Multi-Level Risk Factors for Suicidal Ideation Among at-Risk Adolescent Females: The Role of Hypothalamic-Pituitary-Adrenal Axis Responses to Stress
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Adopting a multi-level approach, this study examined risk factors for adolescent suicidal ideation, with specific attention to (a) hypothalamic-pituitary-adrenal (HPA) axis stress responses and (b) the interplay between HPA-axis and other risk factors from multiple domains (i.e., psychological, interpersonal and biological). Participants were 138 adolescent females (M(age) = 14.13 years, SD = 1.40) at risk for suicidal behaviors. At baseline, lifetime suicidal ideation and a number of risk factors were assessed (i.e., depressive symptoms, impulsiveness, pubertal status and peer stress). Participants were exposed to a psychosocial stress task and HPA-axis responses were assessed by measuring cortisol levels pre- and post-stressor. At 3 months post-baseline, suicidal ideation again was assessed. Using group-based trajectory modeling, three groups of cortisol stress-response patterns were identified (i.e., hyporesponsive, normative, and hyperresponsive). As compared to females in the normative and hyporesponsive group, females in the hyperresponsive group were more likely to report a lifetime history of suicidal ideation at baseline, above and beyond the effects of the other predictors. Moreover, as compared to females in the normative group, females in the hyperresponsive group were at increased risk for reporting suicidal ideation 3 months later, after controlling for prior ideation. No interactions between cortisol group and the other risk factors were significant, with the exception of a non-significant trend between impulsiveness and cortisol group on lifetime suicidal ideation. Findings highlight the importance of HPA-axis responses to acute stressors as a risk factor for suicidal ideation among adolescents.
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Overproduction of cortisol has a strong impact on affective disorders and is an additional risk factor for depressive disorders and suicidal thinking.
“Then, it has been reported that the overproduction of cortisol (i.e., hyperactivity) has a strong impact on the affective disorders manifestation and is an additional risk factor for DD and suicidal thinking (Dwivedi, 2012;Giletta et al., 2015;O'Connor, Gartland, & O'Connor, 2020).”
From Comparison of two psychotherapies in cortisol response and their efficacy in reducing symptoms of anxiety and depression in women victims of intimate partner violence (2023) · cites this paper as Giletta et al., 2015
The Discussion reports that hyperreactive cortisol responses to stress were associated with increased risk of suicidal ideation among at-risk adolescent females, even after accounting for depressive symptoms (page not provided). It notes a reported relation between depression and HPA stress responses, but does not establish cortisol overproduction as an additional risk factor for depressive disorders or a strong cause of affective disorders generally. The claim also broadens a finding about responses to acute stress into one about cortisol overproduction. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn our research, cortisol hyperreactivity to the TSST had a significant effect on risk for suicidal ideation 3 months later, with a marginal trend for hyporeactivity, controlling for lifetime suicidal ideation and other distal risk factors.
“Initial findings revealed a significant effect for cortisol hyperreactivity (and a marginal trend for hyporeactivity) to the TSST on the risk for suicidal ideation 3 months later, even after controlling for the lifetime history of suicidal ideation and other distal risk factors (e.g., impulsivity) (Giletta et al. 2015)”
From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Giletta et al. 2015
In adolescent females, both hyperreactivity and hyporeactivity (blunting) of cortisol response to a psychosocial stressor predicted suicidal ideation over a 3-month period, with the association with blunting marginally significant.
“The one study examining the HPA axis and suicidal ideation among adolescent females (N = 138) draws from an early subsample from the present study; both hyperreactivity and hyporeactivity (blunting) of cortisol (CORT) response to a psychosocial stressor predicted suicidal ideation over a 3-month period, although the association with blunting was marginally significant [9].”
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References 69 · Cited by 89
- Authors
- Giletta, M., Calhoun, C. D., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of California, Davis (US)
- University of Illinois Urbana-Champaign (US)
- Harvard University (US)
- Corresponding author
- Giletta, Matteo
- ORCID
- Venue
- Journal of Abnormal Child Psychology
- Published
- 2014-06-24
- Volume
- 43
- Issue
- 5
- Pages
- 807-820
- ISSN
- 0091-0627 (ISSN-L)
- 1573-2835
- PMC
- PMC4276541
- OpenAlex
- W2127910781
- Cited by
- 89
- References
- 69
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 6 · 2023: 9 · 2022: 13 · 2021: 12 · 2020: 7 · 2019: 8 · 2018: 7 · 2017: 4 · 2016: 6 · 2015: 6
- FWCI
- 6.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Research on Child and Adolescent Psychopathology (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- UNC Libraries
- Funders
- University of North Carolina at Chapel Hill
- National Institute of Mental Health (R01MH085505)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- suicidal ideation, adolescent girls, hypothalamic-pituitary-adrenal axis, cortisol stress response, psychosocial stress, risk factors, depressive symptoms, impulsivity, peer stress, pubertal stage
- MeSH terms
- Adolescent, Adolescent Behavior, Child, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Psychological Tests, Risk Factors, Saliva, Stress, Psychological, Suicidal Ideation
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