Effects of childhood trauma, daily stress, and emotions on daily cortisol levels in individuals vulnerable to suicide.
Open accessAbstract
Suicide is a leading cause of mortality worldwide. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as 1 potential risk factor. Evidence has indicated that childhood trauma is associated with dysregulated cortisol reactivity to stress in adulthood. The current study investigated for the first time whether childhood trauma and daily stressors and emotions were associated with diurnal cortisol levels over a 7-day study in individuals vulnerable to suicide. One hundred and forty-two participants were categorized according to their suicidal history into 3 groups: suicide attempt, suicidal ideation, or control group. Participants completed questionnaires before commencing a 7-day study. Cortisol samples were provided immediately upon waking, at 15 min, 30 min, 45 min, 3 hr, 6 hr, 9 hr, and 12 hr on 7 consecutive days. Measures of daily stressors, mood, defeat, and entrapment were completed at the end of each day. Participants in the suicide attempt and ideation groups released significantly lower cortisol upon awakening (CAR) and had a tendency toward flatter wake-peak to 12 hr (WP-12) cortisol slopes compared to controls. Childhood trauma was found to be associated with significantly lower CAR and a tendency toward flatter WP-12 cortisol slope. Childhood trauma also had an indirect effect on suicide vulnerability group membership via lower daily CAR levels. Lower CAR was associated with increased suicide ideation at 1 month but not 6 months. Daily stress and emotion measures were not associated with cortisol levels. This is the first 7-day daily diary investigation of naturally fluctuating cortisol levels in individuals vulnerable to suicide. The results indicate that dysregulated HPA axis activity is associated with suicidal ideation and behavior. Childhood trauma appears to be an important distal factor associated with HPA-axis dysregulation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Reduced morning cortisol levels have repeatedly been observed in chronically stressed individuals.
“In contrast, reduced morning cortisol levels have repeatedly been observed in chronically stressed individuals (40–42).”
From Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis (2022) · cites this paper as [42]
Cites
The interpersonal theory of suicide.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010) · Psychological Review · doi:10.1037/a0018697 · Cited by 5,292 · see citing works
Validity of adult retrospective reports of adverse childhood experiences: review of the evidence
Hardt, J., & Rutter, M. (2004) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2004.00218.x · Cited by 2,827 · see citing works
Miller, G. E., Chen, E., & Zhou, E. S. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.1.25 · Cited by 2,467 · see citing works
Heim, C. (2000) · JAMA · doi:10.1001/jama.284.5.592 · Cited by 1,968 · see citing works
Toward a clinical model of suicidal behavior in psychiatric patients
Mann, J. J., Waternaux, C., Haas, G. L., & Malone, K. M. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.2.181 · Cited by 1,791 · see citing works
The integrated motivational–volitional model of suicidal behaviour
O'Connor, R. C., & Kirtley, O. J. (2018) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2017.0268 · Cited by 1,559 · see citing works
Self-citationThe psychology of suicidal behaviour
O'Connor, R. C., & Nock, M. K. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70222-6 · Cited by 1,193 · see citing works
Self-citationCortisol awakening response and psychosocial factors: a systematic review and meta-analysis
Chida, Y., & Steptoe, A. (2009) · Biological Psychology · doi:10.1016/j.biopsycho.2008.10.004 · Cited by 1,032 · see citing works
Adam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.05.018 · Cited by 905 · see citing works
The awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P., & Hucklebridge, F. (2004) · Stress · doi:10.1080/10253890410001667205 · Cited by 856 · see citing works
Towards an integrated motivational–volitional model of suicidal behaviour
O'connor, R. C. (2011) · International Handbook of Suicide Prevention · doi:10.1002/9781119998556.ch11 · Cited by 552 · see citing works
Self-citationvan Heeringen, K., & Mann, J. J. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70220-2 · Cited by 550 · see citing works
Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.10.005 · Cited by 540 · see citing works
Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence
