enhance progress in this area.

DHEAS patterning across childhood in three sub-Saharan populations: Associations with age, sex, ethnicity, and cortisol

OBJECTIVES

Hormones have many roles in human ontogeny, including the timing of life history 'switch points' across development. Limited hormonal data exist from non-Western children, leaving a significant gap in our understanding of the diversity of life history patterning. This cross-sectional study examines dehydroepiandrosterone sulfate (DHEAS) production in relation to age, sex, ethnicity, and cortisol concentrations, as well as average age of adrenarche, among Aka and Ngandu children of the Central African Republic and Sidama children of Ethiopia.

METHODS

Hair was collected from 480 children (160 per population) aged 3-18 years old. These samples were analyzed for DHEAS and cortisol concentrations using ELISAs. A generalized additive model was used to examine DHEAS patterning in relation to age, sex, cortisol, and ethnicity. The derivative of DHEAS as a function of age was used to identify average age of adrenarche in each population.

RESULTS

DHEAS patterning in these three populations is distinct from Euro-American patterns of production. In all three groups, the population-level age at adrenarche onset occurs slightly later than Euro-American averages, with both Central African populations experiencing a later onset than the Ethiopian population.

CONCLUSIONS

DHEAS patterns and age at adrenarche vary across cultures, perhaps indicating adaptive life history responses in diverse eco-cultural environments. Delayed involution of the fetal zone and DHEAS patterning may offer both cognitive protection and immune defense in high-risk, nutritionally-poor environments. Additional research in the majority world is essential to improving our understanding of the diversity of hormonal development and timing of 'switch points' in life history trajectories.

Patterns of neuroendocrine coupling in 9-year-old children: Effects of sex, body-mass index, and life stress

Previous investigations have explored stress and pubertal hormones in parallel; it has been a recent development, however, to explore the relationships between different hormones during puberty, and how this hormonal cross-talk may be influenced by the environment. The current study investigated neuroendocrine coupling, or the extent to which hormones are correlated within the individual, and also investigated early life stressors that may influence coupling. Participants were 405 adrenarcheal children (mean Tanner stage=1.73 for girls and 1.38 for boys) from a longitudinal study who provided saliva samples for analysis of cortisol, dehydroepiandrosterone (DHEA), and testosterone. Saliva was collected when children were 9-years-old, while early life stressors were assessed at each longitudinal assessment (ages 3, 6, and 9). Results from multi-level modeling (MLM) analyses provided evidence of positive cortisol-dehydroepiandrosterone (DHEA) and cortisol-testosterone coupling in middle childhood, and identified body mass index as a predictor of the strength of hormone coordination. While exposure to stressful life events did not impact cortisol-DHEA coupling patterns, stress interacted with sex to predict looser cortisol-testosterone coupling in girls, but not boys. The current study adds to the existing literature on the development of neuroendocrine coupling, and provided further evidence of sex differences in the impact of stress. Furthermore, hormone coupling may be investigated in the future as a mechanism by which puberty is associated with negative behavioral outcomes.

Cortisol Awakening Response as a Prospective Risk Factor for Depressive Symptoms in Women After Treatment for Breast Cancer

OBJECTIVE

The aim of the study was to investigate hypothalamic-pituitary-adrenal axis (HPA axis) functioning as a neurobiological risk factor for depressive symptoms in an ongoing longitudinal, observational study of women undergoing treatment and recovery from breast cancer. Many women with breast cancer experience depressive symptoms that interfere with their treatment, recovery, and quality of life. Psychosocial risk factors for depression among patients with cancer and survivors have been identified, yet neurobiological risk factors in this population remain largely unexamined.

METHODS

Women recently diagnosed with early-stage breast cancer (N = 135) were enrolled before starting neoadjuvant/adjuvant treatment (radiation, chemotherapy, endocrine therapy). At baseline, participants collected saliva samples to measure diurnal HPA axis functioning for 3 days: at waking, 30 minutes after waking, 8 hours after waking, and bedtime. Participants also completed a standardized measure of depressive symptoms (Center for Epidemiological Studies-Depression Scale) at baseline and 6 months after completion of primary treatment. Multivariate regression was used to predict continuous depressive symptoms at 6-month posttreatment from continuous depressive symptoms at baseline, cortisol awakening response (CAR), and other measures of diurnal HPA axis functioning.

