Higher Cortisol Awakening Response Research Articles

Parental depression moderates the relationships of cortisol and testosterone with children's symptoms

BackgroundPrevious research on the hormone-symptom relationship in children suggests that certain hormone patterns may be associated with symptoms, but only under certain circumstances. Having a parent with a history of depression may be one circumstance under which dysregulated hormone patterns are especially associated with emotional and behavioral symptoms in children. The current study sought to explore these relationships in a community sample of 389 9-year-old children. MethodsChildren's salivary cortisol and testosterone levels were collected at home over three consecutive days; parental psychiatric histories were assessed using semi-structured diagnostic interviews; and children's internalizing and externalizing symptoms were rated by the child's mother. ResultsHaving two parents with a history of depression moderated the associations of reduced total daily cortisol output with higher externalizing scores, as well as the association of reduced testosterone with higher internalizing scores. A maternal history of depression, on the other hand, moderated the relationship between higher cortisol awakening response and higher internalizing scores. Furthermore, lower daily cortisol output was associated with higher internalizing scores among girls, but not boys, with two parents with a history depression. LimitationsLimitations include the cross-sectional nature of the current analyses, as well as the limited racial, ethnic, and geographical diversity of the sample. ConclusionsTaken together, the current results suggest that the relationship between hormones and internalizing and externalizing symptoms in children may vary as a function of parental depression and child sex, knowledge that may inform intervention efforts aimed at preventing psychopathology in children whose parents have a history of depression.

High cortisol awakening response in the aftermath of workplace violence exposure moderates the association between acute stress disorder symptoms and PTSD symptoms

Although a majority of people will be exposed to a traumatic event over the course of their lifespan, only a minority will develop post-traumatic stress disorder. Better understanding the factors contributing to the development of this psychopathology is of high importance and could significantly reduce the societal and human costs associated with PTSD. Acute stress disorder symptoms, which refers to clinical manifestations experienced in the aftermath of a traumatic event, have been shown to be associated with subsequent PTSD symptoms. Yet, many people who develop PTSD do not meet criteria for acute stress disorder in the first place, highlighting the need to refine the predictors of PTSD. The secretion of the stress hormone cortisol is dysregulated in PTSD patients. Whether combining clinical and biological measures in the aftermath of trauma could help to better explain subsequent PTSD symptoms remains to be tested. The current prospective study recruited 51 adults who were exposed to a traumatic event in their work setting, i.e. a psychiatric hospital. Acute stress disorder symptoms and cortisol awakening responses were assessed one to five weeks following trauma exposure (Time 1). PTSD symptoms were measured two months following trauma exposure. Results revealed a significant interaction between acute stress disorder symptoms and cortisol awakening response in predicting later PTSD symptoms. The results suggest that higher cortisol awakening response is a protective factor in that it abolishes the relationship between acute stress disorder symptoms and subsequent PTSD symptoms. These results point to the importance of considering multi-level information in the aftermath of trauma, such as clinical and biological measures, in order to better identify individuals who are at higher risk of developing PTSD.

Abstract # 3129 Stress management and immune-physiological changes in emergency teams during rescue operations

Background Emergency medical teams experience stress not only from traumatic events, but also from many small stressors during their everyday work. Despite the high stress level, paramedics seem to ignore or even negate the stress. As this can be detrimental and lead to stress-related diseases, the aim of this study is to empirically investigate the divergence between physiological and psychological stress responses of paramedics compared to healthy controls. Methods Participants were 19 paramedics and 17 age- and sex-matched white-collar workers as controls. We assessed psychological stress parameters with self-report questionnaires. Cortisol levels were measured as cortisol awakening response (CAR) using saliva samples and the quantification of immune parameters was performed in blood. Results Absolute leucocyte count did not differ significantly between paramedics and control. However, the CAR was higher in paramedics compared to controls. Despite the higher CAR, the answers in the questionnaires regarding chronic stress, burnout, satisfaction about life and health did not differ between paramedics and controls. Conclusions Paramedics have higher cortisol values compared to controls, thus suggesting higher stress. As expected, we did not find a difference between paramedics and controls in the subjective reports, supporting the assumption that paramedics negate their daily stress, probably due to high identification with their job. Our findings underline the importance to develop stress-management interventions for paramedics including a sensitization of paramedics for their stress reactions.

