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Psychosocial Stress, Mental Health and Salivary Cortisol in Children and Adolescents
Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stressful experiences and conditions in childhood influence the health and well-being of the growing individual, and can also confer a long-lasting impact into adult life. Delineating the social, mental and biological aspects of stress in children and adolescents is therefore of great concern for human beings. Despite these notions, much knowledge is lacking regarding stress in childhood.

This thesis aimed at examining diverse aspects of stress in children and adolescents: associations between social conditions, traumatic life events, mental health, and salivary cortisol as a measure of the activity of a major physiological stress system. Cross-sectional samples included two non-clinical samples of school-aged children (N=240-336) and adolescents (N =400), and two clinical samples of children with obsessive-compulsive disorder (OCD) (N =23) and adolescents who had experienced childhood abuse (N =15). Main measures were salivary cortisol sampled three times a day, and questionnaires to teachers, parents and children with questions about each child’s mental health, traumatic life events and about the socioeconomic situation of the parents.

The main findings include observation of 1) higher cortisol levels in children with a moderate level of psychosocial burden (low socioeconomic status, immigrant family, social impairment of mental health problems), 2) higher cortisol levels in children with OCD who also displayed a tendency to decreasing cortisol in the face of an acute stressor, and 3) cortisol was positively related to mental health problems in abused adolescents. Furthermore, the deleterious effect of 4) traumatic events involving a social dimension, interpersonal traumas, and 5) cumulative traumatic events, polytraumatization, on the mental health of children and adolescents was indicated.

The findings are discussed with respect to the complex interactions between social, mental and biological aspects of children and adolescents. The consequences of adverse experiences in childhood may represent pathways to future health problems. Consideration of the social circumstances in childhood might in the future guide public health policies and the identification of target groups for preventive interventions as well as leading to improvements in treatment for children exposed to severe stress.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 138 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1084
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-15686ISBN: 978-91-7393-776-4 (print)OAI: oai:DiVA.org:liu-15686DiVA: diva2:126940
Public defence
2008-12-03, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2009-08-21Bibliographically approved
List of papers
1. Cortisol levels and psychosocial factors in preadolescent children
Open this publication in new window or tab >>Cortisol levels and psychosocial factors in preadolescent children
2006 (English)In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 22, no 1, 3-9 p.Article in journal (Refereed) Published
Abstract [en]

Regarding the relationship between psychosocial factors and health, one model of explanation states that psychosocial stress constitutes a principal mediator connecting psychosocial factors to health outcome, affecting the body through psychobiological mechanisms. This relationship has scarcely been studied in children. In the present study the relation between diurnal cortisol secretion and psychosocial factors [socio-economic status (SES), immigrant status and impact of psychiatric symptoms] was investigated in a normal population of 6-12 year old children (n = 273). Salivary cortisol levels were measured in the early morning, late morning and in the evening during three consecutive days. Parents answered demographic questionnaires and teachers answered psychiatric questionnaires concerning the children. Children exposed to one or more of the factors of psychosocial load (n = 117) had significantly higher morning (p < 0.001) and evening (p = 0.029) cortisol levels as well as total daily cortisol secretion [measured by the area under the curve (AUC), p = 0.003] compared to the group of children with none of the factors (n = 156). Different psychosocial stressors seemed to influence different parts of the diurnal cortisol curve. In conclusion, this study indicates that even children exposed to a moderate degree of psychosocial load differ in their cortisol levels compared to non-exposed children.

Keyword
Psychiatric symptoms, child, cortisol, socio-economic factors, stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15680 (URN)10.1002/smi.1074 (DOI)
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14
2. Diurnal Cortisol Levels and Cortisol Response in Youths with Obsessive-Compulsive Disorder
Open this publication in new window or tab >>Diurnal Cortisol Levels and Cortisol Response in Youths with Obsessive-Compulsive Disorder
2008 (English)In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 57, no 1-2, 14-21 p.Article in journal (Refereed) Published
Abstract [en]

Background/Aims: Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects.

Methods: Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined.

Results: Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters.

Conclusion: These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.

