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Cited by 281Child Abuse and TraumaStress Responses and CortisolChild Welfare and Adoption

Cortisol response to stress in female youths exposed to childhood maltreatment: results of the youth mood project

Open access
MacMillan, Harriet L., Georgiades, Katholiki, Duku, Eric K., Shea, Alison, Steiner, Meir, Niec, Anne, Tanaka, Masako, Gensey, Susan +7 more·2009·Biological Psychiatry
DOI 10.1016/j.biopsych.2008.12.014PMC PMC3816014
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Abstract

Background Few studies have examined stress reactivity and its relationship to major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) among maltreated youth. We examined differences between maltreated and control participants in heart rate and cortisol resting and reactivity levels in response to a psychosocial stressor.Methods We recruited 67 female youths aged 12 to 16 with no prior history of depression from child protection agencies and a control group of 25 youths matched on age and postal code. Child maltreatment was measured with two self-report instruments. Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children.Results Piecewise multilevel growth curve analysis was used to model group differences in resting and reactivity cortisol levels and heart rate in response to the Trier Social Stress Test (TSST). During the resting period, both the maltreated and control groups showed a similar decline in levels of cortisol. During the reactivity phase, youth in the control group showed an increase in cortisol levels following the TSST and a gradual flattening over time; maltreated youth exhibited an attenuated response. This blunted reactivity was not associated with current symptoms of MDD or PTSD. There were no group differences in resting and reactivity levels of heart rate.Conclusions These findings provide further support for hypothalamic-pituitary-adrenal axis dysregulation among maltreated youth. Since the ability to respond to acute stressors by raising cortisol is important for health, these findings may assist in understanding the vulnerability of maltreated youth to experience physical and mental health problems.

AI snapshot

Written from the paper’s full text.

TL;DR

In female youths aged 12–16 with no prior depression, childhood maltreatment was associated with a blunted salivary cortisol response to the Trier Social Stress Test, while heart rate responses did not differ from controls. The blunted cortisol reactivity was not explained by current MDD or PTSD symptoms.

Key findings

  • Maltreated youth showed an attenuated cortisol response to the TSST: controls increased cortisol after the stressor and then flattened, whereas maltreated youth did not show an increase or gradual flattening.
  • There were no group differences in resting cortisol decline or in resting/reactivity heart rate.
  • The blunted cortisol response was not associated with current MDD or PTSD symptoms; excluding cases meeting criteria for current MDD and/or PTSD produced the same results, and reactivity × MDD and reactivity × PTSD interaction terms were not statistically significant.
  • In a reduced sample excluding 12 participants on oral contraceptives, the blunted response persisted: maltreated × reactivity β = −.233 (.067), p < .001; maltreated × reactivity² β = .026 (.08), p < .01.

Methods

  • Recruited 67 female youths aged 12–16 with no prior history of depression from child protection agencies and 25 control youths matched on age and postal code; maltreatment was measured with the CEVQ and CTQ, and psychiatric status with the K-SADS-E.
  • Participants underwent the TSST, with heart rate and saliva samples collected at −45, −25, −5, +20, +40, and +60 minutes; cortisol was assayed by enzyme immunoassay.
  • Piecewise multilevel growth curve modeling in MLwiN examined resting and reactivity trajectories, with covariates including SES, Tanner pubertal stage, and current MDD/PTSD symptoms.

Limitations

  • The paper states that almost all maltreated participants had experienced neglect, precluding comparison of abuse versus neglect; only female youth were recruited, so male stress reactivity cannot be addressed; and psychiatric status ideally would have used multiple informants, but many maltreated youths were in foster care and only one third had a biological parent at home.
  • The paper also states that maternal prenatal stress could not be obtained, so prenatal programming could not be controlled; because of domestic violence exposure and high poverty in the sample, mothers of maltreated youth may have had greater prenatal stress.
  • Evident from the text: the control group was small (n = 25), and ACTH could not be measured because only salivary samples were permitted under the agreement with participating child protection agencies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.biopsych.2008.12.014

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Maltreated female youths exhibited an attenuated cortisol response during the reactivity phase compared with control youths.

