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Cited by 87Suicide and Self-Harm StudiesStress Responses and CortisolChild and Adolescent Psychosocial and Emotional Development

HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework

Open access
Eisenlohr-Moul, Tory A., Miller, Adam B., Giletta, Matteo, Hastings, Paul D., Rudolph, Karen D., Nock, Matthew K., Prinstein, Mitchell J.·2018·Neuropsychopharmacology
DOI 10.1038/s41386-018-0206-6PMC PMC6224611
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Abstract

Prior studies suggest that hypothalamic-pituitary-adrenal (HPA) axis stress response is a relatively stable risk factor for suicidal behavior in adults, and also that fluctuations in developmentally salient social stress (i.e., peer stress) predict acute suicidal ideation and behavior in adolescent females. Here, we test the hypothesis that periods of high peer stress are prospectively associated with concurrent episodes of suicidal ideation and behavior, but that abnormal cortisol responses to stress at baseline act as a diathesis that strengthens this stressor-suicidality link, using a longitudinal, multi-wave study design. We measured cortisol responses to an adolescent modification of the Trier Social Stress Test in 220 adolescent females recruited for mental health concerns, and measured stress (peer, academic, and mother-child) and suicidal ideation and behaviors repeatedly across 18 months. Logistic multilevel models revealed the predicted interaction between altered cortisol response and elevated periods of peer stress in predicting suicidal behavior, but not ideation. Higher-than-usual peer stress predicted suicidal ideation regardless of HPA function, but predicted suicide attempt only among those with blunted cortisol responses. Results suggest that peer stress serves to trigger suicidal ideation among female youth, but only triggers suicidal behavior among those with blunted cortisol reactivity.

Integrity signals

Registry

Crossref · 10.1038/s41386-018-0206-6

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

19 of 32 cited sources checked · 6 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    HPA axis stress response is a relatively stable factor.

    “Given its well-defined role in adaptive responses to environmental stressors, the HPA axis stress response represents a relatively stable factor [7,8] that may shape the influence of developmentally salient stressors (i.e., peer stress) on suicidal ideation and behavior in adolescent females.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [7] Koss KJ, Gunnar MR. Annual Research Review: early adversity, the hypothalamic–pituitary–adrenocortical axis, and child psychopathology. J Child Psychol Psychiatry. 2018;59:327–46. source

      The “Sensitive Periods for Programing the HPA Axis” section says the axis adapts throughout life and that changes under chronic stress can reverse after the threat ends. “The HPA Axis” section also describes responses as stressor-specific. These passages run contrary to treating the HPA stress response as a generally stable factor; the review does allow that some early influences may have lasting effects. (LLM, conf=0.78)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [8] Gunnar M, Quevedo K. The neurobiology of stress and development. Annu Rev Psychol. 2007;58:145–73. source
  • Premisecitation

    Two adult studies demonstrated blunted CORT to psychosocial stress among those with suicidal behavior relative to controls or those with suicidal ideation only.

    “Two adult studies (N = 160, 208) demonstrated blunted CORT to psychosocial stress among those with suicidal behavior relative to controls or those with suicidal ideation only [10,11].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [10] Melhem NM, Keilp JG, Porta G, Oquendo MA, Burke A, Stanley B, et al. Blunted HPA axis activity in suicide attempters compared to those at high risk for suicidal behavior. Neuropsychopharmacology. 2016;41:1447–56. source

      The Abstract and Discussion report lower total cortisol output during the psychosocial stress test in suicide attempters than in the comparison groups. But the Materials and Methods describe the 208 participants as ages 16–38, not exclusively adults, and the non-attempter comparison group included behaviors beyond suicidal ideation. The Discussion also reports no group difference in cortisol reactivity to stress; the supported finding concerns total output, not a blunted reactive increase. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [11] O’Connor DB, Green JA, Ferguson E, O’Carroll RE, O’Connor RC. Cortisol reactivity and suicidal behavior: investigating the role of hypothalamic–pituitary–adrenal axis responses to stress in suicide attempters and ideators. Psychoneuroendocrinology. 2017;75:183–91. source
  • Interpretationcitation

    Developmentally salient social stressors lie at the heart of risk for suicidal behavior in adolescent females.

    “This suggests that developmentally salient social stressors lie at the heart of risk for suicidal behavior in adolescent females [4].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] King CA, Merchant CR. Social and interpersonal factors relating to adolescent suicidality: a review of the literature. Arch Suicide Res. 2008;12:181–96. source
  • Interpretationown data

    The blunted CORT responses observed in adults with suicidal behavior may be observable in adolescent females.