RESULTS

The magnitude of CAR predicted changes in depressive symptoms over time, such that women with a higher CAR showed a greater increase from baseline to 6-month posttreatment (b = 5.67, p = .023). Diurnal slope and total cortisol output were not associated with concurrent depressive symptoms or their change over time.

CONCLUSIONS

Elevated CAR may be a neurobiological risk factor for increases in depressive symptoms in the months after breast cancer treatment and warrants further investigation.

The relationship between cannabis use and cortisol levels in youth at ultra high-risk for psychosis

Recent studies have posited a relationship between cannabis use and the biological stress system, but this critical relationship has not been evaluated during the ultra high-risk (UHR) period immediately preceding the onset of psychotic disorders. Salivary cortisol samples were collected on 46 UHR and 29 control adolescents; these individuals were assessed for current cannabis use with a urine panel and self-report. UHR participants where separated into two groups: Current Cannabis Use (UHR-CU) and No Current Cannabis Use (UHR-NC). Healthy Control participants (HC) were free of cannabis use. Consistent with the literature, results indicate UHR individuals showed elevated cortisol levels when compared to HC participants. Further, we also observed that UHR-CU participants exhibited elevated levels when compared to both the non-using UHR and HC groups. Findings suggest that cannabis use may interact with underlying biological vulnerability associated with the hypothalamic-pituitary-adrenal (HPA) axis system.

Maternal late pregnancy anxiety and stress is associated with children's health: a longitudinal study

AIM

Maternal prenatal anxiety and stress (PNS) have been positively associated to physical health prob lems in offspring in the first year of life. Whether these associations are transient, persistent, or even progressive over time, is as yet unknown. The goal of this study is to investigate associations between late pregnancy PNS and child health from 18 months to age 6.

METHODS

Mothers were recruited in late pregnancy, and had uncomplicated, singleton pregnancies without physical health problems. Around week 37 of pregnancy, mothers reported on their PNS by means of questionnaires, and provided saliva for determination of circadian cortisol concentrations. Children's illnesses in the preceding year were assessed using maternal reports at 30, 48, 60, and 72 months. Antibiotic use was obtained from medical records between one and six years. Multilevel models (N¼174) showed a positive relation between maternal prenatal general and pregnancy-specific anxiety during late pregnancy and offspring respiratory illnesses and symptoms. Interaction effects with time indicated that more PNS was related to more respiratory illnesses until toddlerhood, but not later in life. Furthermore, maternal prenatal cortisol concentrations were related to child digestive illnesses. A steeper maternal cortisol decline over the day was related to more child digestive illnesses, until around three years of age. Finally, children of mothers who suffered more from daily hassles during pregnancy received more antibiotics between one and six years of age. PNS was not related to general and skin illnesses.

CONCLUSION

Summarizing, this study showed that late pregnancy anxiety and cortisol was associated with children's respiratory and digestive illnesses till the age of 3.0-3.5 years. Additionally, more daily hassles were related to more prescribed antibiotics between one and six years. These findings point in the direction of possible effects of PNS persisting beyond the first year of life and into toddlerhood, but disappearing at older ages.