    “maltreated youth exhibited an attenuated response.”
    • Also stated in: § Results · plain
      “Differences in slopes between the maltreated and control group are evident during the reactivity phase.”
    • Also stated in: § Discussion · plain
      “We found a blunted cortisol response (but no difference in heart rate response) to a psychosocial stressor among maltreated female youth even after controlling for SES and Tanner pubertal staging, as well as current symptoms of MDD and PTSD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.
  • Findingown data

    Examining stress ratings as main effects and interaction terms did not alter the findings.

    “We also examined the stress ratings as main effects and interaction terms; this did not alter our findings.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The blunted cortisol reactivity among maltreated female youths was not associated with current symptoms of MDD or PTSD.

    “This blunted reactivity was not associated with current symptoms of MDD or PTSD.”
    • Also stated in: § Results · hedged
      “The results remained the same, suggesting that the blunted response evident among the maltreated youth was not due to the presence of PTSD or MDD symptoms.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.
  • Findingown data

    The majority of both control and maltreated participants experienced stress with the TSST.

    “Self-report ratings of stress regarding participation in the TSST showed that the majority of both control and maltreated participants experienced stress with this task.”
    Quote in the paperNot a substantial claim
  • Findingown data

    During the resting period, log cortisol decreased by an average of .108 nmol/L per 10-minute interval.

    “During the resting period of the assessment, there was an average decrease of .108 nmol/L in log cortisol per 10-minute interval (model 1, resting).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Findingown data

    There were no statistically significant differences between control and maltreated participants in the proportion who rated the TSST as at least 'sort of stressful' (76.0% vs. 68.1%; p = .8) or as at least 'stressful' (40% vs. 44%; p = .6).

    “There were no statistically significant differences in the proportion of control and maltreated participants who rated the TSST as at least “sort of stressful” (76.0% vs. 68.1%; Fisher’s exact test; p = .8) or as at least “stressful” (40% vs. 44%; Fisher’s exact test; p = .6), respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Interaction terms for reactivity × MDD and reactivity × PTSD were not statistically significant, suggesting parallel slopes for those with and without symptoms.

    “We also included two interaction terms to test for differences in slopes during the reactivity period for those who had current symptoms of MDD or PTSD and those who did not (reactivity × MDD; reactivity × PTSD). The interaction terms were not statistically significant, suggesting that the slopes were parallel for those who had symptoms and those who did not.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • May combine two claims.

    Findingown data

    Both maltreated and control groups showed a general decline in heart rate during the resting period, an increase following the TSST, and a gradual flattening over time.

    “Both groups showed a general decline in HR during the resting period, an increase following the TSST, and a gradual flattening over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During the reactivity phase, control female youths showed an increase in cortisol levels following the TSST and a gradual flattening over time.

    “During the reactivity phase, youth in the control group showed an increase in cortisol levels following the TSST and a gradual flattening over time; maltreated youth exhibited an attenuated response.”
    • Also stated in: § Results · plain
      “Youth in the control group show an increase in levels of cortisol following the TSST and a gradual flattening over time, while maltreated youth do not show an increase in levels of cortisol, nor do they have a gradual flattening of response.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • May combine two claims.

    Findingown data

    Excluding participants taking oral contraceptives, the blunted cortisol response to the TSST among maltreated youth remained, with no evidence of flattening over time.

    “We redid our analyses excluding all 12 participants on oral contraceptives. We continued to find a blunted response to the TSST among the maltreated group and no evidence of a flattening of response over time.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • May combine two claims.

    Findingown data

    Excluding all cases who met criteria for current MDD and/or PTSD symptoms, the results remained the same, indicating the blunted response among maltreated youth was not due to PTSD or MDD symptoms.