    “The blunted CORT responses observed in adults with suicidal behavior [10,11] may be observable in adolescent females.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [10] Melhem NM, Keilp JG, Porta G, Oquendo MA, Burke A, Stanley B, et al. Blunted HPA axis activity in suicide attempters compared to those at high risk for suicidal behavior. Neuropsychopharmacology. 2016;41:1447–56. source

      The Discussion reports lower total cortisol output during a stress test in suicide attempters, supporting the cited premise of blunted cortisol activity. But the Abstract reports no significant difference in cortisol reactivity to stress, so the source does not establish blunted responses if that means reactivity. The Materials and Methods describe a predominantly adult sample (mean age 23.3); the possibility concerning adolescent females is the citing authors’ own proposal, not a finding attributed to this source. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [11] O’Connor DB, Green JA, Ferguson E, O’Carroll RE, O’Connor RC. Cortisol reactivity and suicidal behavior: investigating the role of hypothalamic–pituitary–adrenal axis responses to stress in suicide attempters and ideators. Psychoneuroendocrinology. 2017;75:183–91. source
  • Premisecitation

    Blunted CORT responses to psychosocial stress compromise executive functioning, including emotion processing and inhibition of prepotent responses.

    “blunted CORT responses to psychosocial stress compromise executive functioning, including emotion processing and inhibition of prepotent responses [35,36].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [35] McGirr A, Diaconu G, Berlim MT, Pruessner JC, Sablé R, Cabot S, et al. Dysregulation of the sympathetic nervous system, hypothalamic–pituitary–adrenal axis and executive function in individuals at risk for suicide. J Psychiatry Neurosci. 2010;35:399. source

      The Salivary measures section says that an inability to mount a stress response may have consequences including executive impairment, and the Neuropsychology section reports stress-related difficulty inhibiting inappropriate actions in relatives of people who died by suicide. The paper does not establish that blunted cortisol responses cause that impairment, and the cited passages do not address emotion processing. Page numbers are not available in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [36] Turecki G, Ernst C, Jollant F, Labonté B, Mechawar N. The neurodevelopmental origins of suicidal behavior. Trends Neurosci. 2012;35:14–23. source
  • May combine two claims. 17
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] Giletta M, Calhoun CD, Hastings PD, Rudolph KD, Nock MK, Prinstein MJ. Multi-level risk factors for suicidal ideation among at-risk adolescent females: the role of hypothalamic–pituitary–adrenal axis responses to stress. J Abnorm Child Psychol. 2015;43:807–20. source

  • May combine two claims.

    Premisecitation

    Moderate CORT stress responses may facilitate coping whereas hypo- or hyper-responsiveness of the HPA axis may increase vulnerability to suicide during periods of stress.

    “Therefore, moderate CORT stress responses may facilitate coping [21] whereas hypo-or hyper-responsiveness of the HPA axis may increase vulnerability to suicide during periods of stress [10].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [21] Hoyt LT, Zeiders KH, Ehrlich KB, Adam EK. Positive upshots of cortisol in everyday life. Emotion. 2016;16:431–5. source

      The Abstract says elevated cortisol during stressful situations might help people cope by reducing negative emotional responses, and the Discussion reports that cortisol increases were followed by greater relaxation. The paper does not establish that specifically moderate responses have this effect. The suicide-vulnerability clause is attached to a different citation and is not judged here. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [10] Melhem NM, Keilp JG, Porta G, Oquendo MA, Burke A, Stanley B, et al. Blunted HPA axis activity in suicide attempters compared to those at high risk for suicidal behavior. Neuropsychopharmacology. 2016;41:1447–56. source

      The Discussion concludes that blunted HPA-axis activity may increase suicide-attempt risk by reducing the ability to respond adaptively to ongoing stressors. The Introduction reports associations involving elevated cortisol, but the paper does not establish that hyper-responsiveness to stress increases suicide vulnerability. The separate claim about moderate responses is cited to [21], not this source. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Evidence from Melhem et al. shows adults with suicidal behavior, but not individuals with ideation, had lower hair CORT, elevated inflammation, and poorer GR sensitivity.