The relationship between diurnal cortisol secretion and climacteric-related symptoms

ObjectivesChronic stress, also associated with climacteric-related symptoms, may influence cortisol secretion. We studied cortisol metabolism in peri- and postmenopausal women with diverse climacteric-related symptoms. Study design and main outcome measuresThe study population was 35 women, aged 45–70 years. Plasma cortisol levels were measured from blood samples collected every 20 min over 24 h. Urinary cortisol was analysed from 24-hour urine collections. Climacteric-related symptoms (vasomotor, sleep, depressive, anxiety, cognitive, sexual, menstrual, and somatic) were evaluated with the Women’s Health Questionnaire (WHQ). Associations between cortisol variables (24-hour, night, day, maximum, minimum, morning baseline, cortisol awakening response (CAR), area under the curve, slope, and 24-hour urinary cortisol) and the symptoms were first examined with a correlation analysis. Then, the women were divided into two groups according to their climacteric symptomatology, and differences in cortisol variables between the groups were investigated. Diurnal cortisol curves by symptomatology were also analyzed visually. ResultsIn the correlation analysis, more frequent vasomotor symptoms were associated with a higher CAR (rs = 0.37, p = 0.039) and lower 24-hour urinary cortisol excretion (rs= -0.45, p = 0.012), and more frequent depressive symptoms were associated with a higher minimum cortisol level (rs = 0.33, p = 0.0498). When the women were divided into two groups, women with more frequent vasomotor (p = 0.012) or somatic symptoms (p = 0.021) had a lower 24-hour urinary cortisol excretion than less symptomatic women. ConclusionsAlthough previous studies have reported associations between climacteric-related symptoms and cortisol secretion, these two factors were not substantially interrelated in our study.

Being an optimist or a pessimist and its relationship with morning cortisol release and past life review in healthy older people

Objective: Investigate the relationship between optimism and pessimism and the cortisol awakening response (CAR) and past life review in healthy older people.Design: 76 older volunteers summarised their lives, highlighting the most important events, impressions and experiences. Cortisol saliva samples were collected on two consecutive weekdays. High and low optimism and pessimism groups were computed by mean split.Main Outcome Measures: Percentages of positive (PE) and negative events (NE) and positive (PCE) and negative cognitions and emotions (NCE) were obtained. Optimism and pessimism were measured with the Life Orientation Test Revised. The areas under the curve with respect to the ground and with respect to the increase were computed, with the latter understood as the CAR.Results: The high pessimism group reported more NE and NCE and less PE and PCE (p’s < 0.041). No significant differences in CAR were found between high and low optimism and pessimism groups after removing suspected non-adherent participants (p’s > 0.116). Higher CAR was related to lower PCE, but higher NCE (both p < 0.008).Conclusion: Pessimism seems to increase the focus on negative aspects of the past, which may lead to a worse perception of life in ageing, whereas optimism contributes to a healthier CAR.

Adolescents' Daily Worry, Morning Cortisol, and Health Symptoms

PurposeTo assess short-term effects of daily worries on hypothalamic-pituitary-adrenal axis activity and later implications for adolescents' health symptoms. We hypothesized that heightened worry would be associated with stronger next-morning cortisol awakening response (CAR) to prepare the body for the demands of the upcoming day. Guided by biological adaptation to stress theories, we also hypothesized that dysregulated CAR would heighten associations between worries and later health symptoms, while also testing direct associations between worries and dysregulated CAR and health. MethodsNinety-nine late adolescents during waves 5 and 6 of a longitudinal study reported on 26 worries for 10 days. On 3 of the 10 days, participants also provided morning saliva samples that were assayed for cortisol to capture the CAR. At both waves, participants reported on 22 common health symptoms. ResultsMultilevel models showed significant within-person associations between high daily worries and next-morning heightened CAR for females. Contrary to expectation, worries were inversely related to concurrent health symptoms. For the whole sample, CAR moderated the effect of worries on later health symptoms: Worries were positively associated with health symptoms in adolescents with high CAR and inversely associated with health symptoms for those with low CAR. ConclusionsIn this sample of typically developing adolescents, worries alone do not increase the risk for common health complaints and may be somewhat protective in the short run. However, high worries in the context of high CAR appear to increase the risk for health symptoms.

