Stability of the diurnal cortisol profile in children and adolescents (original) (raw)
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Psychoneuroendocrinology, 2009
Early-onset mood disorders have become a significant public health problem in recent years. The Children's Depression Inventory (CDI) is a commonly used self-report measure. We studied the relation of CDI cut-offs to biological markers of depression such as the diurnal cortisol rhythm and evening cortisol. In 58 post-pubertal adolescents (29 boys and 29 girls, M age = 15.1 years), the diurnal cortisol profile was derived from three saliva samples, collected at awakening, at noon and in the evening on a week-end day. Longitudinal repeated measurements regression revealed that the group with CDI > 18 (high depressive symptoms) clearly had a higher and flatter diurnal rhythm with elevated evening cortisol compared to either the group with CDI between 13 and 18 (moderate depressive symptoms) or CDI < 13 (low depressive symptoms). Multinomial logistic regression indicated that evening cortisol was useful in classifying the adolescents in the high depressive symptoms group, while awakening and noon cortisol were not. Our results indicate that the type of high flattened profiles sometimes seen in individuals who are clinically depressed according to diagnostic interviews can also be identified with a selfreport inventory, at high levels of symptom reporting. Given the complexity of conducting diagnostic interviews, this result bears clinical relevance. #
PsyCh Journal, 2014
The hypothalamic-pituitary-adrenal (HPA) axis, including its regulation of cortisol, is central to bodily functioning and salivary cortisol is a commonly used biomarker that reflects the functioning of the HPA axis. However, knowledge of diurnal cortisol rhythms in healthy adolescents is limited and few studies have examined patterns in midadolescent girls and boys across single and aggregate cortisol measures. To fill this gap, the present study investigated single and aggregate cortisol measures reflecting diurnal rhythms in 14 to 16-year-old girls and boys. Self-administered salivary samples from 79 girls and 42 boys were collected during two schooldays at four timepoints: (a) immediately at awakening, (b) 30 min after waking up, (c) 60 min after waking up, and (d) at 8:00 p.m. Additionally, diary data including time of awakening, sampling times, and other potential confounders were analyzed. As for single measures, both girls and boys exhibited a typical diurnal cortisol profile with high levels in the morning that decreased throughout the day. However, girls had higher morning cortisol than did boys with significant differences at time of awakening, and at 30 and 60 min postawakening. For the aggregate measures, girls had a larger total level of cortisol in terms of cortisol awakening response (CARG), area under the curve (AUCG), and rise over run (slopeawake to last), while no differences emerged for reactivity measures. Taken together, these findings suggest differences in single and aggregate cortisol measures between midadolescent girls and boys. Such differences in diurnal cortisol between pubertal girls and boys may play a role for the differential health trajectories typically found among adult women and men.
Psychoneuroendocrinology, 2014
Information on the associations between objectively measured sleep and hypothalamic-pituitary-adrenal axis function in early adolescence is scarce. We examined associations between average sleep duration and quality (sleep efficiency and wake after sleep onset) over 8 days with actigraphs and (1) diurnal cortisol patterns and (2) cortisol reactivity to a low-dose (3 μg/kg) overnight dexamethasone suppression test (DST) in a birth cohort born in 1998 (N=265 participants, mean age 12.3 years, SD=0.5). We also explored (3) if sleep duration and quality were affected the nights after the DST exposure. Cortisol was measured during 2 days, and participants were exposed to dexamethasone in the evening of first day. In boys, short sleep duration was associated with higher cortisol upon awakening and lower cortisol awakening response (CAR; P<0.05 and P<0.01). Long sleep duration in boys associated with higher CAR (P<0.02). Lower sleep quality in boys associated with lower CAR, but f...
Journal of Psychosomatic Research, 2012
Objective: Adolescents of single and/or chronically ill parents (target groups) reportedly have elevated psychological stress. However, their salivary cortisol pattern as part of the physiological stress system has not been compared to controls. The aim of this study is to examine differential outcomes in the diurnal cortisol pattern of the target groups. Methods: In total, 100 adolescents of three groups with either single, chronically ill or two healthy parents were compared on cortisol. Three salivary cortisol samples were taken after awakening, one sample at noon and one sample at 20:00 p.m. during a non-school day. Group differences and interaction effects between measurement (5 times), group membership and covariates were tested through linear mixed modeling, repeated measures. Covariates were children's sex and age, socioeconomic status (SES) and parental depression as measured with the Beck Depression Inventory. Results: The three groups did not differ significantly concerning the amount of salivary cortisol, even after controlling for the covariates. The target groups had a lower SES than adolescents with two healthy parents. In addition, chronically ill parents were more depressed than single and healthy parents. Male sex and older age of the child, and lower parental depression were associated with increased cortisol values throughout the day. Conclusion: Research on cortisol in children should control for children's sex and age, and parental depression. Adolescents with single and/or chronically ill parents displayed a healthy pattern of diurnal salivary cortisol.
Peri-Sleep-Onset Cortisol Levels in Children and Adolescents with Affective Disorders
Biological Psychiatry, 2006
Background: Changes in the hypothalamic-pituitary-adrenal (HPA) axis, as evidenced by patterns of cortisol secretion, have been of interest in understanding depression and anxiety disorders across the life span. Previous studies of pediatric depression have pointed to the period around sleep onset as a key time point for observing alterations in cortisol secretion associated with affective disorders. Evidence also indicates that pubertal development may influence the expression of HPA dysregulation. We hypothesized that adolescents with depression and youth with anxiety disorders exhibit elevated peri-sleep-onset cortisol. Methods: Plasma cortisol was sampled every 20 min around sleep onset from children and adolescents with major depressive disorder (n ϭ 116), anxiety disorders (n ϭ 32), or no history of psychiatric disorder (control; n ϭ 76). Sleep onset was determined by polysomnography. Classification of participants as children or adolescents was based on Tanner staging of pubertal maturation. Results: Children with anxiety disorders had higher peri-sleep-onset cortisol than children with depression or control children. Adolescents with depression had marginally higher peri-sleep-onset cortisol than control adolescents and significantly higher peri-sleep-onset cortisol than children with depression. Conclusions: Depression and anxiety are associated with altered cortisol secretion around sleep onset, and these changes appear to be influenced by pubertal maturation.
