Alterations in stress cortisol reactivity in depressed preschoolers relative to psychiatric and no-disorder comparison groups
Alterations in stress cortisol reactivity in depressed preschoolers relative to psychiatric and no-disorder comparison groups
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DOI：
10.1001/archpsyc.60.12.1248
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发表时间：
2003-12-01
影响因子：
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通讯作者：
Spitznagel, E
中科院分区：
文献类型：
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作者：
Luby, JL;Heffelfinger, A;Spitznagel, E
背景资料：尽管在抑郁症成人中下丘脑-垂体-肾上腺（HPA）轴反应性升高的发现是可靠的和广泛重复的，但对抑郁症儿童的研究却得出了模糊的结果。早期抑郁症的动物模型和对经历早期心理社会剥夺的儿童的研究表明，HPA轴反应性的改变在早期“抑郁样”状况中是明显的。目前的研究是，据我们所知，第一次调查HPA轴反应在非常年轻的儿童与临床抑郁syndrome的内容效度已established.Methods：抑郁症，精神病，和无障碍的比较儿童年龄3至5.6岁的HPA轴反应实验心理社会压力进行了研究。这些儿童是使用发育适当的，结构化的精神病学访谈进行诊断的。唾液皮质醇在3个时间点，在实验室评估之前和之后的压力源，涉及分离从父母和令人沮丧的tasks.Results：重复测量的多变量方差分析显示诊断组和2皮质醇百分比变化分数之间的显着相互作用。抑郁的学龄前儿童在整个评估过程中表现出一种皮质醇水平增加的模式，以应对分离和挫折压力。与此相反，两个对照组表现出减少皮质醇水平的分离应激。所有的小组在面对令人沮丧的任务时都表现出皮质醇水平的上升。学龄前儿童与推定的抑郁亚型显示这些变化在一个更大的幅度相对于comparationgroups.Conclusions：据我们所知，这些研究结果是第一次证明改变HPA轴反应性抑郁的学龄前儿童。这些变化与抑郁症成年人和早期抑郁症动物模型中描述的变化一致。这些研究结果提供了证据，可能的连续性HPA轴改变抑郁症在整个生命周期中，并讨论了在临床抑郁症儿童和青少年的HPA轴反应性的背景下，以前的研究表明，年龄较小和住院状态与HPA轴反应性改变的功能。
Background: Despite the robust and widely replicated finding of elevated hypothalamic-pituitary-adrenal (HPA) axis reactivity in depressed adults, studies of depressed children have yielded ambiguous findings. Animal models of early depression and studies of children experiencing early psychosocial deprivation have suggested that alterations in HPA axis reactivity are evident in early "depressive-like" conditions. The current study is, to our knowledge, the first investigation of HPA axis reactivity in very young children with a clinical depressive syndrome for which content validity has been established.Methods: Depressed, psychiatric, and no-disorder comparison children aged 3 through 5.6 years were studied for HPA axis reactivity in response to experimental psychosocial stressors. The children were diagnosed using a developmentally appropriate, structured psychiatric interview. Salivary cortisol was obtained at 3 time points during a laboratory assessment before and after stressors involving separation from the parent and frustrating tasks.Results: Repeated measures of multivariate analysis of variance revealed a significant interaction between the diagnostic group and 2 cortisol percent change scores. Depressed preschoolers displayed a pattern of increasing cortisol levels throughout the assessment in response to both separation and frustration stressors. In contrast, both comparison groups showed decreasing cortisol levels in response to the separation stressor. All groups displayed increasing cortisol levels in response to frustrating tasks. Preschoolers with a presumptive melancholic depressive subtype displayed these alterations at a greater magnitude relative to comparison groups.Conclusions: To our knowledge, these findings are the first to demonstrate altered HPA axis reactivity in depressed preschoolers. These alterations are consistent with those described in depressed adults and in animal models of early depression. These findings provide evidence for possible continuity of HPA axis alterations in depressive disorders across the lifespan and are discussed in the context of prior studies of HPA axis reactivity in clinically depressed children and adolescents, suggesting that younger age and inpatient status are features associated with altered HPA axis reactivity.