Maltreatment and diurnal cortisol regulation: A meta-analysis

Association of childhood adversity with HPA axis activity in children and adolescents: A systematic review and meta-analysis

Childhood adversity (CA) is associated with alteration of the hypothalamus-pituitary-adrenal (HPA) axis. We conducted a meta-analysis to synthesize existing evidence on the association between CA and HPA axis activity among children and adolescents and investigate four research questions: (1) Is CA associated with different aspects of the HPA axis (i.e., diurnal cortisol, acute stress response, chronic cortisol levels)?, (2) Does this association vary by the child's age?, (3) Are threat and deprivation dimensions of CA differentially associated with HPA axis activity?, and (4) Does this association depend on both the dimension and timing of CA? Meta-analyses were conducted with 129 studies reporting 506 effect sizes. Results showed significant associations between CA with higher afternoon cortisol levels (r = 0.053), a flatter diurnal slope (r = 0.048), more blunted reactivity (r = -0.043), and higher hair cortisol concentration (r = 0.098), but not other cortisol indicators (morning cortisol, cortisol awakening response, daily output, and cortisol recovery). Older children and adolescents had more pronounced blunted reactivity and steeper recovery with CA than younger children. Threat and deprivation did not differ in overall impact for any cortisol indicator; however, there are timing-dependent associations specific to threat or deprivation for some cortisol indicators. For instance, threat was associated with heightened reactivity when occurred before middle childhood, and with blunted reactivity when occurred after age 15 years; in contrast, deprivation was associated with blunted reactivity regardless of its timing. Findings could inform targeted interventions to reduce negative impacts of CA on development.

Adverse childhood experiences and diurnal cortisol pattern and heart rate variability in adults

Dysregulation of hypothalamic-pituitary-adrenal axis (HPA axis) and of the autonomic nervous system may link stress throughout the life course with poorer health. This study aims to investigate whether multiple adverse childhood experiences have a long-term impact on markers of these systems - cortisol secretion and heart rate variability - in adulthood. Data were from the Whitehall II cohort study. Fourteen adversities, collected retrospectively in midlife, were considered. Outcomes were total amount of cortisol secretion during the day (area under the curve [AUC]), cortisol awakening response (CAR), and diurnal slope, estimated from six saliva samples taken on a weekday; and resting heart rate (rHR) and heart rate variability (HRV) measured for five minutes at three time points over 10 years with the last measures taken at the same time as the salivary measurement. Regression models were used to examine the association of adversities with AUC, CAR, rHR and HRV and multilevel modelling was applied to analyses of cortisol diurnal slope and the 10-year follow-up of rHR and HRV. At least one early life adversity was reported by 68 % of participants. There was little evidence that increasing number of adversities was associated with any measures of cortisol, rHR or HRV or 10-year change in rHR or HRV. Of the individual adversities, only parental death was associated with increased AUC and CAR. In conclusion, although the HPA axis and autonomic nervous system have been hypothesized as mechanisms relating to adverse childhood experiences with health, our study finds no evidence to support this.

Sex-Specific Outcomes in a Rat Model of Early-Life Stress Due to Adverse Caregiving

Early parental care is critical for the development of cortico-limbic circuits regulating stress responses and emotional well-being. Conversely, infant maltreatment can increase susceptibility to mood disorders-such as anxiety and depression-and impair stress-coping abilities. Here, we employed the Scarcity-Adversity Model (SAM) in rats, limiting nesting resources from postnatal days 8-12, to examine its effects on maternal and adult offspring behavior. SAM-exposed mothers exhibited fragmented care and increased violence towards pups. By postpartum day (PPD) 13, maternal fecal corticosterone metabolites (FCM) were elevated, indicating heightened stress. At weaning, SAM dams also showed increased anxiety-like behavior in the Elevated Plus Maze (EPM), suggesting significant emotional alterations. In adulthood, SAM-exposed offspring underwent anxiogenic tests. Both male and female SAM offspring showed increased latency to enter open arms and reduced risk-assessment in the EPM, though females displayed anxiolytic-like behavior in the Light-Dark Box. Male SAM rats had reduced locomotion in the Open Field, earlier onset and increased immobility in the Forced Swim, and increased latency to groom in the Sucrose Splash. When exposed to acute stress, male SAM rats had lower FCM levels, consistent with their passive stress reactivity. These findings confirm SAM induces long-lasting, sex-specific changes in risk-taking, novelty responsiveness, and stress reactions, underscoring the importance of early nurturing in promoting well-being and reducing psychopathological risk.

Relationship between bullying victimization and murderous behaviors and impulsivity's mediating role: Evidence from Chinese early adolescents

BACKGROUND

Evidence suggests a robust relationship between experiencing bullying victimization (BV) and engaging in murderous behaviors among adolescents. However, the potential mediating effect of impulsivity on the relationship between BV and murderous behaviors in early adolescents remains underexplored.

METHODS

A total of 5724 adolescents, with a mean age of 13.5 years, were enrolled from three middle schools in Anhui Province, China. Participants completed self-report questionnaires detailing their experiences with bullying, impulsiveness, and murderous behaviors. To assess the relationship between BV and murderous behaviors, multivariate logistic regression and Poisson regression analyses were conducted. Mediation analysis was performed using structural equation modeling.

RESULTS

After controlling for confounding factors, a positive association was found between experiencing BV and engaging in murderous behaviors (p < 0.05). Mediation analysis revealed a significant indirect effect of BV on the occurrence of murderous behaviors through impulsivity (indirect effect = 0.027, 95 % CI: 0.021, 0.033). BV appears to heighten levels of impulsivity, which in turn increases the likelihood of murderous behaviors. Additionally, sex-specific analysis indicated that impulsivity played a greater mediating role in the link between verbal and relational BV and murderous behaviors in females, while physical and cyber BV were more significant in males.

CONCLUSIONS

Our findings underscore the necessity of early targeted interventions for adolescents experiencing BV and exhibiting high levels of impulsivity to mitigate their risk of engaging in murderous behaviors.