The Journal of Clinical Endocrinology & Metabolism, 1997
To provide basic information on the normal functioning of the hypothalamus-pituitary-adrenal axis in relation to pubertal development, growth (weight and height), body composition, and gender and to obtain reference data for serum cortisol concentrations in children, we investigated the basal circadian rhythm of serum cortisol in a group of 235 healthy children (162 boys and 73 girls). The age range was between 2.2-18.5 yr. Serum cortisol was analyzed from venous blood samples taken at 1400, 1800, 2200, 0200, 0400, 0600, and 1000 h. No evidence was found for differences in temporal placement or level of the circadian cortisol rhythm in relation to age, growth, or body composition. However, we found a broad range of cortisol levels in a healthy population, with individual mean diurnal levels ranging from 100-510 nmol/L. Regardless of high or low mean diurnal cortisol levels, repeated measurements within and between pubertal stages indicated that an individual remains in his or her cortisol range throughout pubertal development. In conclusion, the present study shows that 1) serum cortisol levels do not correlate with either age or gender; 2) there is a large and significant interindividual variability in endogenous mean diurnal cortisol levels; and 3) despite this variability between individuals, there is no correlation between cortisol levels and either body composition or growth rate. This suggests that the variability in cortisol levels is an expression of normal homeostasis rather than pathology.
Latent state trait modeling of children's cortisol at two points of the diurnal cycle
Psychoneuroendocrinology
One challenge in examining stable individual differences in basal activity of the HPA axis is controlling for internally or externally based situational factors that lead to day-to-day variation in ambulatory cortisol. Disturbed basal activity is of particular interest in studies with children, for whom a dysregulated HPA axis may play an etiologic role in emotional or health outcomes. The purpose of this study was to determine whether trait vs. situationally specific sources of variation can be identified at different points of the diurnal cycle in children and if so, whether state and trait components vary according to time of measurement. Early morning and late evening salivary cortisol was collected from 164 children aged 7 to 11 years. Samples were collected 30 min after wakeup and 30 min before bedtime on 3 weekdays. State, trait, and error components of cortisol levels were assessed using a latent state trait model. Possible influences of sampling day and outlier treatment on parameter estimates were examined. The results showed that a latent trait factor superimposed on state residuals and measurement error was identified for both early morning and late evening cortisol. Model fit was excellent and criteria for invariance tests were met. Trait factors accounted for 41% and 57% of the variance in morning and evening cortisol, respectively. These findings suggest cortisol attributed to trait factors can be identified and are of substantial magnitude at both the peak and nadir of the diurnal cycle. Latent state trait modeling is a potentially useful tool in understanding the role of stable individual differences in cortisol levels for development and health.
Development and Psychopathology, 2001
The purpose of this study was to examine adrenocortical activity (basal, diurnal variation, and responses to social stressors) in adolescents at risk for psychopathology. Salivary cortisol levels were examined in normally developing and at-risk youth with internalizing and externalizing symptoms ranging from subclinical to clinical levels. Adolescents showed expected patterns of diurnal variation, with high early morning cortisol levels and a pattern of decline throughout the day. Females showed higher midday and late afternoon levels than males, and these patterns interacted with risk status. Internalizing problems sometimes were associated with gradual rather than steep declines in basal cortisol production. Both immediate and delayed cortisol reactivity to a social performance stressor were associated with internalizing symptoms. There was no evidence of relations between externalizing problems and underarousal of the hypothalamic-pituitary-adrenal (HPA) system. These and other results suggest that gender is an important moderating factor linking psychopathology, development, and context with HPA axis functioning in adolescence.
Psychoneuroendocrinology
Background: Indices of cortisol activity, including the cortisol awakening response (CAR), diurnal slope, and cortisol output across the day (total daily output), are often studied as mechanistic indicators that could link stress with health. Yet there is a paucity of data speaking to their temporal features, particularly whether they behave in a more state- or trait-like manner across time. Methods: To address this issue, data from 3 studies were used to assess CAR, diurnal slope and total daily output stability over different age groups and time spans: 130 healthy children and adolescents collected salivary cortisol samples 5 times/day (1, 4, 9 and 11 hours after wake) over 2 days at 5 visits spaced 6 months apart (Study 1); 147 adolescent girls collected saliva 6 times/day (wake, 1, 4, 9 and 14 hours after wake) for 2 days at 3 visits, each a year apart (Study 2); and 47 healthy, primarily middle age adults collected saliva 6 times/day (wake, 1, 4, 9 and 14 hours after wake) for 3 days at 4 visits spaced 2 to 3 months apart (Study 3). Stability was estimated by multilevel model-derived intraclass correlation coefficients (ICCs). Results: Across studies, approximately 50% of the variance in cortisol indices was attributable to day-to-day fluctuations, suggesting state-like properties. Of the indices, total daily output emerged as the most stable over time, followed by diurnal slope and CAR, but stability estimates were generally quite modest regardless of index and sample. Over time spans of >1 year, ICCs were ≤ .13. Conclusions: Most of the variance in CAR, diurnal slope and TOTAL DAILY OUTPUT reflects day-to-day fluctuation; there was little evidence for more stable trait-like influences. These findings suggest that future research should focus on short-term fluctuations in stress, cortisol and health, as opposed to lengthy disease processes.