Adam, E. K., Doane, L. D., Zinbarg, R. E., Mineka, S., Craske, M. G., & Griffith, J. W. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.12.007 · Cited by 315 · see citing works
Cortisol levels and suicidal behavior: A meta-analysis
O’Connor, D. B., Ferguson, E., Green, J. A., O’Carroll, R. E., & O’Connor, R. C. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.10.011 · Cited by 173 · see citing works
Self-citationO’Connor, D. B., Green, J. A., Ferguson, E., O’Carroll, R. E., & O’Connor, R. C. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.10.019 · Cited by 146 · see citing works
Self-citationBlunted HPA axis activity prior to suicide attempt and increased inflammation in attempters
Melhem, N. M., Munroe, S., Marsland, A., Gray, K., Brent, D., Porta, G., Douaihy, A., Laudenslager, M. L., DePietro, F., Diler, R., et al. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.01.001 · Cited by 124 · see citing works
Boggero, I. A., Hostinar, C. E., Haak, E. A., Murphy, M. L. M., & Segerstrom, S. C. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.08.058 · Cited by 97 · see citing works
Smyth, N., Clow, A., Thorn, L., Hucklebridge, F., & Evans, P. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.12.013 · Cited by 85 · see citing works
Hwang, A.-C., Peng, L.-N., Wen, Y.-W., Tsai, Y.-W., Chang, L.-C., Chiou, S.-T., & Chen, L.-K. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.02.001 · Cited by 76 · see citing works
Childhood maltreatment increases the risk of suicide attempt in schizophrenia
Hassan, A. N., Stuart, E. A., & De Luca, V. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.05.012 · Cited by 44 · see citing works
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O'Connor, D. B., Thayer, J. F., & Vedhara, K. (2021) · Annual Review of Psychology · doi:10.1146/annurev-psych-062520-122331 · Cited by 948 · see citing works
Self-citationChildhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis
Murphy, F., Nasa, A., Cullinane, D., Raajakesary, K., Gazzaz, A., Sooknarine, V., Haines, M., Roman, E., Kelly, L., O'Neill, A., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.748372 · Cited by 181 · see citing works
Howarth, E. J., O'Connor, D. B., Panagioti, M., Hodkinson, A., Wilding, S., & Johnson, J. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.171 · Cited by 134 · see citing works
Self-citationStress, cortisol and suicide risk
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Self-citationHernández-Díaz, Y., González-Castro, T. B., Tovilla-Zárate, C. A., Juárez-Rojop, I. E., López-Narváez, M. L., Pérez-Hernández, N., Rodríguez-Pérez, J. M., Genis-Mendoza, A. D., & Nicolini, H. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113448 · Cited by 25 · see citing works
Hennings, J. M., Ising, M., Uhr, M., Holsboer, F., & Lucae, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.937582 · Cited by 13 · see citing works
Ferrara, P., Cammisa, I., Zona, M., Pacucci, I., Grimaldi, M. T., Scaltrito, F., Giardino, I., Verrotti, A., & Pettoello-Mantovani, M. (2025) · Current Pediatric Reviews · doi:10.2174/0115733963316599240704061209 · Cited by 5 · see citing works
- Authors
- O'Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O'Carroll, R. E., & O'Connor, R. C.
- Affiliations
- University of Leeds (GB)
- Northumbria University (GB)
- University of Nottingham (GB)
- Corresponding author
- O'Connor, Daryl B.
- Venue
- Journal of Abnormal Psychology
- Published
- 2020-01
- Volume
- 129
- Issue
- 1
- Pages
- 92-107
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- OpenAlex
- W2975750256
- Cited by
- 60
- References
- 21
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 9 · 2023: 5 · 2022: 14 · 2021: 8 · 2020: 6 · 2019: 1
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Abnormal Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, public-domain)
- PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
- PsyArXiv (OSF Preprints) (submittedVersion)
- Funders
- US Department of Defense (W81XWH-12-1-0007)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- childhood trauma, daily stress, cortisol, HPA axis dysregulation, suicide vulnerability, suicidal ideation, suicide attempts, diurnal cortisol rhythm, defeat, entrapment
- MeSH terms
- Adult Survivors of Child Adverse Events, Adolescent, Adult, Emotions, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Pituitary-Adrenal System, Surveys and Questionnaires, Risk Factors, Saliva, Stress, Psychological, Suicide, Attempted, Young Adult, Suicidal Ideation
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