    “This possibility is bolstered by evidence from Melhem et al. [10] showing adults with suicidal behavior-but not individuals with ideation-had lower hair CORT but also elevated inflammation (CRP, TNF-α, stimulated IL-6 production) and poorer GR sensitivity (ability of CORT to downregulate inflammation).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] Melhem NM, Keilp JG, Porta G, Oquendo MA, Burke A, Stanley B, et al. Blunted HPA axis activity in suicide attempters compared to those at high risk for suicidal behavior. Neuropsychopharmacology. 2016;41:1447–56. source

      The Discussion (page unavailable) reports lower baseline and stress-test cortisol output in suicide attempters than in high-risk participants who had not attempted suicide. But the Methods (page unavailable) specify saliva samples, not hair cortisol; the cited study does not report the claimed inflammation markers or GR sensitivity. Its sample was offspring of parents with mood disorders, not simply adults with suicidal behavior versus people with ideation. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    If CORT stress response is compromised, this may permit uncontrolled inflammatory brain signaling, which increases suicide-promoting emotional experiences including social loss, shame, and anhedonia.

    “If CORT stress response is compromised, perhaps due to a history of extreme stress exposures, this may permit uncontrolled inflammatory brain signaling, which increases a variety of suicide-promoting emotional experiences, including social loss, shame, and anhedonia [38].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [38] Slavich GM, Irwin MR. From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychol Bull. 2014;140:774–815. source

      The ‘Central Regulation of Systemic Inflammation’ section says glucocorticoid resistance can promote excessive inflammation, and the paper links inflammation to anhedonia and suicidal ideation. But its ‘Stress Is Associated With Major Depression’ and ‘Laboratory-Based Social Stressors Trigger Inflammatory Activity’ sections treat social loss and shame chiefly as stressors or accompanying experiences, not as effects of inflammatory brain signaling. The paper does not establish that the proposed pathway increases suicide-promoting experiences as a group. Page numbers were not available in our copy. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • Rests on an assumption: Social threats are accompanied by inflammatory brain signaling that is normatively downregulated by CORT at the glucocorticoid receptor (GR).

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

    Interpretationcitation

    A stress-related subtype of suicidality may be expected to demonstrate blunted CORT responses, while other subtypes may have different characteristics.

    “While a stress-related subtype of suicidality (characterized broadly by episodes of suicidality following stress, trauma histories, and impulsivity [49]) may be expected to demonstrate blunted CORT responses, other subtypes may have different characteristics.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [49] Bernanke JA, Stanley BH, Oquendo MA. Toward fine-grained phenotyping of suicidal behavior: the role of suicidal subtypes. Mol Psychiatry. 2017;22:1080–1. source

  • May combine two claims.

    Premisecitation

    Progesterone and its neurosteroid metabolites, which rise and begin to fluctuate during puberty, upregulate social behaviors, increase social threat monitoring, and regulate the HPA axis.

    “Progesterone and its neurosteroid metabolites, which rise and begin to fluctuate during puberty, upregulate social behaviors [40], increase social threat monitoring [41,42], and regulate the HPA axis [43].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [40] Koonce CJ, Frye CA. Progesterone facilitates exploration, affective and social behaviors among wildtype, but not 5α-reductase Type 1 mutant, mice. Behav Brain Res. 2013;253:232–9. source

      The Results (section 4.2; page unavailable) report that progesterone increased social interaction in wildtype female mice and its metabolite 3α,5α-THP increased interaction in both wildtype and mutant mice. This supports the social-behavior point attached to [40], but the cited study does not establish the sentence’s puberty-related context. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [41] Maner JK, Miller SL. Hormones and social monitoring: menstrual cycle shifts in progesterone underlie women’s sensitivity to social information. Evol Hum Behav. 2014;35:9–16. source
    • cites [42] Wingen GA, van, Broekhoven F, van, Verkes RJ, Petersson KM, Bäckström T, Buitelaar JK, et al. Progesterone selectively increases amygdala reactivity in women. Mol Psychiatry. 2008;13:325–33. source

      The Results report that progesterone increased amygdala responses during a task using angry and fearful faces, which is relevant to social threat processing. But the Behavioral task section says the contrast measures a general response to salient stimuli, not an emotion-specific effect; the study did not measure social threat monitoring itself. The citation is attached to that clause, not to the separate claims about puberty, social behavior, or the HPA axis. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

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

    Study design and conductcitation

    This study had strengths including prospective evaluation of suicidal outcomes, measurement at multiple RDoC levels in a transdiagnostic sample, and a dynamic, multilevel statistical approach allowing for prospective modeling of diathesis and stress interplay.