Cortisol and DHEA in development and psychopathology

Dehydroepiandrosterone (DHEA) and cortisol are the most abundant hormones of the human fetal and adult adrenals released as end products of a tightly coordinated endocrine response to stress. Together, they mediate short- and long-term stress responses and enable physiological and behavioral adjustments necessary for maintaining homeostasis. Detrimental effects of chronic or repeated elevations in cortisol on behavioral and emotional health are well documented. Evidence for actions of DHEA that offset or oppose those of cortisol has stimulated interest in examining their levels as a ratio, as an alternate index of adrenocortical activity and the net effects of cortisol. Such research necessitates a thorough understanding of the co-actions of these hormones on physiological functioning and in association with developmental outcomes. This review addresses the state of the science in understanding the role of DHEA, cortisol, and their ratio in typical development and developmental psychopathology. A rationale for studying DHEA and cortisol in concert is supported by physiological data on the coordinated synthesis and release of these hormones in the adrenal and by their opposing physiological actions. We then present evidence that researching cortisol and DHEA necessitates a developmental perspective. Age-related changes in DHEA and cortisol are described from the perinatal period through adolescence, along with observed associations of these hormones with developmental psychopathology. Along the way, we identify several major knowledge gaps in the role of DHEA in modulating cortisol in typical development and developmental psychopathology with implications for future research.

Dimensions of Adversity, Physiological Reactivity, and Externalizing Psychopathology in Adolescence: Deprivation and Threat

OBJECTIVE

Dysregulation of autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis function is a putative intermediate phenotype linking childhood adversity (CA) with later psychopathology. However, associations of CAs with autonomic nervous system and HPA-axis function vary widely across studies. Here, we test a novel conceptual model discriminating between distinct forms of CA (deprivation and threat) and examine their independent associations with physiological reactivity and psychopathology.

METHODS

Adolescents (N = 169; mean [SD] age, 14.9 [1.4] years) with a range of interpersonal violence (e.g., maltreatment, community violence) and poverty exposure participated in the Trier Social Stress test (TSST). During the TSST, electrocardiogram, impedance cardiograph, salivary cortisol, and dehydroepiandrosterone-sulfate data were collected. We compared the associations of poverty (an indicator of deprivation) and interpersonal violence (an indicator of threat) on sympathetic, parasympathetic, and HPA-axis reactivity to the TSST, and assessed whether these differences mediated the association of adversity with internalizing and externalizing symptoms.

RESULTS

Exposure to poverty and interpersonal violence was associated with psychopathology. Interpersonal violence, adjusting for poverty, was associated with blunted sympathetic (b = 1.44, p = .050) and HPA-axis reactivity (b = -.09; p = .021). Blunted cortisol reactivity mediated the association of interpersonal violence with externalizing, but not internalizing, psychopathology. In contrast, poverty was not associated with physiological reactivity after adjusting for interpersonal violence.

CONCLUSIONS

We provide evidence for distinct neurobiological mechanisms through which adversity related to poverty and interpersonal violence is associated with psychopathology in adolescence. Distinguishing distinct pathways through which adversity influences mental health has implications for preventive interventions targeting youths exposed to childhood adversity.

Cortisol/DHEA ratio and hippocampal volume: A pilot study in major depression and healthy controls

Structural imaging studies investigating the relationship between hippocampal volume (HCV) and peripheral measures of glucocorticoids (GCs) have produced conflicting results in both normal populations and in individuals with MDD, raising the possibility of other modulating factors. In preclinical studies, dehydroepiandrosterone (DHEA) and its sulfate ester (DHEAS; together abbreviated, DHEA(S)) have been shown to antagonize the actions of GCs on the central nervous system. Therefore, considering the relationship of HCV to both of these hormones simultaneously may be important, although it has rarely been done in human populations. Using high-resolution magnetic resonance imaging (MRI), the present pilot study examined the relationship between morning serum cortisol, DHEA(S), and HCV in nineteen normal controls and eighteen unmedicated subjects with Major Depressive Disorder (MDD). Serum cortisol and DHEA(S) were not significantly correlated with HCV across all subjects (cortisol: r=-0.165, p=0.33; DHEA: r=0.164, p=0.35; DHEAS: r=0.211, p=0.22, respectively). However, the ratios of cortisol/DHEA(S) were significantly negatively correlated with HCV in combined group (Cortisol/DHEA: r=-0.461, p=0.005; Cortisol/DHEAS: r=-0.363, p=0.03). Significant or near-significant correlations were found between some hormonal measurements and HCV in the MDDs alone (DHEA: r=0.482, p=0.059; DHEAS: r=0.507, p=0.045; cort/DHEA: r=-0.589, p=0.02; cort/DHEAS: r=-0.424p=0.10), but not in the controls alone (DHEA: r=0.070, p=0.79; DHEAS: r=0.077, p=0.77; cort/DHEA: r=-0.427, p=0.09; cort/DHEAS: r=-0.331, p=0.19). However, Group (MDDs vs controls) did not have a significant effect on the relationship between cortisol, DHEA(S), and their ratios with HCV (p>0.475 in all analyses). Although the exact relationship between serum and central steroid concentrations as well as their effects on the human hippocampus remains not known, these preliminary results suggest that the ratio of cortisol to DHEA(S), compared to serum cortisol alone, may convey additional information about "net steroid activity" with relation to HCV.