Profiles of self-regulation and their association with behavior problems among sexually abused children

This study aimed to delineate profiles of self-regulation among sexually abused children and their association with behavior problems using a person-centered approach. A sample of 223 children aged six to 12, their parents, and teachers were recruited in specialized intervention centers. Latent profile analysis revealed four profiles: (1) Dysregulated, (2) Inhibited, (3) Flexibly Regulated, and (4) Parent Perceived Self-Regulation. Children from the Flexibly Regulated profile showed relatively low behavior problems, and those from the Dysregulated profile were characterized by high behavior problems. Children from the Parent Perceived Self-Regulation profile showed overall good adaptation, although teachers reported higher behavior problems than parents. Children from the Inhibited profile, characterized by the highest level of inhibition but low parent-rated emotion regulation competencies and executive functions, showed the highest level of internalizing behavior problems, indicating that high inhibition does not necessarily translate to better adaptation. Results also show a moderation effect of sex. Being assigned to the Inhibited profile was associated with decreased externalizing behaviors in boys and increased internalizing behaviors in girls. This study underscores the complexity of self-regulation in sexually abused children and supports the need to adopt a multi-method and multi-informant approach when assessing these children.

Early life adversities, psychopathologies and novel pharmacological strategies

Exposure to adversities during early life stages (early life adversities - ELA), ranging from pregnancy to adolescence, represents a major risk factor for the vulnerability to mental disorders. Hence, it is important to understand the molecular and functional underpinning of such relationship, in order to develop strategies aimed at reducing the psychopathologic burden associated with ELA, which may eventually lead to a significant improvement in clinical practice. In this review, we will initially recapitulate clinical and preclinical evidence supporting the link between ELA and psychopathology and we will primarily discuss the main biological mechanisms that have been described as potential mediators of the effects of ELA on the psychopathologic risk, including the role for genetic factors as well as sex differences. The knowledge emerging from these studies may be instrumental for the development of novel therapeutic strategies aimed not only at correcting the deficits that emerge from ELA exposure, but also in preventing the manifestation of a full-blown psychopathologic condition. With this respect, we will specifically focus on adolescence as a key time frame for disease onset as well as for early therapeutic intervention. We believe that incorporating clinical and preclinical research data in the context of early life adversities can be instrumental to elucidate the mechanisms contributing to the risk for psychopathology or that may promote resilience. This will ultimately allow the identification of 'at risk' individuals who may benefit from specific forms of interventions that, by interfering with disease trajectories, could result in more benign clinical outcomes.

Reconsidering the nature of threat in infancy: Integrating animal and human studies on neurobiological effects of infant stress

Early life stress has been associated with elevated risk for later psychopathology. One mechanism that may contribute to such long-term risk is alterations in amygdala development, a brain region critical to stress responsivity. Yet effects of stress on the amygdala during human infancy, a period of particularly rapid brain development, remain largely unstudied. In order to model how early stressors may affect infant amygdala development, several discrepancies across the existing literatures on early life stress among rodents and early threat versus deprivation among older human children and adults need to be reconciled. We briefly review the key findings of each of these literatures. We then consider them in light of emerging findings from studies of human infants regarding relations among maternal caregiving, infant cortisol response, and infant amygdala volume. Finally, we advance a developmental salience model of how early threat may impact the rapidly developing infant brain, a model with the potential to integrate across these divergent literatures. Future work to assess the value of this model is also proposed.

The impact of maternal childhood maltreatment on child externalizing behaviour and the mediating factors underlying this association: a three-level meta-analysis and systematic review

Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.

Allostasis, health, and development in Latin America

The lifespan is influenced by adverse childhood experiences that create predispositions to poor health outcomes. Here we propose an allostatic framework of childhood experiences and their impact on health across the lifespan, focusing on Latin American and Caribbean countries. This region is marked by significant social and health inequalities nested in environmental and social stressors, such as exposure to pollution, violence, and nutritional deficiencies, which critically influence current and later-life health outcomes. We review several manifestations across cognition, behavior, and the body, observed at the psychological (e.g., cognitive, socioemotional, and behavioral dysfunctions), brain (e.g., alteration of the development, structure, and function of the brain), and physiological levels (e.g., dysregulation of the body systems and damage to organs). To address the complexity of the interactions between environmental and health-related factors, we present an allostatic framework regarding the cumulative burden of environmental stressors on physiological systems (e.g., cardiovascular, metabolic, immune, and neuroendocrine) related to health across the life course. Lastly, we explore the relevance of this allostatic integrative approach in informing regional interventions and public policy recommendations. We also propose a research agenda, potentially providing detailed profiling and personalized care by assessing the social and environmental conditions. This framework could facilitate the delivery of evidence-based interventions and informed childhood-centered policy-making.

Childhood trauma and hair cortisol response over the year following onset of a chronic life event stressor

OBJECTIVE

Childhood trauma may contribute to poor lifelong health in part through programming of the HPA-axis response to future life stressors. To date, empirical evidence shows an association of childhood trauma with dysregulation of the HPA-axis and blunted cortisol reactivity to acute stressors. Here, we conduct an initial examination of childhood trauma as a moderator of changes over time in perceived stress levels and HPA-axis response to a major chronic stressor in adulthood.

METHODS

Participants were 83 maternal caregivers of children newly diagnosed with cancer who completed the Childhood Trauma Questionnaire (CTQ), and who, over the year following their child's cancer diagnosis, had hair samples collected up to 7 times for the assessment of cortisol and completed monthly measures of perceived stress.

RESULTS

CTQ scores were in the expected range for a community sample and associated with changes in perceived stress and cortisol concentration over time (γ =.003, p =.002; γ = -.0004, p =.008, respectively) independently of age, education, treatment intensity and randomization to stress management intervention. Maternal caregivers who endorsed lower childhood trauma showed a steeper decline in perceived stress and a larger increase in cortisol levels across the year than caregivers who recalled more childhood trauma.

CONCLUSIONS

Findings extend animal models and studies that examine cortisol reactivity to acute stressors and suggest that childhood trauma may program a phenotype that is more psychologically reactive but shows a blunted HPA-axis response to chronic stress. While adaptive in the short-term, this early life programming may incur long-term costs for health. Further work is warranted to examine this possibility.