    “To further examine the association between cortisol reactivity and current symptoms of MDD and PTSD, we reanalyzed our data excluding all cases who met the criteria for current MDD and/or PTSD symptoms. The results remained the same, suggesting that the blunted response evident among the maltreated youth was not due to the presence of PTSD or MDD symptoms.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At 5 minutes before the TSST, the predicted mean log cortisol was 1.055 nmol/L.

    “In model 1, at 5 minutes before the introduction of the TSST, the predicted mean value of the log cortisol is 1.055 nmol/L (model 1, intercept).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • May combine two claims.

    Findingown data

    Following the TSST, log cortisol initially increased by an average of .116 nmol/L per 10-minute interval, with the increase gradually reduced by an average of .004 per 10-minute intervals.

    “Following the TSST, levels of cortisol initially increased by an average of .116 nmol/L per 10-minute interval, but the increase was gradually reduced by an average of .004 per 10-minute intervals (2 × −.002).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • May combine two claims.

    Interpretationcitation

    The clinical relevance of the blunted cortisol response in maltreated youth is not clear but may put them at risk for impairment in both physical and emotional health.

    “The clinical relevance of the blunted cortisol response in this group of maltreated youth is not clear but may put them at risk for impairment in both physical and emotional health; the ability to respond to acute stressors by raising cortisol is important for health (40).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Cicchetti, 2001, The impact of child maltreatment and psychopathology on neuroendocrine functioning, Dev Psychopathol source

      Not checked in the free run.

    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • Classified as probably not a substantial claim.

    Premisecitation

    HPA responsiveness to stress is affected by menstrual cycle phase.

    “since HPA responsiveness to stress is affected by menstrual cycle phase (25).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Kirschbaum, 1999, Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis, Psychosom Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The TSST has been found to reliably induce psychological and endocrine stress responses in different populations of adults, children, and youth.

    “The TSST has been found to reliably induce psychological and endocrine stress responses in different populations of adults, children, and youth (27,28).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Kirschbaum, 1993, The “Trier Social Stress Test”—a tool for investigating psychobiological stress responses in a laboratory setting, Neuropsychobiology source

      Not checked in the free run.

    • cites [28] Buske-Kirschbaum, 1997, Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis, Psychosom Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The ability to respond to acute stressors by raising cortisol is important for health.

    “the ability to respond to acute stressors by raising cortisol is important for health (40).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Cicchetti, 2001, The impact of child maltreatment and psychopathology on neuroendocrine functioning, Dev Psychopathol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Peak cortisol concentrations are reliably found 10 minutes after stress termination in this protocol.

    “Peak cortisol concentrations are reliably found 10 minutes after stress termination in this protocol (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Buske-Kirschbaum, 1997, Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis, Psychosom Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The blunted cortisol response is related to exposure to maltreatment and not the presence of internalizing symptoms.

    “Our results suggest that the blunted cortisol response is related to the exposure to maltreatment and not the presence of internalizing symptoms, an important finding in view of the evidence for the association between internalizing problems and increased basal cortisol levels among maltreated children (15,40).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Tarullo, 2006, Child maltreatment and the developing HPA axis, Horm Behav source

      Not checked in the free run.

    • cites [40] Cicchetti, 2001, The impact of child maltreatment and psychopathology on neuroendocrine functioning, Dev Psychopathol source

      Not checked in the free run.

    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.
    • The authors state this as an assumption: The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Major depressive disorder has a strong association with maltreatment, especially among female individuals.

    “Major depressive disorder (MDD) has a strong association with maltreatment, especially among female individuals (4,6,7).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [4] MacMillan, 2001, Childhood abuse and lifetime psychopathology in a community sample, Am J Psychiatry source

      Not checked in the free run.

    • cites [6] Kaufman, 2001, Effects of early stress on brain structure and function: Implications for understanding the relationship between child maltreatment and depression, Dev Psychopathol source

      Not checked in the free run.

    • cites [7] Weiss, 1999, Childhood sexual abuse as a risk factor for depression in women: Psychosocial and neurobiological correlates, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Growth curve models are better than repeated measures ANOVA for analyzing cortisol data because they do not require complete data for every participant or equally spaced observations.

