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

The DOI matches its Crossref record; 38 of the 40 references it cites were found in a registry or an index; none of the 45 sources its claims cite is checked for support yet.

Cortisol Response to Stress in Female Youths Exposed to Childhood Maltreatment: Results of the Youth Mood Project

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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.

Overview

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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.

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Integrity signals

Registry

Crossref · 10.1016/j.biopsych.2008.12.014

Cites

38 of 38 references verified0 citation errors · 0 not checkable

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  • It may state two separate claims as one. 18
  • Probably not a substantial claim. 27
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  • 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.”
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Metadata

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.
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2009-07
Volume
66
Issue
1
Pages
62-68
ISSN
0006-3223 (ISSN-L)
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
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 › Sociology and Political Science › 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

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