Association among childhood adversity and susceptibility to interference during varying salience: two studies in healthy males

Childhood adversity, a prevalent experience, is related to a higher risk for externalizing and internalizing psychopathology. Alterations in the development of cognitive processes, for example in the attention-interference domain may link childhood adversity and psychopathology. Interfering stimuli can vary in their salience, i.e. ability to capture attentional focus, and valence. However, it is not known if interference by salience or valence is associated with self-reported adversity. In two independent study samples of healthy men (Study 1: n = 44; mean age [standard deviation (SD)] = 25.9 [3.4] years; Study 2: n = 37; 43.5 [9.7] years) we used the attention modulation task (AMT) that probed interference by two attention-modulating conditions, salience and valence separately across repeated target stimuli. The AMT measures the effects of visual distractors (pictures) on the performance of auditory discrimination tasks (target stimuli). We hypothesized that participants reporting higher levels of childhood adversity, measured with the childhood trauma questionnaire, would show sustained interference in trials with lower salience. Due to conflicting reports on the valence-modulation, we tested the valence condition in an exploratory manner. Linear mixed models revealed an interaction between reported childhood adversity and the salience condition across tone presentations in both study samples (Sample 1: p = .03; Sample 2: p = .04), while there were no effects for the valence condition across both studies. Our study suggests that higher self-reported childhood adversity is related to faster processing of target cues during high salience, but slower during low salience conditions. These results hint to the mechanisms linking childhood adversity and psychopathological symptoms in the attentional domain.

Struggling Can Also Show on the Inside: Current Knowledge of the Impact of Childhood Maltreatment on Biomarkers in Mood Disorders

The link between childhood maltreatment and mood disorders is complex and involves multiple bio-psycho-social factors that affect multiple molecular pathways. The present narrative review aims to clarify the current understanding of the impact of childhood maltreatment on biomarkers in patients with mood disorders and their first-degree relatives. Neurotransmitters, such as serotonin, dopamine, norepinephrine, and hormones (eg the stress hormone cortisol), play a crucial role in regulating mood and emotion. Childhood maltreatment can alter and affect the levels and functioning of these neurotransmitters in the brain; further, childhood maltreatment can lead to structural and connectivity changes in the brain, hence contributing to the development of mood disorders and moderating illness presentation and modifying response to treatments. Childhood maltreatment information, therefore, appears mandatory in treatment planning and is a critical factor in therapeutic algorithms. Further research is needed to fully understand these pathways and develop new treatment modalities for individuals with mood disorders who have experienced childhood maltreatment and effective preventive interventions for individuals at risk of developing mood disorders.

Cortisol's diurnal rhythm indexes the neurobiological impact of child adversity in adolescence

Adverse early life experiences, such as child maltreatment, shapes hypothalamic-pituitary-adrenal (HPA) activity. The impact of social context is often probed through laboratory stress reactivity, yet child maltreatment is a severe form of chronic stress that recalibrates even stable or relatively inflexible stress systems such as cortisol's diurnal rhythm. This study was designed to determine how different social contexts, which place divergent demands on children, shape cortisol's diurnal rhythm. Participants include 120 adolescents (9-14 years), including 42 youth with substantiated child physical abuse. Up to 32 saliva samples were obtained in the laboratory, on days youth stayed home, and on school days. A 3-level hierarchical linear model examined cortisol within each day and extracted the diurnal rhythm at level 1; across days at level 2; and between-individual differences in cortisol and its rhythm at level 3. While cortisol's diurnal rhythm was flattened when youth were in the novel laboratory context, the impact of maltreatment was observed within the home context such that maltreated children had persistently flattened diurnal rhythms. The effect of maltreatment overlapped with current chronic interpersonal family stress. Results are consistent with the idea that maltreatment exerts a robust, detrimental impact on the HPA axis and are interpreted in the context of less flexibility and rhythmicity. The HPA axis adapts by encoding signifiers of relevant harsh or unpredictable environments, and the extreme stress of physical abuse in the family setting may be one of these environments which calibrates the developing child's stress responsive system, even throughout a developmental stage in which the family takes on diminishing importance.

Association Between Child Maltreatment and Aggression in Chinese Early Adolescents: The Mediating Role of Irritability

Child maltreatment (CM) is a major global public health issue, and a strong association exists between CM and aggression. However, the underlying mechanism of this association has not been understood to date. The objective of this study was to explore the mediating role of irritability in the association between CM and aggression in Chinese early adolescents. A cross-sectional study was conducted using a self-report questionnaire to evaluate the levels of CM, aggression, and irritability in 5,724 middle school students from the Anhui Province, China. Structural equation modeling was used to test the hypothesis of the mediating effect of irritability on the relationship between CM and aggression. We further investigated gender differences in this association using multiple group analyses. CM was positively related to both irritability and aggression, and irritability was positively associated with aggression (p < .01). The mediating effects of irritability between CM and aggression were significant (β = .107, 95% confidence intervals [CI]: 0.077-0.133, p < .05). Males had a higher indirect effect size of the pathway from CM to aggression via irritability compared with females. Overall, irritability was a crucial mediator in the relationship between CM and aggression in Chinese adolescents, and males were more prone to engage in aggression compared with females through the pathway of irritability. Therefore, early irritability characteristics should be carefully monitored in adolescents, and they should be provided adequate support to acquire critical emotion regulation skills.

Dimensions of childhood adversity differentially affect autonomic nervous system coordination in response to stress

It is well-established that disrupted autonomic nervous system (ANS) reactivity exacerbates risk for long-term maladjustment following childhood adversity (CA). However, few studies have integrated measures of both the sympathetic (SNS) and parasympathetic (PNS) branches of the ANS, resulting in a unidimensional understanding of ANS functioning as a mechanism of risk. Further, past work has primarily measured CA only at the aggregate level (e.g. "total CA"), necessitating further research to accurately characterize this risk pathway. The present study examines how CA, measured cumulatively and dimensionally (i.e. CA characterized by threat versus deprivation), moderates the association between the SNS and PNS at rest and in response to acute social and nonsocial stressors. Participants included 97 adolescents ages 10-15 (Mage = 12.22, SDage = 1.68) experiencing a range of CA and one accompanying caregiver. Participants completed questionnaires assessing prior CA exposure. SNS and PNS responses were then continuously measured during rest and two stress tasks. First, results indicate a blunting effect of cumulative CA and CA characterized by threat (e.g. physical abuse) on resting SNS activity. Second, in moderation analyses assessing ANS coordination, threat exposure emerged as a significant moderator of the association between SNS and PNS reactivity to social stress. Results suggest that CA characterized by threat may specifically impact physiologic regulation by disrupting the coordination of the two branches of the ANS. Disentangling the independent and concurrent engagement of biological stress response systems following CA remains an important target for research to identify the etiology of aberrant stress reactivity patterns.