The Effects of Alcohol and Cigarette Consumption on Dehydroepiandrosterone (DHEA) in Rural African Americans

Objective: Rurally situated African Americans suffer from stress and drug-related health disparities. Unfortunately, research on potential mechanisms that underlie this public health problem have received limited focus in the scientific literature. This study investigated the physiological impact of nicotine and alcohol use on dehydroepiandrosterone (DHEA) functioning, a biomarker previously linked to hypothalamic-pituitary-adrenal functioning. Method: A rural sample of African American emerging adults ( n = 84) completed a battery of assessments and provided six samples of salivary DHEA at wakeup, 30 minutes postwakeup, 90 minutes postwakeup, 3:00 p.m., 3:30 p.m., and 4:30 p.m. Results: Participants had more DHEA on waking as a function of smoking greater number of cigarettes throughout the day. Although this effect was not replicated with increased levels of alcohol consumption, the interaction between cigarette and alcohol use was associated with increased levels of DHEA on waking. Conclusion: While use of a single substance (i.e., cigarettes) was related to higher DHEA and greater hypothalamic-pituitary-adrenal activation, the addition of a second substance (i.e., alcohol) shifted the individual toward the hyperactive arousal profile common within chronically stressed or challenged populations. These findings support the need to further investigate the relationship between polysubstance use and physiological functioning that may be linked to known health disparities in the African American community.

How to Improve Adolescent Stress Responses: Insights From Integrating Implicit Theories of Personality and Biopsychosocial Models

This research integrated implicit theories of personality and the biopsychosocial model of challenge and threat, hypothesizing that adolescents would be more likely to conclude that they can meet the demands of an evaluative social situation when they were taught that people have the potential to change their socially relevant traits. In Study 1 (N = 60), high school students were assigned to an incremental-theory-of-personality or a control condition and then given a social-stress task. Relative to control participants, incremental-theory participants exhibited improved stress appraisals, more adaptive neuroendocrine and cardiovascular responses, and better performance outcomes. In Study 2 (N = 205), we used a daily-diary intervention to test high school students' stress reactivity outside the laboratory. Threat appraisals (Days 5-9 after intervention) and neuroendocrine responses (Days 8 and 9 after intervention only) were unrelated to the intensity of daily stressors when adolescents received the incremental-theory intervention. Students who received the intervention also had better grades over freshman year than those who did not. These findings offer new avenues for improving theories of adolescent stress and coping.

How to Improve Adolescent Stress Responses: Insights From Integrating Implicit Theories of Personality and Biopsychosocial Models

This research integrated implicit theories of personality and the biopsychosocial model of challenge and threat, hypothesizing that adolescents would be more likely to conclude that they can meet the demands of an evaluative social situation when they were taught that people have the potential to change their socially relevant traits. In Study 1 (N = 60), high school students were assigned to an incremental-theory-of-personality or a control condition and then given a social-stress task. Relative to control participants, incremental-theory participants exhibited improved stress appraisals, more adaptive neuroendocrine and cardiovascular responses, and better performance outcomes. In Study 2 (N = 205), we used a daily-diary intervention to test high school students' stress reactivity outside the laboratory. Threat appraisals (Days 5-9 after intervention) and neuroendocrine responses (Days 8 and 9 after intervention only) were unrelated to the intensity of daily stressors when adolescents received the incremental-theory intervention. Students who received the intervention also had better grades over freshman year than those who did not. These findings offer new avenues for improving theories of adolescent stress and coping.