Place, publisher, year, edition, pages
S. Karger, 2008
Keyword
Cortisol, Stress response, Obsessive-compulsive disorder, children
National Category
Neurosciences
Identifiers
urn:nbn:se:liu:diva-15681 (URN)10.1159/000123117 (DOI)000257134900005 ()
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14Bibliographically approved
3. Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents
Open this publication in new window or tab >>Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents
2010 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 1, 27-31 p.Article in journal (Refereed) Published
Abstract [en]

Background. The role of the HPA axis in psychiatric disorders following trauma is poorly studied and most studies have been done on adults. Aims. To investigate the association of mental well-being and diurnal cortisol in abused adolescents. Methods. The present crosssectional study examined diurnal salivary cortisol (measured three times a day during three days) in relation to psychiatric symptoms (Trauma Symptoms Checklist for Children) and the salutogenic construct “Sense of coherence”, in fifteen adolescents exposed to childhood abuse. Results. Significant positive correlations were found between symptoms and sense of coherence versus early and late morning cortisol concentrations. The correlations were most consistent for internalizing and externalizing symptoms, and somewhat less for post-traumatic symptoms and sense of coherence. In contrast, evening cortisol did not correlate with any of the psychological measures. Conclusion. These results extend previous research findings by pointing towards a relation between symptoms and higher morning cortisol and accentuated diurnal cortisol variation in abused adolescent as opposed to lower basal cortisol and a flattening of the cortisol rhythm repeatedly observed in traumatized adults.

Keyword
Adolescents, Childhood Abuse, Cortisol, Psychiatric Symptoms, Sense of Coherence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15683 (URN)10.3109/08039480903265314 (DOI)000273780200005 ()
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14
4. Sociocultural Disadvantage, Traumatic Life Events, and Psychiatric Symptoms in Preadolescent Children
Open this publication in new window or tab >>Sociocultural Disadvantage, Traumatic Life Events, and Psychiatric Symptoms in Preadolescent Children
2009 (English)In: American Journal of Orthopsychiatry, ISSN 0002-9432, E-ISSN 1939-0025, Vol. 79, no 3, 387-397 p.Article in journal (Refereed) Published
Abstract [en]

Previous research has demonstrated impact of psychosocial adversity on the mental health of children. This cross-sectional study examined the differential relationships between life-time exposure to interpersonal and non-interpersonal traumatic life events as well as sociocultural factors (family social class and immigrant family), and the level of externalizing versus internalizing symptoms. Participants included 258 children aged 6 to 12 years from two Swedish elementary schools. Information was obtained from their parents by means of questionnaires (a demographic form including information about parental occupation and country of origin, the Strengths and Difficulties Questionnaire and the Life Incidence of Traumatic Events checklist). While controlling for gender, age and the other symptom dimension, the sociocultural factors were associated to internalizing but not to externalizing symptoms. In contrast, traumatic life events and especially interpersonal traumas related to externalizing symptoms but not to internalizing symptoms. These findings provide some support for specificity of psychosocial adversities and for the importance of interpersonal traumas, in the impact on child mental health.

 

Keyword
stressor-outcome specificity, traumatic life events, sociocultural disadvantage, mental health, children
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15684 (URN)10.1037/a0016559 (DOI)
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14
5. Polytraumatization and Psychological Symptoms in Children and Adolescents
Open this publication in new window or tab >>Polytraumatization and Psychological Symptoms in Children and Adolescents
2009 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 18, no 5, 274-283 p.Article in journal (Refereed) Published
Abstract [en]

Previous research on the impact of traumatic experiences in children and adolescents has focused almost entirely on the effect of single trauma. Research on cumulative traumas been lacking, but Finkelhor (2007) has recently directed the attention to the concept of polyvictimization. As an extension of this concept, this study examined the impact of polytraumatization, operationalized as the number of different potentially traumatic events. The study population comprised two cross-sectional samples of school-aged children (n = 270) and adolescents (n = 400). Information of life-time incidence of traumatic events was collected by the Life Incidence of Traumatic Events (LITE), and psychological symptoms by the parent version of the Strengths and Difficulties Questionnaire (SDQ) for the school children and the self-report Trauma Symptom Checklist for Children (TSCC) for the adolescents. We found that exposure to at least one traumatic event was common in both the samples (63% of the children and 89.5% of the adolescents). The number of different traumatic events, polytraumatization, was highly predictive of symptoms in both samples, and with a few exceptions surpassed the impact of specific events in exploratory analyses. We furthermore replicated previous findings of the important impact of interpersonal over noninterpersonal events on symptoms in both samples, and found an indication that this effect differed by gender in different manners in the two samples. This study emphasizes the significance of both the quantity of traumatic events, polytraumatization, as well as the quality, interpersonal events.

Keyword
child traumatization, symptomatology, multiple traumatization, gender differences
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-15685 (URN)10.1007/s00787-008-0728-2 (DOI)
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14

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