    “This study had many strengths, including prospective evaluation of suicidal outcomes, measurement at multiple Research Domain Criteria (RDoC) levels in a transdiagnostic sample [48], and the dynamic, multilevel statistical approach allowing for prospective modeling of diathesis and stress interplay.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [48] Glenn CR, Cha CB, Kleiman EM, Nock MK. Understanding suicide risk within the Research Domain Criteria (RDoC) Framework: insights, challenges, and future research considerations. Clin Psychol Sci. 2017;5:568–92. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Neither abuse exposure nor number of PTSD symptoms endorsed was significantly related to CORT AUCi.

    “notably, neither abuse exposure nor the number of PTSD symptoms endorsed was significantly related to CORT AUC i .”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    CORT AUCi moderated the prospective association between elevated peer stress and concurrent suicidal behavior, but not the association with academic or mother-child stress.

    “As predicted, CORT AUC i moderated the prospective association between elevated peer stress (and not the less developmentally salient academic or mother-child stress) with concurrent suicidal behavior.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The TSST produced a typical CORT stress response, with significant increases over baseline at 20 min and 30 min post-TSST and a return to baseline at 40 min post-TSST.

    “We observed the typical CORT stress response to the TSST, with significant increases over baseline at 20 min post-TSST (Estimate = 0.03, SE = 0.005, t(860) = 5.96, p < 0.0001), and 30 min post-TSST (Estimate = 0.011, SE = 0.005, t(860) = 2.15, p = 0.03), with a return to baseline at 40 min post-TSST (Estimate = -0.001,SE = 0.005, t(860) = 0.20, p = 0.84).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Rates of suicidal behavior at each time point were lower but elevated: 33.6% at baseline, 8.4% at 3 months, 6.2% at 6 months, 2.5% at 9 months, 6.5% at 12 months, 2.2% at 15 months, and 2.9% at 18 months.

    “Rates of suicidal behavior at each time point were lower but also elevated: 33.6% at baseline, 8.4% at 3 months, 6.2% at 6 months, 2.5% at 9 months, 6.5% at 12 months, 2.2% at 15 months, and 2.9% at 18 months”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Higher-than-usual peer stress predicted greater risk of suicidal behavior only among subjects with blunted/lower (-1 SD) CORT AUCi; in subjects with high (+1 SD) CORT AUCi, higher-than-usual stress did not predict behavior.

    “Simple slopes (Table 3) of peer stress predicting suicidal behavior at high vs. low CORT AUC i suggest that higher-than-usual peer stress predicts greater risk of behavior only among subjects with blunted/lower (-1 SD) CORT AUC i ; in subjects with high (+1 SD) CORT AUC i , higher-than-usual stress did not predict behavior.”
    • Also stated in: § Abstract · plain
      “Higher-than-usual peer stress predicted suicidal ideation regardless of HPA function, but predicted suicide attempt only among those with blunted cortisol responses.”
    • Also stated in: § DISCUSSION · plain
      “and (2) that periods of elevated peer stress increase risk of suicidal behavior only among subjects with blunted CORT responses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Rates of suicidal ideation at each time point were relatively high, reflecting clinical enrichment: 49.4% at baseline, 25.6% at 3 months, 19.1% at 6 months, 20.1% at 9 months, 18.8% at 12 months, 13.6% at 15 months, and 18.5% at 18 months.

    “Rates of suicidal ideation at each time point were relatively high, reflecting the clinical enrichment of our sample: 49.4% at baseline, 25.6% at 3 months, 19.1% at 6 months, 20.1% at 9 months, 18.8% at 12 months, 13.6% at 15 months, and 18.5% at 18 months.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Although all stressors predicted ideation, only peer stress predicted suicidal behavior in adolescents with blunted CORT responses.

    “Although all stressors predicted ideation, only peer stress predicted suicidal behavior in adolescents with blunted CORT responses.”
    • Also stated in: § CONCLUSIONS · hedged
      “Specifically, peer stress appears to be prospectively linked with acute risk of suicidal behavior, but only among subjects with blunted HPA axis responses to psychosocial stress.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The smallest detectible odds ratio for suicidal behavior across follow-up was 1.36, a conventionally small effect.

    “the smallest detectible odds ratio for any single predictor (given R 2 other X = 0.25, power = 0.8, and α = 0.05) was 1.36-a conventionally small effect.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Blunted CORT responses to psychosocial stress might promote suicidal behavior by impairing glucocorticoid regulation of inflammatory immune signaling.