Maternal Childhood Abuse Versus Neglect Associated with Differential Patterns of Infant Brain Development

Severity of maternal childhood maltreatment has been associated with lower infant grey matter volume and amygdala volume during the first two years of life. A developing literature argues that effects of threat (abuse) and of deprivation (neglect) should be assessed separately because these distinct aspects of adversity may have different impacts on developmental outcomes. However, distinct effects of threat versus deprivation have not been assessed in relation to intergenerational effects of child maltreatment. The objective of this study was to separately assess the links of maternal childhood abuse and neglect with infant grey matter volume (GMV), white matter volume (WMV), amygdala and hippocampal volume. Participants included 57 mother-infant dyads. Mothers were assessed for childhood abuse and neglect using the Adverse Childhood Experiences (ACE) questionnaire in a sample enriched for childhood maltreatment. Between 4 and 24 months (M age = 12.28 months, SD = 5.99), under natural sleep, infants completed an MRI using a 3.0 T Siemens scanner. GMV, WMV, amygdala and hippocampal volumes were extracted via automated segmentation. Maternal history of neglect, but not abuse, was associated with lower infant GMV. Maternal history of abuse, but not neglect, interacted with age such that abuse was associated with smaller infant amygdala volume at older ages. Results are consistent with a threat versus deprivation framework, in which threat impacts limbic regions central to the stress response, whereas deprivation impacts areas more central to cognitive function. Further studies are needed to identify mechanisms contributing to these differential intergenerational associations of threat versus deprivation.

Reliability of diurnal salivary cortisol metrics: A meta-analysis and investigation in two independent samples

Stress-induced dysregulation of diurnal cortisol is a cornerstone of stress-disease theories; however, observed associations between cortisol, stress, and health have been inconsistent. The reliability of diurnal cortisol features may contribute to these equivocal findings. Our meta-analysis (5 diurnal features from 11 studies; total participant n = 3307) and investigation (15 diurnal cortisol features) in 2 independent studies (St. Louis Personality and Aging Network [SPAN] Study, n = 147, ages 61-73; Minnesota Longitudinal Study of Risk and Adaptation [MLSRA] Study, n = 90, age 37) revealed large variability in the day-to-day test-retest reliability of diurnal features derived from salivary cortisol data (i.e., ICC = 0.00-0.75). Collectively, these data indicate that some commonly used diurnal cortisol features have poor reliability that is insufficient for individual differences research (e.g., cortisol awakening response) while others (e.g., area under the curve with respect to ground) have fair-to-good reliability that could support reliable identification of associations in well-powered studies.

Childhood maltreatment contributes to the medical morbidity of individuals with bipolar disorders

BACKGROUND

Individuals with bipolar disorders (BD) are at risk of premature death, mainly due to medical comorbidities. Childhood maltreatment might contribute to this medical morbidity, which remains underexplored in the literature.

METHODS

We assessed 2891 outpatients with BD (according to DSM-IV criteria). Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Lifetime diagnoses for medical disorders were retrospectively assessed using a systematic interview and checked against medical notes. Medical morbidity was defined by the sum of medical disorders. We investigated associations between childhood maltreatment (neglect and abuse) and medical morbidity while adjusting for potential confounders.

RESULTS

One quarter of individuals had no medical comorbidities, while almost half of them had at least two. Multivariable regression showed that childhood maltreatment (mainly abuse, but also sexual abuse) was associated with a higher medical morbidity. Medical morbidity was also associated with sex, age, body mass index, sleep disturbances, lifetime anxiety disorders and lifetime density of mood episodes. Childhood maltreatment was associated with an increased prevalence of four (i.e. migraine/headache, drug eruption, duodenal ulcer, and thyroid diseases) of the fifteen most frequent medical disorders, however with no difference in terms of age at onset.

CONCLUSIONS

This large cross-sectional study confirmed a high medical morbidity in BD and its association with childhood maltreatment. The assessment of childhood maltreatment in individuals with BD should be systematically included in routine care and the potential impact on physical health of psycho-social interventions targeting childhood maltreatment and its consequences should be evaluated.

The neural, stress hormone and inflammatory correlates of childhood deprivation and threat in psychosis: A systematic review

Childhood adversity increases the risk of developing psychosis, but the biological mechanisms involved are unknown. Disaggregating early adverse experiences into core dimensions of deprivation and threat may help to elucidate these mechanisms. We therefore systematically searched the literature investigating associations between deprivation and threat, and neural, immune and stress hormone systems in individuals on the psychosis spectrum. Our search yielded 74 articles, from which we extracted and synthesized relevant findings. While study designs were heterogeneous and findings inconsistent, some trends emerged. In psychosis, deprivation tended to correlate with lower global cortical volume, and some evidence supported threat-related variation in prefrontal cortex morphology. Greater threat exposure was also associated with higher C-reactive protein, and higher and lower cortisol measures. When examined, associations in controls were less evident. Overall, findings indicate that deprivation and threat may associate with partially distinct biological mechanisms in the psychosis spectrum, and that associations may be stronger than in controls. Dimensional approaches may help disentangle the biological correlates of childhood adversity in psychosis, but more studies are needed.

