Prospective prediction of major depression from cortisol awakening responses in adolescence

School of Education and Social Policy, Northwestern University, Evanston, IL 60640, United States.
Psychoneuroendocrinology (Impact Factor: 4.94). 07/2010; 35(6):921-31. DOI: 10.1016/j.psyneuen.2009.12.007
Source: PubMed


Levels of the stress-sensitive hormone cortisol increase dramatically in the first 30-40min after waking, an effect known as the cortisol awakening response (CAR). There is considerable cross-sectional evidence that psychosocial stress is associated with an increased CAR, and the CAR has been found to be altered in the presence of stress-related diseases, including major depressive disorder (MDD). To date, no prospective longitudinal studies have examined whether individual differences in the CAR serve as a premorbid risk factor for MDD. In a sample of 230 late adolescents, clinical diagnoses of MDD were predicted from the CAR as well as other indicators of basal cortisol functioning gathered 1 year earlier, including: waking cortisol levels, bedtime cortisol levels, the size of the CAR, average cortisol, and the slope of the diurnal cortisol rhythm across the waking day. Age and gender, health and health behaviors, baseline neuroticism, exposure to stressful life events and past episodes of mood and anxiety disorders were included as covariates, to help ensure effects are attributable to the CAR rather than related variables. A higher baseline CAR was associated with a significantly increased risk of developing MDD by follow-up, even when excluding individuals with baseline MDD. No other baseline cortisol measures were significant prospective predictors of MDD. In summary, the CAR is a significant prospective risk factor for the development of MDD in young adults, providing some support for the possibility that a heightened CAR may play a role in the etiology of major depressive disorder.