Adrenarche and the Emotional and Behavioral Problems of Late Childhood

PURPOSE

Mental and behavioral disorders increase in prevalence with the passage through puberty. Yet the first symptoms for many children emerge between seven and 11 years, before the pubertal rise in gonadal hormones. A possibility that symptom onset may be linked to the adrenarchal rise in androgens has been little explored.

METHODS

The Childhood to Adolescence Transition Study recruited a stratified random sample of 1,239 eight-nine year olds from primary schools in Melbourne, Australia. Saliva samples were assayed for dehydroepiandrosterone, dehydroepiandrosterone-sulphate (DHEA-S), and testosterone. Emotional and behavioral problems were assessed through parental report on the Strengths and Difficulties Questionnaire.

RESULTS

In males, high levels of all androgens were associated with greater total difficulties and peer problems. Higher dehydroepiandrosterone and testosterone were associated with emotional symptoms and DHEA-S with conduct problems. In females, DHEA-S was associated with peer problems.

CONCLUSIONS

In late childhood, androgens are associated with emotional and behavioral problems in males, raising a possibility that the adrenarchal transition plays a contributing role. If so, the late primary school years may prove to be an important phase for preventing the onset of mental health and behavioral problems in boys.

Serum DHEAS levels are associated with the development of depression

The aim of study was to evaluate the association between serum DHEAS levels and depression with a case-control study together with a meta-analysis. Radioimmunoassay (RIA) was performed to measure the serum DHEAS levels of all participants before and after treatment. Depression Patients were divided into mild depression and severe depression based on Hamilton depression scale (HAMD24) and received 5-hydroxytryptamine (5-HT) and citalopram (20mg/d) for 8 weeks. Case-control studies related to our study theme were enrolled for meta-analysis and Comprehensive Meta-analysis 2.0 (CMA 2.0) was used for statistical analysis. After treatment, DHEAS levels in depression patients were significantly increased, while before and after treatment, DHEAS levels were all lower in depression patients than in controls (all P<0.001); further analysis on age revealed that DHEAS levels were decreased with the rising of age. Meta-analysis results suggested that serum DHEAS levels (ng/mL) were significantly higher in healthy controls compared to depression patients (SMD=0.777, 95%CI=0.156-1.399, P=0.014). In conclusion, our study suggests that serum DHEAS levels are associated with the development of depression and it decreased with the rising of age.

Neuroendocrine coupling across adolescence and the longitudinal influence of early life stress

Drawing on conceptual models illustrating the advantages of a multisystemic, interactive, developmental approach to understanding development, the present study examines the covariation of stress and sex hormones across the adolescent transition and the effect of early life stress (ELS) on neuroendocrine coupling to gain insight into atypical development. Morning levels of cortisol, testosterone, and dehydroepiandrosterone (DHEA) were assessed at ages 11, 13, and 15; ELS was assessed during the infancy and preschool periods. Hierarchical linear modeling revealed that cortisol-DHEA coupling patterns progressed to tight, positive coupling across adolescence. Cortisol-testosterone coupling was positive at age 11 but became more negative at ages 13 and 15. Exposure to ELS resulted in more adultlike neuroendocrine coupling patterns earlier in life than non-exposed youth; however the effect of ELS on cortisol-testosterone coupling was unique to girls. Results illustrate trajectories of neuroendocrine coupling that may be unique to adolescence. Moderation by ELS suggests that early stress exposure may prompt earlier adultlike neuroendocrine coupling, particularly within girls, which may contribute to early pubertal development.

Serum dehydroepiandrosterone sulfate and incident depression in the elderly: the Pro.V.A. study

OBJECTIVE

Dehydroepiandrosterone sulfate (DHEAS) appears to have a protective effect against depression, but contrasting findings are available. Therefore, we investigated whether high serum DHEAS levels were associated with any protective effect on incident depression and incident severe depression in a representative group of elderly men and women.