Profiles of diurnal cortisol and DHEA regulation among children: Associations with maltreatment experiences, symptomatology, and positive adaptation

Person-centered methods represent an important advance in the simultaneous examination of multiple indicators of neuroendocrine functioning and may facilitate a more nuanced understanding of the impact of child maltreatment on hypothalamic-pituitary-adrenal axis dysregulation. The aims of the present study were threefold: (a) identify naturally occurring patterns of diurnal cortisol and dehydroepiandrosterone (DHEA) regulation among a sample of N = 1,258 children with and without histories of maltreatment, (b) investigate which neuroendocrine profiles characterize children with exposure to maltreatment, and (c) examine which profiles are related to adaptive outcomes and symptomatology among children. Cortisol and DHEA were sampled three times per day (9 a.m., 12 p.m., and 4 p.m.) across 5 and 2 days, respectively. Four profiles of cortisol and DHEA regulation were identified. Among females, a pattern marked by high cortisol and low DHEA was associated with more pervasive maltreatment experiences. Furthermore, we found evidence of adaptive interpersonal resilience such that children with maltreatment exposure who evidenced this pattern of high cortisol and low DHEA were viewed as more likeable than maltreated children with other neuroendocrine patterns. Finally, results pointed to higher levels of internalizing symptoms among children who displayed a profile marked by average cortisol and high DHEA.

Cognitive Outcomes of Children With Complex Trauma: A Systematic Review and Meta-Analyses of Longitudinal Studies

Longitudinal studies have shown that children with complex trauma (i.e., exposure to multiple or repeated traumatic events of an interpersonal nature) have poorer cognitive outcomes later in life than children without complex trauma. This association may be moderated by the timing of the trauma, which may explain, in part, some heterogeneity in the findings reported across previous investigations. The objective of the systematic review and meta-analyses was to compare the cognitive outcomes of children with complex trauma and controls and to explore whether the timing of trauma (i.e., its onset and recency) moderated this association. Electronic databases (APA PsycNET, Pubmed Central, ERIC, CINAHL, Embase) and gray literature were systematically searched. To be included, studies had to (1) have a longitudinal design, (2) comprise children with complex trauma and controls, and (3) include a cognitive assessment. Thirteen studies were identified. Meta-analyses were conducted to compare children with complex trauma and controls, while subgroup analyses and meta-regressions explored the impact of potential moderators. Children with complex trauma had poorer overall cognitive functioning than controls, and the timing of trauma (early onset and, to a greater extent, recency of trauma) moderated this association. Thus, findings suggest that children with complex trauma are at risk of cognitive difficulties quickly after trauma exposure. As such, systematic neuropsychological assessment and interventions supporting the optimal development of cognitive functioning among children with complex trauma should be investigated to determine whether prompt interventions lead to better cognitive functioning.

Dimensions of child maltreatment and longitudinal diurnal cortisol patterns: The roles of resilience and child sex

Informed by the dimensional approach to adversity, this study disaggregated child maltreatment effects to examine how abuse versus neglect influenced cortisol at the baseline assessment and longitudinal changes in diurnal cortisol among a sample of Chinese children and adolescents (N = 312; aged 9-13 years; M age = 10.80, SD = 0.84; 67% boys). The moderating roles of resilience and sex differences in these associations were also explored. Results revealed distinct effects of abuse versus neglect on diurnal cortisol in girls, but not boys, which varied by the time scale of assessment and type of cortisol measure. Specifically, abuse was associated with girls' longitudinal changes in awakening cortisol, cortisol awakening response, and diurnal cortisol slope over one year, whereas neglect was associated with girls' awakening cortisol and cortisol awakening response at the baseline assessment. Further, resilience moderated the effects of abuse on girls' baseline awakening cortisol and longitudinal changes in diurnal cortisol slope, suggesting both the potential benefits and costs of resilience. Findings support the application of the dimensional approach to research on stress physiology and deepen our understanding of individual differences in the associations between child maltreatment and diurnal cortisol.

From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction

Childhood adversity is a prominent predisposing risk factor for latent stress vulnerability, expressed as an elevated likelihood of developing stress-related psychopathology upon subsequent exposure to trauma in adulthood. Sleep disturbances have emerged as one of the most pronounced maladaptive behavioral outcomes of childhood adversity and are also a highly prevalent core feature of stress-related psychopathology, including post-traumatic stress disorder (PTSD). After reviewing the extensive literature supporting these claims, the current review addresses the notion that childhood adversity-induced sleep disturbances may play a causal role in elevating individuals' stress vulnerability in adulthood. Corroborating this, sleep disturbances that predate adult trauma exposure have been associated with an increased likelihood of developing stress-related psychopathology post-exposure. Furthermore, novel empirical evidence suggests that sleep disturbances, including irregularity of the sleep-wake cycle, mediate the link between childhood adversity and stress vulnerability in adulthood. We also discuss cognitive and behavioral mechanisms through which such a cascade may evolve, highlighting the putative role of impaired memory consolidation and fear extinction. Next, we present evidence to support the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these associations, stemming from its critical role in stress and sleep regulatory pathways. Childhood adversity may yield bi-directional effects within the HPA stress and sleep axes in which sleep disturbances and HPA axis dysfunction reinforce each other, leading to elevated stress vulnerability. To conclude, we postulate a conceptual path model from childhood adversity to latent stress vulnerability in adulthood and discuss the potential clinical implications of these notions, while highlighting directions for future research.

The phenotypic associations and gene-environment underpinnings of socioeconomic status and diurnal cortisol secretion in adolescence

While converging evidence suggests that both environmental and genetic factors underlie variations in diurnal cortisol, the extent to which these sources of influence vary according to socioeconomic status (SES) has seldom been investigated, particularly in adolescence. To investigate whether a distinct genetic and environmental contribution to youth's diurnal cortisol secretion emerges according to family SES and whether the timing of these experiences matters. Participants were 592 twin pairs, who mostly came from middle-income and intact families and for whom SES was measured in childhood and adolescence. Diurnal cortisol was assessed at age 14 at awakening, 30 min later, in the afternoon and evening over four nonconsecutive days. SES-cortisol phenotypic associations were specific to the adolescence period. Specifically, higher awakening cortisol levels were detected in wealthier backgrounds, whereas higher cortisol awakening response (CAR) and diurnal changes were present at both ends of the SES continuum. Moreover, smaller genetic contributions emerged for awakening cortisol in youth from poorer compared to wealthier backgrounds. The results suggest that the relative contribution of inherited factors to awakening cortisol secretion may be enhanced or suppressed depending on the socio-family context, which may help to decipher the mechanisms underlying later adjustment.