Cortisol awakening response among women exposed to intimate partner violence

The studies of the effects of intimate partner violence (IPV) on the cortisol awakening response (CAR) are scarce and contradictory. While some of the studies suggested that female victims of IPV showed high CAR, other studies found low CAR. Mixed results may be related to differences in sample characteristics as well as other potential covariates associated with the cortisol, as femalés history of abuse, chronicity, severity and type of IPV, psychological distress, posttraumatic stress disorder, and social support. The study examined individual differences in CAR among 149 female victims of severe IPV reported to authorities, including 76 (51%) living in shelter and 73 (49%) living with the abusive partners. Results revealed several individual differences in CAR that may contribute to understanding the mixed results found in literature, including women with cortisol that decreased between the baseline and 30min later, women with no increase of cortisol, and women whose cortisol increased above baseline. Additionally, women without CAR experienced more chronic and severe violence, more psychological distress and PTSD symptoms. However, hierarchical multiple regression indicated that chronic severe violence was the only independent variable that significantly explained 13% of the variance in CAR, even after including all covariates in the model, and adjusting for sociodemographic variables. In conclusion, this study suggests that the HPA axis dysregulation is influenced by chronic severe violence among women victims of IPV.

Neuroanatomical correlates of HPA axis biomarkers among children at elevated risk for schizophrenia

Background: The hypothalamic-pituitary-adrenal (HPA) axis disturbances observed in psychosis might feasibly contribute to some of the structural brain abnormalities associated with the disorder (i.e., via the potentially toxic effects of elevated glucocorticoid levels on the brain). However, the association between brain structure and cortisol has rarely been investigated. The current study examined relationships between salivary cortisol and regional brain volumes among at-risk children aged 11-14 years, who present multiple antecedents of schizophrenia (ASz=30) or a family history of illness (FHx=22), and typically-developing children (TD=32). Methods: Volumes of specific brain regions known to express glucocorticoid receptors were extracted from structural brain images using FreeSurfer. Diurnal cortisol levels and the cortisol awakening response (CAR) were determined from multiple salivary cortisol samples obtained throughout the day. Results: In the FHx group only, higher diurnal cortisol was correlated with smaller right amygdala and white matter hypointensity volumes (r=-0.51 and -0.62, respectively, p<0.05). In post-hoc analyses, a higher CAR was associated with smaller bilateral cerebellum, bilateral hippocampus, right ventral diencephalon, and total subcortical grey matter volumes among FHx children with a first-degree relative with schizophrenia. In FHx children with an affected second-degree relative, increased diurnal cortisol levels were associated with smaller left hippocampal and white matter hypointensity volumes. Conclusions: Our findings are consistent with the few previous studies examining cortisol and brain structure among adults with established psychosis. These associations may not necessarily reflect a direct effect of cortisol on the developing brain; indeed, abnormal neurodevelopment affecting these brain regions may contribute to HPA-axis dysregulation. Funding: This work was supported by a Sir Henry Wellcome Postdoctoral Fellowship (107395/Z/15/Z) and a Waterloo Foundation Child Development Fund grant (164/1719)

Inter-relation between autonomic and HPA axis activity in children and adolescents

Stress research in youth typically considers either the autonomic nervous system or HPA axis. However, these systems are highly coordinated and physically interconnected. We examined whether the inter-relation between cardio-autonomic and HPA axis measures was better associated with perceived stress than their singular associations. Children and adolescents (N=201) collected saliva samples to measure cortisol (AUCAG, AUCI, maximum), wore an electrocardiogram monitor for 24h to derive heart rate variability (HRV; LF, HF, LF/HF ratio), and completed the Perceived Stress Scale. The interaction between sympathovagal modulation (LF, LF/HF ratio) and cortisol awakening response (AUCAG, AUCI, maximum) explained significantly greater variance in perceived stress than either stress system alone. Higher sympathovagal modulation combined with higher cortisol awakening response was associated with greater perceived stress. Findings suggest that the inter-relation between cardio-autonomic and HPA axis activity may advance our understanding of how stress impacts health.

High Anger Expression is Associated with Reduced Cortisol Awakening Response and Health Complaints in Healthy Young Adults.

The extant evidence suggests a robust positive association between expression (anger expression-out) and suppression (anger expression-in) of anger and compromised health. Nevertheless, the underlying psychobiological mechanisms which explain these relationships are not well understood. This study examined whether anger expression would predict general health, cortisol awakening response (CAR) and evening cortisol levels in a community sample of 156 healthy young adults of both genders. Participants were distributed into two groups according to their anger expression scores: high and low anger expression (HAE and LAE, respectively). Findings indicated that those with HAE had worse self-reported health (p = .02) and higher CAR than the LAE group (p = .04). Moreover, high levels of anger expression-out (p < .01) and -in (p < .01, for all) predicted a worse self-reported health in both groups. On the other hand, high anger expression-out was associated with flattened CAR but only in the HAE group (p < .01). This study reinforces the need to develop effective strategies to provide mechanisms to regulate anger expression by promoting personal growth and positive skills that enhance individuals' well-being and quality of life and, in turn, their own health.

