Cortisol Levels in Childhood Associated with Emergence of Attenuated Psychotic Symptoms in Early Adulthood

Ae Cullen,H.L Fisher,N Gullet,E.R Fraser,R.E Roberts,U Zahid,M To,N Yap,P.A Zunszain,C.M Pariante,S.J Wood,P Mcguire,R.M Murray,V Mondelli,K.R Laurens

doi:10.1016/j.psyneuen.2021.105553

Abstract

In youth at clinical high-risk for psychosis, cortisol elevations predict transition to psychosis, but it is unclear whether cortisol alterations are evident at an earlier clinical stage. We investigated whether cortisol levels and stressors in childhood were associated with later attenuated psychotic (AP) symptoms. A sample of children (N=109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. AP symptoms were assessed at T2. Diurnal cortisol (β = 0.915, 95% CI: 0.062, 1.769) and daily stressors (β = 0.379, 95% CI: 0.034, 0.723) at T1 were independently associated with AP symptoms at T2 after accounting for demographic factors and T1 psychopathology. Exploratory analyses indicated a significant interaction between diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081, 1.405), with the highest predicted T2 AP symptoms occurring when both were increased. Daily stressors and diurnal cortisol elevations during late childhood (a neurodevelopmentally vulnerable time-period) confer risk for developing AP symptoms.

Highlights

There is convincing evidence implicating psychosocial stressors in the development and exacerbation of psychotic disorders [1,2,3,4,5,6,7]
The current sample includes 109 participants who were assessed at time 1 (T1) and time 2 (T2)
We find that that diurnal cortisol and daily stressors were independently associated with total Prodromal Questionnaire (PQ) score after accounting for demographic factors and prior psychopathology, and provide preliminary evidence that these factors interacted in predicting total PQ score

Summary

Introduction

There is convincing evidence implicating psychosocial stressors (e.g., major life events, daily stressors, and childhood trauma) in the development and exacerbation of psychotic disorders [1,2,3,4,5,6,7]. Individuals with psychosis and those at-risk for the disorder (either due to a family history of psychosis and/or clinical features) have been found to show HPA axis alterations, meta-analyses indicate substantial heterogeneity across studies [12,13,14,15,16] These alterations include elevations in basal and diurnal cortisol levels in blood and saliva1 [12,13,14, 17,18,19,20,21] and increased pituitary volume [15, 21, 22], but diminished salivary cortisol secretion in response to acute stress exposure [16, 23,24,25] and awakening 2 [21, 26,27,28].

Methods

Results

Conclusion