Childhood maltreatment disrupts HPA-axis activity under basal and stress conditions in a dose-response relationship in children and adolescents

BACKGROUND

This study investigates the impact of childhood maltreatment (CM) on hypothalamic-pituitary-adrenal (HPA)-axis functioning and on anxiety perception. Moreover, the influence of CM severity and frequency was also explored.

METHODS

In total, 187 participants aged 7-17 were assessed for CM history using validated questionnaires and ad hoc interviews to be classified according to the criteria of the Tool for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV). Psychopathology was ascertained using the K-SADS-PL5. To assess HPA-axis functioning, salivary cortisol samples were collected throughout a normal day and during an acute psychosocial stressor, the Trier Social Stress Test for children (TSST-C). Subjective anxiety was evaluated using STAI/-C.

RESULTS

Youth with a CM history had higher overall diurnal cortisol levels (p = 0.001), blunted cortisol response to acute psychosocial stress (p = 0.002) and greater perceived anxiety (p = 0.003), than those without CM. Specifically, participants exposed to moderate/severe or often/frequent CM showed the greater diurnal cortisol output (p_severity = 0.002; p_frequency = 0.003), and blunted cortisol response during the TSST-C (p_severity = 0.006; p_frequency = 0.008). Meanwhile, youth with low CM severity/frequency exhibited a similar cortisol response to those without CM. However, perceived anxiety was higher in those exposed to CM (p < 0.001), regardless of its severity/frequency.

CONCLUSIONS

Disturbances in HPA-axis functioning are already evident early after CM exposure, while psychological and physiological responses to an acute stressor are dissociated in youth exposed to CM. The dose-response relationship described in this paper highlights the need to comprehensively evaluate CM so that vulnerable children can be identified and assigned to proper interventions.

Association of Child Sexual Abuse Victimization and Murderous Behaviors and the Mediating Role of Psychological Adjustment among College Students in China

A history of child sexual abuse (CSA) is associated with a variety of psychological issues and conduct disorders in adolescents. However, little is known about the association between CSA and its characteristics and murderous behaviors in young adults. The purpose of this study was to examine this relationship and explore the mediating effect of psychological adjustment (PA). A cross-sectional study was conducted with 4034 college students in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding the history of CSA, self-perceived PA and murderous behaviors. PA was evaluated by two of the most important indicators: resilience and emotional release. Mediation analyses were computed via parallel mediation models. Of the participants, 14.1% reported experiencing CSA. After controlling for potential confounders, CSA victimization was robustly and positively associated with murderous ideation (OR: 2.36, 95% CI: 1.77-3.14), murderous plans (OR: 4.02, 95% CI: 2.63-6.12), murderous preparation (OR: 3.87, 95% CI: 2.37-6.31), and murderous attempts (OR: 5.35, 95% CI: 3.11-9.21). CSA victimization that was persistent and of the combined contact or noncontact types greatly increased the risk of murderous behaviors. A dose-response relationship was observed between the duration of experienced CSA and murderous behaviors. Furthermore, the results of the mediation analysis revealed that PA partially mediated the relationship between CSA victimization and murderous behaviors. Therefore, PA protects against the development of murderous behaviors in abused individuals. These findings have important implications for the prevention and intervention of murderous behaviors in adolescents who experienced CSA, highlighting the importance of considering PA as a protective role in this relationship.

An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

BACKGROUND AND OBJECTIVES

A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy.

METHODS

Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized.

RESULTS

Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.

Childhood violence exposure and externalizing behaviors: A systematic review of the role of physiological biomarkers

Childhood exposure to violence has been consistently linked to externalizing behaviors like delinquency and aggression. Growing evidence indicates that physiological biomarkers from the parasympathetic and sympathetic nervous systems (PNS and SNS) and hypothalamic-pituitary-adrenal (HPA) axis may moderate or mediate the relation between childhood violence exposure and externalizing behaviors. We conducted a systematic review to synthesize recent findings on physiological biomarkers as mediators and/or moderators of this association across the life course, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search yielded 3878 articles, of which 44 met inclusion criteria (describing a total of 46 independent studies). We found consistent evidence for blunted HPA-axis reactivity as a mediator of the relation between childhood violence exposure and subsequent externalizing behaviors, and for non-reciprocal PNS/SNS activation as moderators exacerbating this relation. However, the results of the majority of included studies that demonstrated significant moderating effects of physiological biomarkers varied by participant sex, type of childhood violence exposure, and type of stimuli used to induce physiological reactivity. The observed mixed findings are consistent with some theories that emphasize that both high and low stress reactivity can be adaptive depending on one's early environment. These findings highlight the need for systematic explorations of heterogeneity, theory-driven research questions, and longitudinal studies that span multiple developmental periods and multiple biological systems. Clinical implications include the need to assess physiological biomarkers in treatment and intervention studies and the potential to target interventions based on both autonomic functioning and environmental contexts.

Early childhood stress responses to psychosocial stressors: The state of the science

The aim of this systematic review was to better understand whether and to what extent psychosocial stressors are associated with hypothalamic-pituitary-adrenal axis or autonomic nervous system stress responses in young children (1-6 years of age). Studies were classified by psychosocial stressors from the ecobiodevelopmental model: social and economic resources, maternal mental health, parent-child relationships, and the physical environment. Of the 2388 identified studies, 32 met full inclusion criteria, including over 9107 children. Child physiologic stress responses were measured as hair and urinary cortisol and cortisone, salivary diurnal and reactive cortisol, salivary reactive alpha-amylase, and respiratory sinus arrhythmia. There were 107 identified relations between psychosocial stressors and physiologic stress responses. Nearly two thirds of these relations suggested that children have dysregulated stress responses as either significantly blunted (n = 27) or increased (n = 37); 43 relations were not significant. Children most consistently had significantly dysregulated stress responses if they experienced postnatal maternal depression or anxiety. Some reasons for the mixed findings may be related to characteristics of the child (i.e., moderators) or stressor, how the stress response or psychosocial stressor was measured, unmeasured variables (e.g., caregiving buffering), researcher degrees of freedom, or publication bias.

Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis

Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.