Daily salivary cortisol profile: Insights from the Croatian Late Adolescence Stress Study (CLASS).

IntroductionThe aim of the study was to examine basal hypothalamic-pituitary-adrenal (HPA) axis activity and to determine associations of various covariates (gender, sleep-wake rhythm, demographic, academic, life style and health-related characteristics) with altered daily salivary cortisol profiles in late adolescence.Materials and methodsThe total analytic sample consisted of 903 Croatian secondary school students aged 18 - 21 years (median 19 years). Salivary cortisol was sampled at home at three time points over the course of one week and its concentrations were measured by using the enzyme immunoassay.ResultsIn comparison to males, female students had a higher cortisol awakening response (CAR) (median 4.69, IQR 10.46 and median 3.03, IQR 8.94, respectively; P < 0.001), a steeper (“healthier”) diurnal cortisol slope (DCS) (median 0.51, IQR 0.55 and median 0.44, IQR 0.51, respectively; P = 0.001), and a greater area under curve with respect to ground (AUCG) (median 206.79, IQR 111.78 and median 191.46, IQR 104.18, respectively; P < 0.001). Those students who woke-up earlier and were awake longer, had a higher CAR (P < 0.001), a flatter (“less healthy”) DCS (P < 0.001), and a greater AUCG (P < 0.001), than students who woke-up later and were awake shorter. Less consistent but still significant predictors of salivary cortisol indexes were age, school behaviour, friendship, diet healthiness and drug abuse.ConclusionGender and sleep-wake up rhythm were major determinants of the altered daily salivary cortisol profiles in late adolescence. The predictive power of other covariates, although less clear, has a potential for identifying vulnerable subgroups such as male drug users and females without a best friend.

Cortisol, Health, and Coping in Patients with Nonspecific Low Back Pain.

Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to "stress". Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.

High reactivity of the cortisol awakening response predicts positive treatment outcome in heterogeneous depressed patients completing an alternate milieu inpatient program

ObjectiveDelineating clinically meaningful subgroups within heterogeneous depressed populations is a major challenge. As outlined in the Research Domain Criteria Strategy, biomarkers may help to empirically classify such patients. Following this basic strategy, the current pilot study examined whether the cortisol awakening response (CAR) following admission to hospital predicts treatment response in heterogeneous depressed patients completing a 4-week alternate milieu inpatient program. MethodsThe Alternate Inpatient Milieu program at the Centre for Addiction and Mental Health is composed of both individual-based and group-based programming designed to promote a recovery-oriented, collaborative treatment environment. The current sample consisted of 25 consecutive patients with various forms of complex/chronic depression who completed the full program. Saliva samples were collected at 0, 30 and 60 min after awakening on 2 consecutive days following admission. Linear regressions controlling for baseline depression scores were used to assess whether the CAR AUCg (area under the curve ground) and/or AUCi (area under the curve increase) at admission predicted the change in depression scores from admission to discharge based on the Quick Inventory of Depressive Symptoms scale. ResultsThe CAR AUCi, but not the CAR AUCg, at admission significantly predicted treatment response over the 4-week hospital stay. In these naturalistic patients with major depressive disorder, high CAR reactivity as assessed using the AUCi was associated with a better treatment response (t=2.20; df=2,24; P=.039). The CAR was easy to implement and well accepted by patients and staff. ConclusionThis pilot study suggests that CAR reactivity at admission may help to identify a subgroup of depressed patients most likely to respond clinically to a 4-week alternate milieu inpatient program.