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    • "The higher CAR found among Blacks with high young adult PRD may also have mental health relevance. Past evidence has linked an elevated CAR to the onset of depression and anxiety disorders in adolescents and young adults (Adam et al., 2010, 2014; Vrshek-Schallhorn et al., 2013). There are numerous strengths to the current study, the largest of which is our use of 20 years of prospective longitudinal data to measure histories of discrimination. "
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    ABSTRACT: Perceived racial discrimination (PRD) has been associated with altered diurnal cortisol rhythms in past cross-sectional research. We investigate whether developmental histories of PRD, assessed prospectively, are associated with adult diurnal cortisol profiles. One-hundred and twelve (N=50 Black, N=62 White) adults from the Maryland Adolescent Development in Context Study provided saliva samples in adulthood (at approximately age 32 years) at waking, 30min after waking, and at bedtime for 7 days. Diurnal cortisol measures were calculated, including waking cortisol levels, diurnal cortisol slopes, the cortisol awakening response (CAR), and average daily cortisol (AUC). These cortisol outcomes were predicted from measures of PRD obtained over a 20-year period beginning when individuals were in 7th grade (approximately age 12). Greater average PRD measured across the 20-year period predicted flatter adult diurnal cortisol slopes for both Black and White adults, and a lower CAR. Greater average PRD also predicted lower waking cortisol for Black, but not White adults. PRD experiences in adolescence accounted for many of these effects. When adolescent and young adult PRD are entered together predicting cortisol outcomes, PRD experiences in adolescence (but not young adulthood) significantly predicted flatter diurnal cortisol slopes for both Black and White adults. Adolescent, but not young adult PRD, also significantly predicted lower waking and lower average cortisol for Black adults. Young adult PRD was, however, a stronger predictor of the CAR, predicting a marginally lower CAR for Whites, and a significantly larger CAR for Blacks. Effects were robust to controlling for covariates including health behaviors, depression, income and parent education levels. PRD experiences interacted with parent education and income to predict aspects of the diurnal cortisol rhythm. Although these results suggest PRD influences on cortisol for both Blacks and Whites, the key findings suggest that the effects are more pervasive for Blacks, affecting multiple aspects of the cortisol diurnal rhythm. In addition, adolescence is a more sensitive developmental period than adulthood for the impacts of PRD on adult stress biology.
    Psychoneuroendocrinology 09/2015; 62:279-291. DOI:10.1016/j.psyneuen.2015.08.018 · 4.94 Impact Factor
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    • "Although there was not a statistically significant association for morning levels or the CAR, increases in loneliness were significantly associated with steeper slopes. Previous research using naturalistic assessment of diurnal cortisol has demonstrated that chronic loneliness at one time point was concurrently associated with flatter cortisol slopes in a sample of 17–20-year- olds (Doane & Adam, 2010). This previous cross-sectional finding was consistent with results from a meta-analysis, which indicated that flatter cortisol slopes are typically indicative of chronic, cumulative stress (Miller et al., 2007). "
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    ABSTRACT: Many late adolescents who transition to the college environment perceive changes in psychosocial stress. One such stressor, loneliness, has been associated with numerous health problems among adolescents and adults. The hypothalamic–pituitary–adrenal axis is one mechanism through which loneliness may affect health. Guided by a risk and resilience framework, the present study investigated the association between longitudinal changes in loneliness from high school to college and diurnal cortisol activity (waking levels, cortisol awakening response, diurnal slope) by sampling saliva intensively 5 times a day for 3 weekdays in a US sample of late adolescents in their first semester of college (N = 70; M age = 18.49, SD = 0.38). The present study also explored how the link between loneliness and cortisol might depend on coping efficacy—one’s belief in successfully coping with future stressors or novel situations. Results from hierarchical linear growth curve models demonstrated that an increase in loneliness across this contextual transition was associated with steeper cortisol slopes in college. Coping efficacy at baseline (in high school) significantly moderated the relation between changes in loneliness and diurnal slopes, such that late adolescents with low levels of coping efficacy who reported increased loneliness across the transition exhibited significantly flatter diurnal slopes in college. Higher levels of coping efficacy at baseline also significantly predicted lower waking cortisol levels during the first semester of college. These results suggest that coping efficacy may serve as a protective factor by contributing to regulation of daily physiological stress activity for late adolescents as they struggle with loneliness across the transition to college.
    International Journal of Behavioral Development 04/2015; DOI:10.1177/0165025415581914 · 1.58 Impact Factor
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    • "Consistent with this formulation, higher levels of cortisol over the transition through puberty have been found to be related to a greater vulnerability to depression in adolescence (Dahl & Gunnar, 2009; Stroud et al., 2009). For example, several investigators have found that higher levels of morning cortisol predict the subsequent onset of depression in adolescence (Adam et al., 2010; Vrshek-Schallhorn et al., 2013; Owens et al., 2014). Importantly, however, findings regarding cortisol stress responsivity as a predictor of subsequent changes in depressive symptoms are less consistent. "
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    ABSTRACT: Both elevated and blunted levels of cortisol secretion during childhood and adolescence have been linked to the subsequent onset of major depressive disorder (MDD). These mixed findings may be due to developmental changes in HPA-axis functioning, which have not been previously assessed in the context of risk. In the present study, therefore, we examined whether pubertal development moderated the influence of cortisol secretion on the subsequent development of MDD. Eighty-nine never-disordered girls ages 9-15 years, many of whom were at high risk for depression by virtue of having a maternal history of the disorder, completed a laboratory stress task. To index cortisol reactivity, salivary cortisol samples were collected at baseline and 15min following the onset of the stressor. Girls' levels of pubertal development were measured using Tanner staging. All participants were followed through age 18 in order to assess the subsequent development of MDD. Pubertal stage moderated the effects of cortisol stress reactivity on the development of MDD. Specifically, the onset of MDD was predicted by cortisol hyporeactivity in girls who were earlier in pubertal development (Tanner stage≤2), but by cortisol hyperreactivity in girls who were later in pubertal development (Tanner stage≥3.5). These findings demonstrate that girls' cortisol stress reactivity predicts the subsequent onset of MDD, and further, that the nature of this effect depends on the girls' level of pubertal development. Results are discussed in the context of clarifying previous findings, and directions for future research are offered. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Psychoneuroendocrinology 02/2015; In press. DOI:10.1016/j.psyneuen.2015.02.004 · 4.94 Impact Factor
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