Caregiving quality modulates neuroendocrine and immunological markers in young children in foster care who have experienced early adversity

BACKGROUND

Early adversity is believed to alter the body's stress-response systems, putting children at increased risk for somatic and mental health problems. However, it remains unclear whether such alterations normalize under improved caregiving experiences. Thus, the goal of the present study was to investigate (a) whether children in foster care show endocrine and immunological alterations relative to children living with their biological families, (b) whether these alterations change over time spent with the foster family, and (c) whether the alterations are modulated by current caregiving experiences.

METHODS

A total of 94 children in foster care and 157 biological children, aged two to seven years, took part in a longitudinal study with three assessments conducted over a 12-month study period. At the initial assessment, children lived for an average of 18 months with their current foster families. Children's cortisol, dehydroepiandrosterone (DHEA) and progesterone concentrations and cortisol/DHEA ratios were measured in scalp hair and children's secretory immunoglobulin A (sIgA) levels in saliva. Caregiving quality was assessed based on caregiver-reports and observational measures of caregiver-child interactions.

RESULTS

Children in foster care had lower cortisol/DHEA ratios and higher progesterone concentrations than biological children, while no group differences were found for cortisol, DHEA or sIgA. Time spent with the current foster family did not significantly influence the child's endocrine or immunological markers. Importantly, caregiving quality modulated cortisol/DHEA ratios and sIgA concentrations: children in foster care of lower caregiving quality had lower cortisol/DHEA ratios than children in foster care of higher caregiving quality and showed decreasing, rather than increasing, sIgA concentrations across the study period.

CONCLUSIONS

Our results indicate that caregiving quality in the foster family may have an important modulating effect on selected indicators of the child's stress response and could thereby mitigate the possible consequences of early childhood adversity.

Adverse childhood experiences and late-life diurnal HPA axis activity: Associations of different childhood adversity types and interaction with timing in a sample of older East Prussian World War II refugees

Adverse childhood experiences (ACEs) have been associated with unfavorable health outcomes throughout the life up to old age. Mechanisms through which ACEs impact later life health are still not entirely clear. There is growing evidence for the idea that alterations in the hypothalamic pituitary adrenal (HPA) axis might cause the effects of ACEs on later health consequences. Only few studies have investigated associations between ACEs and diurnal HPA axis functioning in older adults. Therefore, we investigated the impact of type and timing of ACEs linked to flight of war on diurnal HPA axis activity in a sample of East Prussian World War II refugees aged 74-91 years. We calculated a dichotomous variable according to the (minimum) age at trauma: early ACE (eACE; 0-5 years) and late ACE (lACE; 6-17 years). Multiple linear regression analysis using different ACEs linked to flight of war (war-related trauma, individual experience of violence, neglect) as well as age at trauma and the interactions of ACEs and age at trauma as predictors and three cortisol outcomes (AUC_G (area under the curve with respect to the ground), decline (morning to night) and CAR (cortisol awakening response)) was performed. For AUC_G, we found a negative association of individual experience of violence only in lACE participants. For decline, a positive association with neglect was observed for the whole study sample. The overall model for CAR was not statistically significant. Our findings support the hypothesis that type as well as timing of ACEs might influence diurnal HPA axis functioning into old age. These findings may contribute to a better understanding of the lifelong influence of ACEs.

Neurobiology of early life adversity: A systematic review of meta-analyses towards an integrative account of its neurobiological trajectories to mental disorders

Adverse childhood experiences (ACEs) may leave long-lasting neurobiological scars, increasing the risk of developing mental disorders in later life. However, no review has comprehensively integrated existing evidence across the fields: hypothalamic-pituitary-adrenal axis, immune/inflammatory system, neuroimaging, and genetics/epigenetics. We thus systematically reviewed previous meta-analyses towards an integrative account of ACE-related neurobiological alterations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, a total of 27 meta-analyses until October 2021 were identified. This review found that individuals with ACEs possess blunted cortisol response to psychosocial stressors, low-grade inflammation evinced by increased C-reactive protein levels, exaggerated amygdalar response to emotionally negative information, and diminished hippocampal gray matter volume. Importantly, these alterations were consistently observed in those with and without psychiatric diagnosis. These findings were integrated and discussed in a schematic model of ACE-related neurobiological alterations. Future longitudinal research based on multidisciplinary approach is imperative for ACE-related mental disorders' prevention and treatment.

Effects of parental care and overprotection on adolescents' diurnal cortisol profiles

Parental bonding is a strong determinant of children's health. One of the proposed pathways through which parenting impacts children's health is by altering the functioning of stress response systems. The current study aims to investigate the associations between two types of parental bonding (care and overprotection) and functioning of hypothalamic-pituitary-adrenal (HPA) axis (i.e., diurnal cortisol secretion) in a sample of 255 healthy adolescents (46.3% girls; aged 11-14 years). Participants completed the Parental Bonding Instrument and provided eight cortisol samples across two consecutive days to assess patterns of diurnal cortisol secretion. Multilevel modeling and multiple linear regression were utilized to test the main effects and interactive effects of parental care and overprotection on adolescents' wakeup cortisol, cortisol awakening response, cortisol slope, and total cortisol secretion. Results showed that parental care was associated with higher cortisol levels at awakening, while parental overprotection was associated with lower cortisol levels at awakening. Parental overprotection, but not parental care, was associated with flatter cortisol slopes. No interactive effects between parental care and overprotection on cortisol parameters emerged. The current findings add to the existing literature on parenting behavior and HPA functioning by showing that parental care and overprotection differently regulated daily cortisol parameters implicated in health.