High cortisol awakening response and cortisol levels moderate exposure-based psychotherapy success

Research suggests that elevated stress hormones during exposure can facilitate fear extinction in laboratory settings. However, prospective studies on the clinical benefits of endogenous cortisol on clinical improvements in naturalistic exposures are lacking. Twenty-six patients with panic disorder and agoraphobia completed three weekly in-vivo exposure sessions and a fourth session 2 months following therapy completion, resulting in a total of 94 in-vivo exposure sessions. Salivary cortisol was collected at multiple times during the first exposure day (cortisol morning response, prior, -during, -after exposure) and at subsequent exposure sessions (prior, -during, -after exposure). Cortisol collection on a non-exposure comparison day followed the same time schedule as session 1. Exposure day anxiety and cortisol levels were significantly higher than control day levels. Higher absolute cortisol levels during exposures moderated clinical improvement (avoidance behavior, threat appraisal, perceived control). Therapeutic gains were not just related to exposure day cortisol levels, but were also linked to non-exposure day levels. Greater morning rises in cortisol on exposure day predicted greater treatment gains, but greater rises on the control day were associated with poorer outcomes. The study provides first evidence for a moderating effect of cortisol awakening response and absolute cortisol levels on fear extinction processes during naturalistic, prospective exposure-therapy. Additionally, we replicated and extended prior findings on the therapeutic benefits of high exposure cortisol levels. Together, the findings suggest that cortisol may act as a general moderator of facilitated learning during exposure therapy.

Dietary Intake, Eating Behaviors, and Diurnal Patterns of Salivary Cortisol and Alpha-Amylase Secretion Among Professional Young Adult Female Tennis Players.

The aims of study were to examine the eating behaviors among 26 professional female tennis players and to assess the diurnal patterns of stress hormones through the measurement of awakening and diurnal profiles of salivary alpha-amylase (sAA) and cortisol concentrations. Eating behaviors were assessed through three questionnaires (Eating Attitudes Test-26; Eating Disorders Inventory 2; and Body Shape Questionnaire), food intake by a 7-day diet record, and menstrual status by questionnaire. Perceived stress scale and anxiety state were also evaluated. Saliva samples were collected at awakening, 30 min, 60 min, and 12 hr post awakening after 6-days' rest. Forty-six percent of tennis players presented Disordered Eating attitudes (DE) (n = 12) with a lower body mass index, and higher state anxiety as compared with the group without DE. No differences in the Perceived Stress Scale scores were noted. Mean energy intake, protein and carbohydrates intakes were lower (p < .05) in the DE group as compared with the group without DE. Although in both groups, sAA concentrations presented a decrease in the first 30 min after awakening, and then progressively rose toward the afternoon, DE players exhibited reduced concentrations of the sAA with a decrease in its overall day secretion. Moreover, they showed a higher overall day secretion of salivary cortisol and a higher Cortisol Awakening Response. These results suggest that the activity of the sympathetic nervous system is impaired whereas the cortisol awakening response is enhanced. The long-term consequences of these modifications on health remain to be elucidated.

Increased cortisol awakening response was associated with time to recurrence of major depressive disorder.

Although HPA-axis activity has been studied extensively in relation to depression, there is no consensus whether HPA-axis parameters predicts major depressive disorder (MDD) recurrence. We investigated whether HPA-axis parameters (cortisol awakening response (CAR), the dexamethasone suppression test (DST) and evening cortisol) predict time to recurrence in remitted subjects with a history of MDD and whether childhood trauma and life events interact with HPA-axis parameters in increasing the risk for recurrence. Data were derived from 549 subjects with a lifetime diagnosis of MDD in remission for at least six months preceding the baseline assessment of the Netherlands Study of Depression and Anxiety (NESDA). Subjects were followed up with two interviews over the course of four years to assess recurrence. DSM-IV based diagnostic interviews were used to assess time to recurrence of MDD. Seven salivary cortisol samples collected at baseline with information on CAR, evening cortisol and the DST. Hazard ratios were calculated using Cox regression analysis, adjusted for covariates. A higher CAR was associated with time to recurrence of MDD (HR=1.03, 95%CI 1.003-1.060, p=0.03) whereas evening cortisol and DST were not. No interactions between HPA-axis parameters and stress-related factors were found. Our data support previous studies reporting that subjects with a higher CAR are more vulnerable to recurrence of MDD.

Children’s stress influences their diet, physical activity and adiposity: longitudinal behavioural and hormonal pathways

consumption (BMI, p=0.020) or high cortisol awakening response (waist, p=0.030). Physical activity was a protective moderator: stress decreased adiposity in children with high physical activity (fat%, p=0.025). In the other direction, high BMI (p<0.001), high fat% (p<0.001) and psychological eating behaviour (p=0.014) also increased stress. High cortisol (overall levels, awakening response and diurnal slope) was associated with an unhealthy diet especially with the sweet foods.