    “Blunted CORT responses to psychosocial stress might promote suicidal behavior by impairing glucocorticoid regulation of inflammatory immune signaling.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Blunted CORT response to the TSST has been found in hyperactive-impulsive type ADHD.

    “Blunted CORT response to the TSST has also been found in hyperactive-impulsive type ADHD [37]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] West D, van, Claes S, Deboutte D. Differences in hypothalamic–pituitary–adrenal axis functioning among children with ADHD predominantly inattentive and combined types. Eur Child Adolesc Psychiatry. 2009;18:543–53. source

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

    Interpretationreasoning

    Cognitive dysfunction may be one mechanism by which blunted CORT response to stress increases risk for suicidal behavior during peer stress.

    “Cognitive dysfunction may be one mechanism by which blunted CORT response to stress increases risk for suicidal behavior during peer stress.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The smallest detectible effect size for the descriptive CORT analyses was f = 0.087, a conventionally small effect.

    “Sensitivity analyses (CORT ICC = 0.54; L2N = 220 subjects; L1N = 1205 assessments; adjusted N = 352 assessments; power = 0.8; α = 0.05; nonsphericity correction = 0.75) indicated that the smallest detectible effect size was f = 0.087-a conventionally small effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Moderate CORT response facilitates cognitive function during stress and serves to limit the intensity and duration of stress responses across multiple systems.

    “Moderate CORT response facilitates cognitive function during stress [20] and serves to limit the intensity and duration of stress responses across multiple systems (e.g., immune, sympathetic).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Wingenfeld K, Wolf OT. Effects of cortisol on cognition in major depressive disorder, posttraumatic stress disorder and borderline personality disorder—2014 Curt Richter Award Winner. Psychoneuroendocrinology. 2015;51:282–95. source

  • May combine two claims.

    Interpretationown data

    Peer stress serves to trigger suicidal ideation among female youth, but only triggers suicidal behavior among those with blunted cortisol reactivity.

    “Results suggest that peer stress serves to trigger suicidal ideation among female youth, but only triggers suicidal behavior among those with blunted cortisol reactivity.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The modified adolescent TSST is a standard psychosocial stressor that produces robust CORT responses.

    “a standard psychosocial stressor that produces robust CORT responses [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Allen AP, Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test. Neuroscience & Biobehavioral Reviews. 2014 Jan 1;38:94-124. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    The present study adds to a growing literature linking altered HPA axis regulation to suicidal behavior.

    “Therefore, the present study adds to a growing literature linking altered HPA axis regulation to suicidal behavior.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The study procedures were approved by the institutional review board.

    “Procedures were approved by the institutional review board.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    One should be cautious in generalizing findings to specific clinical groups, since various suicidality subtypes with differing pathophysiology are hypothesized.

    “Finally, one should be cautious in generalizing findings to specific clinical groups, since various suicidality subtypes with differing pathophysiology are hypothesized.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The correlational nature of our study is a limitation when considering causality.

    “The correlational nature of our study is a limitation when considering causality”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The use of a single measure of HPA axis stress response is a limitation.

    “The use of a single measure of HPA axis stress response is a limitation”
    Quote in the paperNot a substantial claim
27 of 27

  • The paper relies on this without support.

    Most diathesis-stress models of suicidal thoughts and behavior are rarely tested.

    “Most models of suicidal thoughts and behavior propose that they arise due to dynamic interactions between stable risk factors (e.g., biological diatheses) and acute environmental stressors; however, such models are rarely tested.”

  • The paper relies on this without support.

    The specificity of peer stress (vs. academic or parental stress) as a precipitant has never been fully tested.

    “although the specificity of peer stress (vs.academic or parental stress) as a precipitant has never been fully tested.”

  • The paper relies on this without support.

    Most individuals do not experience suicidal ideation or behavior during episodes of peer stress.

    “While normative increases in psychosocial sensitivity occur, most individuals do not experience suicidal ideation or behavior during episodes of peer stress.”

  • The authors state this as an assumption.

    Incomplete data are missing completely at random.

    “Models were fit assuming incomplete data as missing completely at random (MCAR; e.g., [29,30]).”

  • The paper relies on this without support.

    Peer stress is a developmentally salient stressor for adolescent females.