METHODS

In a population-based cohort longitudinal study in the general community, 789 older participants without depression and cognitive impairment at the baseline were included, among 3,099 screened subjects. Serum DHEAS levels were determined based on blood samples; incident depression and severe depression were diagnosed by means of the Geriatric Depression Scale (GDS) and confirmed by geriatricians skilled in psychogeriatric medicine.

RESULTS

No baseline differences were found in GDS across age- and gender-specific tertiles of serum DHEAS. Over 4.4 years of follow-up, 137 new cases of depression were recorded. Of them, 35 among men and 64 in women were cases of incident severe depression. Cox's regression analysis, adjusted for potential confounders, revealed that higher DHEAS levels were associated with reduced risk of incident depression irrespective of gender (HR: 0.30; 95% CI: 0.09-0.96; Wald χ(2) = 4.09; df = 1; p = 0.04; women: HR: 0.31; 95% CI: 0.14-0.69; Wald χ(2) = 8.37; df = 1; p = 0.004) and of severe incident depression only in men (HR: 0.25; 95% CI: 0.06-0.99; Wald χ(2) = 4.05; df = 1; p = 0.04).

CONCLUSION

Higher serum DHEAS levels were found to be significantly protective for the onset of depression irrespective of gender, whereas only in men was this association found also for incident severe depression.

Resting cortisol level, self-concept, and putative familial environment in adolescents at ultra high-risk for psychotic disorders

A growing body of evidence suggests that resting cortisol levels are elevated in patients with schizophrenia and closely tied to symptom severity. However, there is limited research on the biological stress system during the ultra high-risk (UHR) period immediately preceding the onset of psychosis, and cortisol has not been examined in relation to individual characteristics such as self-concept or potential stressors such as putative familial environment in this critical population. In the present study, salivary cortisol samples were collected on 37 UHR and 42 matched control adolescents, and these individuals were assessed with clinical interviews as well as a measure of self-concept. For a subsection of the sample (23 UHR and 20 control adolescents), a participating relative/caretaker was also assessed with an expressed emotion interview designed to gauge psychosocial environment. Consistent with previous studies, UHR participants exhibited elevated resting cortisol levels when compared with controls. In addition, UHR adolescents exhibited increased negative self-concept and their relatives/caretakers endorsed significantly fewer initial positive statements about the participant. Interestingly, a strong trend in the UHR group suggests that higher cortisol levels are associated with higher rates of critical statements from relatives/caretakers. Furthermore, elevated cortisol levels in the participants were associated with increased negative self-concept as well as fewer initial positive comments from relatives/caretakers. Results suggest that hypothalamic-pituitary-adrenal axis (HPA) dysfunction is closely associated with both individual and environmental-level characteristics. Taken together, these findings support a neural diathesis-stress model of psychosis and future studies, designed to examine causal relationships, stand to inform both our understanding of pathogenic processes in the high-risk period as well as early intervention efforts.

Clinical and Neurobiological Perspectives of Empowering Pediatric Cancer Patients Using Videogames

Pediatric oncology patients often experience fatigue and physical and mental deconditioning during and following chemotherapy treatments, contributing to diminished quality of life. Patient empowerment is a core principle of patient-centered care and reflects one's ability to positively affect his or her own health behavior and health status. Empowerment interventions may enhance patients' internal locus of control, resilience, coping skills, and self-management of symptoms related to disease and therapy. Clinical and technological advancements in therapeutic videogames and mobile medical applications (mobile health) can facilitate delivery of the empowerment interventions for medical purposes. This review summarizes clinical strategies for empowering pediatric cancer patients, as well as their relationship with developing a “fighting spirit” in physical and mental health. To better understand physiological aspects of empowerment and to elucidate videogame-based intervention strategies, brain neuronal circuits and neurotransmitters during stress, fear, and resilience are also discussed. Neuroimaging studies point to the role of the reward system pathways in resilience and empowerment in patients. Taken together, videogames and mobile health applications open translational research opportunities to develop and deliver empowerment interventions to pediatric cancer patients and also to those with other chronic diseases.