Differences of salivary cortisol levels between long-term and short-term wearers of dento-maxillary prosthesis due to head and neck cancer resection

PurposeThe purpose of this study was to use cortisol awakening response (CAR) to investigate the differences in daily life stress experienced by individuals wearing either a long-term (LT) or a short-term (ST) dento-maxillary prosthesis following head and neck cancer (HNC) resection. Also we used the University of Washington Quality of Life (UW-QOL) version 4 questionnaire to evaluate the differences in quality of life (QOL) scores between ST and LT wearers of a dento-maxillary prosthesis. MethodsSalivary samples were collected from 11 LT and 10 ST prosthesis wearers on two consecutive days at two time points, immediately after waking up (T0) and 30min later (T30), by passive drool collection. Cortisol levels were measured using a high sensitivity salivary cortisol enzyme immunoassay kit (Salimetrics, LLC, State College, PA, USA) and CAR (the differences between the cortisol levels at T0 and T30) was compared between LT and ST prosthesis wearers. In addition, both the groups completed the UW-QOL questionnaire and the scores were compared. ResultsA significant difference was observed in CAR between the two groups. CAR of the ST prosthesis wearers was significantly lower compared with that of the LT prosthesis wearers; moreover, the ST prosthesis wearers revealed significantly lower total UW-QOL scores and there were significant differences in appearance, activity, recreation, speech, and anxiety. ConclusionWithin the limitations of this study, the findings suggest that individuals wearing ST dento-maxillary prostheses following HNC resection experience some sort of daily life stress and complicated socio-demographic factors may influence their QOL.

Hormonal Treatment Reduces Psychobiological Distress in Gender Identity Disorder, Independently of the Attachment Style

Gender identity disorder may be a stressful situation. Hormonal treatment seemed to improve the general health as it reduces psychological and social distress. The attachment style seemed to regulate distress in insecure individuals as they are more exposed to hypothalamic-pituitary-adrenal system dysregulation and subjective stress. The objectives of the study were to evaluate the presence of psychobiological distress and insecure attachment in transsexuals and to study their stress levels with reference to the hormonal treatment and the attachment pattern. We investigated 70 transsexual patients. We measured the cortisol levels and the perceived stress before starting the hormonal therapy and after about 12 months. We studied the representation of attachment in transsexuals by a backward investigation in the relations between them and their caregivers. We used blood samples for assessing cortisol awakening response (CAR); we used the Perceived Stress Scale for evaluating self-reported perceived stress and the Adult Attachment Interview to determine attachment styles. At enrollment, transsexuals reported elevated CAR; their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy, transsexuals reported significantly lower CAR (P < 0.001), falling within the normal range for cortisol levels. Treated transsexuals showed also lower perceived stress (P < 0.001), with levels similar to normative samples. The insecure attachment styles were associated with higher CAR and perceived stress in untreated transsexuals (P < 0.01). Treated transsexuals did not expressed significant differences in CAR and perceived stress by attachment. Our results suggested that untreated patients suffer from a higher degree of stress and that attachment insecurity negatively impacts the stress management. Initiating the hormonal treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be.

Persistent Heightened Cortisol Awakening Response and Adolescent Internalizing Symptoms: A 3-year Longitudinal Community Study

An atypical Cortisol Awakening Response (CAR) has been related to adult anxiety and depression, but little is known about the association between long-term atypical CAR and adolescent anxiety and depression. This study aimed to longitudinally identify subgroups of adolescents with distinct levels of CAR (i.e., adolescents with and without persistent atypical CAR) and to examine their development of anxiety and depressive symptoms over 3 successive years. A community sample of 184 Dutch adolescents (M age = 14.99 at T1, 57% boys) completed annual salivary cortisol assessments at home at time of awakening, and 30 and 60min post-awakening (i.e., CAR) for 3 successive years. Adolescents also reported annually on their anxiety and depressive disorder symptoms. Latent Class Growth Analysis suggested two subgroups of adolescents with respect to CAR: a "low" group with stable low levels of AUCg (Area Under the Curve with respect to the ground) over time and a "high" group with high and increasing levels of AUCg over time. Controlling for sex, the high and low CAR groups significantly differed in depressive symptoms only, but none of the anxiety disorder symptoms. More specifically, adolescents in the high CAR group showed significantly higher mean levels of depressive symptoms over time compared to adolescents in the low CAR group. These results suggest that persistent heightened CAR is a more consistent, yet modest, correlate of adolescent depressive symptoms than anxiety disorder symptoms.