    “Growth curve models are better than repeated measures analysis of variance (ANOVA), which has traditionally been used to analyze cortisol data, because the former do not require complete data for every participant or that observations be equally spaced in time (31).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Hruschka, 2005, Estimating between- and within-individual variation in cortisol levels using multilevel models, Psychoneuroendocrinology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Exposure to child maltreatment is associated with psychiatric impairment in childhood, adolescence, and adulthood.

    “It is now well recognized that exposure to child maltreatment, which includes physical, sexual, and emotional abuse and neglect, is associated with psychiatric impairment in childhood, adolescence, and adulthood (1–5).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [1] Anda, 2006, The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology, Eur Arch Psychiatry Clin Neurosci source

      Not checked in the free run.

    • cites [2] Cahill, 1999, Developmental, cognitive, and behavioral sequelae of child abuse, Child Adolesc Psychiatr Clin N Am source

      Not checked in the free run.

    • cites [3] Kaplan, 1999, Child and adolescent abuse and neglect research: A review of the past 10 years, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [4] MacMillan, 2001, Childhood abuse and lifetime psychopathology in a community sample, Am J Psychiatry source

      Not checked in the free run.

    • cites [5] Margolin, 2000, The effects of family and community violence on children, Annu Rev Psychol source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Kaufman et al. found no differences in cortisol secretion between depressed abused youth and control children, but depressed, abused youth who were continuing to experience chronic adversity showed increased ACTH secretion.

    “There were no differences in cortisol secretion, but depressed, abused youth who were continuing to experience chronic adversity showed increased ACTH secretion.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Kaufman, 1997, The corticotropin-releasing hormone challenge in depressed abused, depressed nonabused, and normal control children, Biol Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Normally developing children manifest an increase in basal cortisol levels from childhood to adolescence related to pubertal status.

    “Tarullo and Gunnar (15) point to the fact that normally developing children manifest an increase in basal cortisol levels from childhood to adolescence related to pubertal status.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Tarullo, 2006, Child maltreatment and the developing HPA axis, Horm Behav source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Most investigations of maltreated children have examined basal cortisol, while studies involving adult participants have focused on stress reactivity.

    “These authors also comment that most investigations of maltreated children have examined basal cortisol, while studies involving adult participants have focused on stress reactivity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Tarullo, 2006, Child maltreatment and the developing HPA axis, Horm Behav source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In their study of adolescents, Murali and Chen found gender differences in physiological measures; male youth had increased diastolic blood pressure reactivity but reduced cortisol reactivity compared with female youth.

    “In their study of adolescents, Murali and Chen (34) found gender differences in physiological measures; male youth had increased diastolic blood pressure reactivity but reduced cortisol reactivity compared with female youth.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Murali, 2005, Exposure to violence and cardiovascular and neuroendocrine measures in adolescents, Ann Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Child maltreatment was measured with two self-report instruments (CEVQ and CTQ).

    “Child maltreatment was measured with two self-report instruments.”
    • Also stated in: § Measures and Procedures · plain
      “At the initial home visit by a public health nurse, youths self-completed demographic questions, the Childhood Experiences of Violence Questionnaire (CEVQ) (18,19), the Childhood Trauma Questionnaire (CTQ) (20,21), and the Tanner scale (22–24) (see Supplement 1 for information about the psychometric properties of these instruments).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [18] Walsh, 2008, Measurement of victimization in adolescence: Development and validation of the Childhood Experiences of Violence Questionnaire, Child Abuse Negl source

      Not checked in the free run.

    • cites [19] Wekerle, 2006

      Not checked in the free run.

    • cites [20] Bernstein, 1998

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Children of low SES have significantly higher salivary cortisol levels than those with high SES, with the largest differences becoming apparent at about age 10.

