Intimate Partner Violence, Mental Health, and HPA Axis Functioning

Abstract

Research results are mixed as to whether stress exerts its damaging effects via underor over-production of diurnal cortisol. Facets of the stressor itself as well as the mental health sequelae that follow have been put forward as important considerations in determining levels of cortisol secretion. We hypothesized that the contradictory findings in the literature were the result of variable-oriented methods masking the presence of distinctive subgroups of individuals. Using person-oriented methods, we explored whether there were classes of women who exhibited unique profiles of cortisol secretion, stress, and mental health by assessing 182 community women, many of whom had experienced intimate partner violence. The best fitting model in a latent profile analysis had 5 groups, each with distinct profiles of intimate partner violence stress (pregnancy and postpartum), cortisol secretion [cortisol awakening response (CAR) and diurnal slope], and mental health (posttraumatic stress, depressive, and anxiety symptoms). These were a Physiologically Under-Responsive group, a Healthy group, a Problematic CAR group, a Highest Stress/Normal Diurnal Slope group, and a Moderate Psychopathology/Normal Diurnal Slope group. Except for the Healthy group, the specific patterns of stress, mental health symptoms, and cortisol secretion identified in the literature were not found. The profiles were validated using variables that, in prior research, had shown relationships with the variables used to constitute the profiles—three types of parenting (neglectful, sensitive, and harsh), antisocial behavior, and physical health. We concluded that there is heterogeneity in women’s responses to stress. Current theories focused on the underor over-production of diurnal cortisol in relation to stress and mental health symptoms are simplistic and fail to account for the significant subgroups of women who show unique biological and psychological responses.