Maltreatment and diurnal cortisol regulation: a meta-analysis
Abstract
Childhood maltreatment leads to a host of negative physical and mental health outcomes, with cortisol dysregulation implicated as a possible mechanism. Given inconsistencies across in the literature regarding the direction and magnitude of the association between maltreatment and diurnal cortisol regulation, the current meta-analysis of 27 studies aimed to examine the association between maltreatment and at least one of 3 indicators of diurnal cortisol regulation: wake-up cortisol levels, the cortisol awakening response (CAR), and/or the diurnal cortisol slope. Effect sizes were calculated using Hedges' g formula and were pooled using a random effects model. For the association between maltreatment and wake-up cortisol level, the aggregate effect size was g=0.08, p=0.26. Notably, effect sizes between maltreatment and wake-up cortisol were significantly larger (Q between=5.18, p=0.02) for studies of agency-referred samples, g=0.24, p=0.006, than studies for which maltreatment status was based on self-report, g=0.00, p=0.97, with maltreatment associated with reduced wake-up cortisol levels. For the association between maltreatment and the CAR and diurnal cortisol slope, the aggregate effect sizes were non-significant and none of the moderator variables were significant. Although results did not indicate a large and robust association between maltreatment and various indicators of diurnal cortisol, studies with more rigorous designs (i.e., agency-referred samples) showed a small, significant association between maltreatment and blunted wake-up cortisol levels, suggesting a pattern of hypocortisolism.
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There can be either low or high basal cortisol, as found in depression, trauma exposure, or chronically high social strain.
“There can be either low or high basal cortisol, as found in depression, trauma exposure, or chronically high social strain (Friedman et al., 2012; Bernard et al., 2017; McEwen, 1998).”
From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Bernard et al., 2017
Inconsistencies are observed for diurnal regulation in adolescents who experienced childhood trauma.
“Likewise, inconsistencies are observed for diurnal regulation (141, 142).”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [142]
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Self-citation
- Authors
- Bernard, K., Frost, A., Bennett, C. B., & Lindhiem, O.
- Affiliations
- Stony Brook University (US)
- University of Pittsburgh Medical Center (US)
- University of Pittsburgh (US)
- Corresponding author
- Bernard, Kristin
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 78
- Pages
- 57-67
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2567839240
- Cited by
- 180
- References
- 79
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 12 · 2023: 14 · 2022: 25 · 2021: 28 · 2020: 52 · 2019: 17 · 2018: 8 · 2017: 3
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- 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 awakening response, diurnal cortisol slope, adrenal insufficiency, HPA axis dysregulation
- MeSH terms
- Adolescent, Adult, Child, Child Abuse, Circadian Rhythm, Female, Humans, Hydrocortisone, Male, Middle Aged, Saliva, Stress, Psychological, Adult Survivors of Child Abuse, Young Adult
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