    “Diathesis-stress models of suicide often emphasize precipitating roles of developmentally salient stressors; female adolescents experience normative increases in sensitivity to social evaluation that may serve as triggers for suicidal behavior among at-risk individuals.”

  • The paper relies on this without support.

    Social threats are accompanied by inflammatory brain signaling that is normatively downregulated by CORT at the glucocorticoid receptor (GR).

    “Social threats are accompanied by inflammatory brain signaling that is normatively downregulated by CORT at the glucocorticoid receptor (GR).”

  • The paper relies on this without support.

    Research on the development of suicidal behavior in adolescent females has been limited by cross-sectional approaches that do not accurately model the interactive, multilevel nature of suicide risk as it unfolds over time.

    “Research on the development of suicidal behavior in adolescent females has been limited by cross-sectional approaches that do not accurately model the interactive, multilevel nature of suicide risk as it unfolds over time.”
7 of 7

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(860) = 5.96reported p < .0001 · recomputed p < .001

    “t(860) = 5.96, p < .0001”

  • Consistentt(860) = 2.15reported p = .03 · recomputed p = .032

    “t(860) = 2.15, p = .03”

  • Consistentt(860) = 0.2reported p = .84 · recomputed p = .842

    “t(860) = 0.20, p = .84”

  • Consistentt(682) = -2.11reported p = .035 · recomputed p = .035

    “t(682) = -2.11,p = .035”

  • Consistentt(689) = -2.07reported p = .038 · recomputed p = .039

    “t(689) = -2.07,p = .038”

  • Consistentt(682) = -1.01reported p = .31 · recomputed p = .313

    “t(682) = -1.01,p = .31”

6 of 6

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different references are numbered 33

    Minor

    The reference list assigns number 33 to two distinct publications, making citations to that number ambiguous.

  • Mean age differs between the sample description and Table 1

    Minor

    Both passages describe 220 participants, but the sample description gives a mean age of 14.69 years and SD of 1.37, while Table 1 gives 14.67 and 1.36. The differences exceed rounding at the printed precision.

  • The stated model link conflicts with its logistic interpretation

    Minor

    A binary model with a log link is not a logistic model, which uses a logit link. The paper describes the same outcome models both ways, leaving the reported odds-ratio interpretation inconsistent with the stated link.

  • High-cortisol slope has an incompatible standard error and confidence interval

    Minor

    For the high-cortisol simple slope, a coefficient of 0.01 with SE 0.009 would yield an odds-ratio 95% interval of approximately 0.99-1.03, not the reported 0.63-1.61.

4 of 4

Cites

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1 of the 54 references couldn’t be matched to a known paper.

Cited by

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Related

Authors
Eisenlohr-Moul, T. A., Miller, A. B., Giletta, M., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J.
Affiliations
  • University of Illinois Chicago (US)
  • University of North Carolina at Chapel Hill (US)
  • Tilburg University (NL)
  • University of California, Davis (US)
  • University of Illinois Urbana-Champaign (US)
  • Harvard University (US)
Corresponding author
Eisenlohr-Moul, Tory A.
ORCID
Venue
Neuropsychopharmacology
Publisher
Springer Science and Business Media LLC
Published
2018-09-06
Volume
43
Issue
13
Pages
2564-2571
ISSN
  • 0893-133X (ISSN-L)
  • 1740-634X
DOI
10.1038/s41386-018-0206-6
PMC
PMC6224611
OpenAlex
W2890063457
Semantic Scholar
8059e0af0d710d841c8c1c84383a95f8c3035fb4
Cited by
87
References
54
Citations by year
2026: 7 · 2025: 14 · 2024: 13 · 2023: 15 · 2022: 14 · 2021: 11 · 2020: 5 · 2019: 7 · 2018: 1
FWCI
7.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuropsychopharmacology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • Research portal (Tilburg University) (publishedVersion)
  • PubMed (publishedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • UNC Libraries
Funders
U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (K99MH109667, F32MH108238, R01MH085505, R01MH107479)
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, suicidal behavior, adolescent girls, hypothalamic-pituitary-adrenal axis, cortisol response, peer stress, psychosocial stress, diathesis-stress model, suicide attempts, Trier Social Stress Test, academic stress
MeSH terms
Adolescent, Adolescent Behavior, Child, Disease Susceptibility, Female, Follow-Up Studies, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Predictive Value of Tests, Stress, Psychological, Cohort Studies, Suicidal Ideation

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 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

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.

What counts as a claim ›How we measure confidence ›How we check this ›

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