    “A study of school children in Quebec varying in age from 6 to 10 years shows that children of low SES have significantly higher salivary cortisol levels than those with high SES, with the largest differences becoming apparent at about age 10 (39).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Lupien, 2000, Child's stress hormone levels correlate with mother's socioeconomic status and depressive state, Biol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Maximum cortisol concentrations were not related to adult trauma or an interaction with adult trauma and child abuse; rather, severity of daily hassles over the past month was negatively associated with cortisol.

    “Unlike ACTH, maximum cortisol concentrations were not related to adult trauma or an interaction with adult trauma and child abuse; rather, severity of daily hassles over the past month was negatively associated with cortisol (11).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Heim, 2002, The role of early adverse experience and adulthood stress in the prediction of neuroendocrine stress reactivity in women: A multiple regression analysis, Depress Anxiety source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a sample of children attending a summer camp, those with a history of maltreatment and comorbid internalizing and externalizing problems of a clinical level were more likely not to show the typical diurnal decrease in cortisol compared with maltreated youth without such comorbidity.

    “Of note, however, in a sample of children (average age 9 years) attending a summer camp, those with a history of maltreatment and comorbid internalizing and externalizing problems of a clinical level were more likely not to show the typical diurnal decrease in cortisol compared with maltreated youth without such comorbidity (40).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Cicchetti, 2001, The impact of child maltreatment and psychopathology on neuroendocrine functioning, Dev Psychopathol source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Both De Bellis et al. and Kaufman et al. studies provide important information about HPA responses to CRH but had limited numbers of maltreated youths in the sample.

    “Both studies provide important information about HPA responses to CRH but had limited numbers of maltreated youths in the sample.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] De Bellis, 1994, Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls, J Clin Endocrinol Metab

      Not checked in the free run.

    • cites [17] Kaufman, 1997, The corticotropin-releasing hormone challenge in depressed abused, depressed nonabused, and normal control children, Biol Psychiatry source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    De Bellis et al. showed that girls with a past history of sexual abuse and higher rates of dysthymia manifested decreased ACTH response to CRH but no differences in cortisol secretion compared with a control group.

    “De Bellis et al. (8) showed that girls with a past history of sexual abuse and higher rates of dysthymia manifested decreased adrenocorticotropic hormone (ACTH) response to CRH but no differences in cortisol secretion compared with a control group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] De Bellis, 1994, Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls, J Clin Endocrinol Metab

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Murali and Chen found no significant associations between stress appraisal of the laboratory task and exposure to violence.

    “They found no significant associations between stress appraisal of the laboratory task and the exposure to violence.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Murali, 2005, Exposure to violence and cardiovascular and neuroendocrine measures in adolescents, Ann Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Evidence exists for an association between internalizing problems and increased basal cortisol levels among maltreated children.

    “an important finding in view of the evidence for the association between internalizing problems and increased basal cortisol levels among maltreated children (15,40).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [15] Tarullo, 2006, Child maltreatment and the developing HPA axis, Horm Behav source

      Not checked in the free run.

    • cites [40] Cicchetti, 2001, The impact of child maltreatment and psychopathology on neuroendocrine functioning, Dev Psychopathol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Participants were asked to refrain from eating, drinking, and smoking for at least 2 hours prior to their visit.

    “Participants were also asked to refrain from eating, drinking, and smoking for at least 2 hours prior to their visit.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis controlled for time of day.

    “Three growth models were developed, after controlling for time of day.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    All appointments were scheduled during the late afternoon (16:00 to 19:00 hours).

    “All appointments were scheduled during the late afternoon (16:00 to 19:00 hours) because cortisol levels show only small spontaneous fluctuations during this time (26).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Weitzman, 1971, Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects, J Clin Endocrinol Metab source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Salivary cortisol concentrations were determined by enzyme immunoassay with intra-assay coefficients of variation of 8.3% for a low-concentration sample and 6.9% for a high-concentration sample, and an interassay coefficient of variation of 10.6% across 10 individual runs.

    “The intra-assay coefficients of variation for cortisol were 8.3% for a low-concentration sample and 6.9% for a high-concentration sample. The interassay coefficient of variation was 10.6% across 10 individual runs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Salivary cortisol concentrations reflect the level of unbound cortisol.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The first clinic visit was scheduled to coincide with days 6 to 10 of the youth's menstrual cycle.

    “The first clinic visit was scheduled to coincide with days 6 to 10 of the youth’s menstrual cycle, since HPA responsiveness to stress is affected by menstrual cycle phase (25).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Kirschbaum, 1999, Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis, Psychosom Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study redid analyses excluding all 12 participants on oral contraceptives.

    “We redid our analyses excluding all 12 participants on oral contraceptives.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children.

    “Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children.”
    • Also stated in: § Measures and Procedures · plain
      “Following the TSST, a trained clinician administered the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Epidemiologic Version 5 (K-SADS-E) (29).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Orvaschel, 1994

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Model 3 included individual-level covariates (SES, Tanner pubertal stage, current MDD symptoms, and current PTSD symptoms) to examine whether group differences remained after taking into account potentially confounding variables.

    “In model 3, individual level covariates, specifically SES, Tanner pubertal stage, current MDD symptoms, and current PTSD symptoms, were included to examine whether group differences remained after taking into account these potentially confounding variables.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study examined stress ratings as main effects and interaction terms.

    “We also examined the stress ratings as main effects and interaction terms; this did not alter our findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two members of the research team and two clinical researchers independently adjudicated the summaries for eligibility and to determine abuse exposures and severity.

    “Two members of the research team and two clinical researchers independently adjudicated the summaries for eligibility and to determine abuse exposures and severity.”
    Quote in the paperNot a substantial claim
39 of 39

  • The paper relies on this without support.

    Salivary cortisol concentrations reflect the level of unbound cortisol.

    “Salivary cortisol concentrations, reflecting the level of unbound cortisol, were determined by enzyme immunoassay (Salimetrics, State College, Pennsylvania).”

  • The authors state this as an assumption.

    The pre-TSST period measures resting cortisol and the post-TSST period measures cortisol reactivity.

    “The time prior to the TSST was conceptualized as a resting measure of cortisol, while the post-TSST period was considered cortisol reactivity.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Reported significance is incompatible with the coefficient and standard error

    Major

    For the maltreated × reactivity2 term, the reported coefficient divided by its standard error is 0.325. That is far too small to support the stated p < .01; this term is used to support the conclusion that the maltreated group did not show a gradual flattening of response.

    Reported 0.01 · recomputed 0.325

1 of 1

Cites

Flagged first, then by citations

2 of the 40 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
MacMillan, H. L., Georgiades, K., Duku, E. K., Shea, A., Steiner, M., Niec, A., Tanaka, M., Gensey, S., Spree, S., Vella, E., Walsh, C. A., De Bellis, M. D., Van der Meulen, J., Boyle, M. H., & Schmidt, L. A.
Affiliations
  • McMaster University (CA)
  • McMaster Children's Hospital (CA)
  • University of Calgary (CA)
Corresponding author
MacMillan, Harriet L.
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2009-07
Volume
66
Issue
1
Pages
62-68
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/j.biopsych.2008.12.014
PMC
PMC3816014
OpenAlex
W2011971945
Cited by
281
References
40
Citations by year
2026: 6 · 2025: 5 · 2024: 9 · 2023: 12 · 2022: 7 · 2021: 21 · 2020: 30 · 2019: 15 · 2018: 13 · 2017: 23 · 2016: 14 · 2015: 18 · 2014: 30 · 2013: 29 · 2012: 16
FWCI
16.95
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K24MH071434)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Safety Research › Child Welfare and Adoption
Keywords
child abuse, cortisol response, HPA axis dysregulation, psychosocial stress, Trier Social Stress Test, heart rate, major depressive disorder, post-traumatic stress disorder, adolescent girls
MeSH terms
Adolescent, Analysis of Variance, Child, Child Abuse, Female, Heart Rate, Humans, Hydrocortisone, Psychiatric Status Rating Scales, Surveys and Questionnaires, Saliva, Stress, Psychological, Time Factors, Case-Control Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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