Childhood Threat Is Associated With Lower Resting-State Connectivity Within a Central Visceral Network

Childhood adversity is associated with altered or dysregulated stress reactivity; these altered patterns of physiological functioning persist into adulthood. Evidence from both preclinical animal models and human neuroimaging studies indicates that early life experience differentially influences stressor-evoked activity within central visceral neural circuits proximally involved in the control of stress responses, including the subgenual anterior cingulate cortex (sgACC), paraventricular nucleus of the hypothalamus (PVN), bed nucleus of the stria terminalis (BNST) and amygdala. However, the relationship between childhood adversity and the resting-state connectivity of this central visceral network remains unclear. To this end, we examined relationships between childhood threat and childhood socioeconomic deprivation, the resting-state connectivity between our regions of interest (ROIs), and affective symptom severity and diagnoses. We recruited a transdiagnostic sample of young adult males and females (n = 100; mean age = 27.28, SD = 3.99; 59 females) with a full distribution of maltreatment history and symptom severity across multiple affective disorders. Resting-state data were acquired using a 7.2-min functional magnetic resonance imaging (fMRI) sequence; noted ROIs were applied as masks to determine ROI-to-ROI connectivity. Threat was determined by measures of childhood traumatic events and abuse. Socioeconomic deprivation (SED) was determined by a measure of childhood socioeconomic status (parental education level). Covarying for age, race and sex, greater childhood threat was significantly associated with lower BNST-PVN, amygdala-sgACC and PVN-sgACC connectivity. No significant relationships were found between SED and resting-state connectivity. BNST-PVN connectivity was associated with the number of lifetime affective diagnoses. Exposure to threat during early development may entrain altered patterns of resting-state connectivity between these stress-related ROIs in ways that contribute to dysregulated neural and physiological responses to stress and subsequent affective psychopathology.

Developmental costs associated with early maternal withdrawal

Neglect is the most prevalent form of maltreatment, but it has been understudied relative to abuse. Additionally, developmental outcomes associated with early maternal withdrawal have been understudied relative to outcomes associated with harsh treatment. However, a large body of studies on rodents has documented the causal effect of low maternal care on altered stress responses in offspring. Other evidence from human studies links early maternal withdrawal to clinical levels of neglect. Studies of both rodents and humans suggest that, rather than the aversive responses (e.g., fight, flight, freeze) modeled in relation to threat of attack or harsh treatment, early maternal withdrawal is associated with increased calling and contact seeking to mothers. Moreover, two longitudinal studies indicate that early maternal withdrawal, but not negative-intrusive interaction, contributes to adolescent borderline psychopathology. The field needs prospective studies with well-operationalized constructs of maternal withdrawal to delineate the distinct developmental pathways that may be associated with neglect.

Adverse childhood experiences and low socioeconomic status with respect to allostatic load in adulthood: A systematic review

Early-life psychosocial stress primes a number of health risk behaviors, and contributes to the development of various mental and somatic disorders in adulthood. It has been reported that adverse childhood experiences (ACEs) and low socioeconomic status (SES) might be associated with allostatic load (AL) in adulthood. In turn, elevated AL index has been found to predict a number of unfavorable health outcomes. Therefore, we aimed to perform a systematic review of studies investigating the association of ACEs and childhood SES with AL in adult populations. Independent online searches covered the publication period up to 20th Jun 2021. A total of 27 studies were included in qualitative synthesis. The majority of eligible studies showed that ACEs (14 out of 19 studies recording ACEs, 73.7%) and low childhood SES (11 out of 12 studies recording childhood SES, 91.7%) are associated with elevated AL in adults. However, several processes were found to mediate or moderate this association. These include educational attainments, social support, health behaviors, adult stress, post-traumatic stress disorder, coping strategies and aging. Moreover, a substantial methodological heterogeneity of approaches to calculating the AL index was observed. Apart from reports from overlapping samples, none of eligible studies used the same set of biomarkers. Findings from this systematic review imply that early-life psychosocial stress might have a lasting impact on biological dysregulations captured by the AL index. Future studies need to explore whether the association between early-life stress and the AL index accounts for the development of specific health outcomes.

Cortisol trajectories measured prospectively across thirty years of female development following exposure to childhood sexual abuse: Moderation by epigenetic age acceleration at midlife

Lasting changes in the hypothalamic-pituitary-adrenal (HPA) axis are a potential indication of the biological embedding of early life adversity, yet, prospective and repeatedly collected data are needed to confirm this relation. Likewise, integrating information from multiple biological systems, such as the HPA axis and the epigenome, has the potential to identify individuals with enhanced embedding of early life adversity. The current study reports results from the Female Growth and Development Study, a 30-year prospective cohort study of childhood sexual abuse (CSA). Females exposed to substantiated CSA and a demographically-similar comparison condition were enrolled and resting state cortisol concentrations were sampled on seven subsequent occasions across childhood, adolescence, and adulthood. Differences in participants' cortisol trajectories were examined in relation to prior CSA exposure and DNA methylation-derived epigenetic age acceleration at midlife. Bilinear spline growth models revealed a trajectory where cortisol secretion increased until approximately age twenty and then declined into mid-life, consistent with normative trends. However, cortisol concentrations peaked at a lower level and transitioned to the decline phase at an earlier age for females in the CSA condition with increased epigenetic age acceleration. Robustness tests across three independent measures of epigenetic age acceleration demonstrated similar results for lower peak cortisol levels and earlier ages at transition. Results suggest that CSA is associated with significant changes in HPA-axis activity over extended periods of time with these changes most pronounced in females with accelerated epigenetic aging in mid-life. Implications for biological embedding models of early life adversity and adulthood health are discussed.

Infant DNA methylation: an early indicator of intergenerational trauma?

Exposure to adverse childhood experiences (ACEs) increases risk for mental and physical health problems. Intergenerationally, mothers' ACEs predict children's health problems including neurodevelopmental and behavioural problems and poorer physical health. Theories of intergenerational trauma suggest that ACEs experienced in one generation negatively affect the health and well-being of future generations, with DNA methylation (DNAm) being one of several potential biological explanations. To begin exploring this hypothesis, we tested whether infant DNA methylation associated with intergenerational trauma. Secondary analysis employed data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Subsample data were collected from mothers during pregnancy and postpartum on measures of distress, stress and ACEs and from infants at 3 months of age on DNAm from blood (n = 92) and buccal epithelial cells (BECs; n = 124; primarily nonoverlapping individuals between tissues). Blood and BECs were examined in separate analyses. Preliminary associations identified in blood and BECs suggest that infant DNAm patterns may relate to maternal ACEs. For the majority of ACE-related DNAm sites, neither maternal perinatal distress, nor maternal cortisol awakening response (CAR; a measure of hypothalamic-pituitary-adrenocortical axis function), substantially reduced associations between maternal ACEs and infant DNAm. However, accounting for maternal perinatal distress and cortisol substantially changed the effect of ACEs in a greater proportion of blood DNAm sites than BEC DNAm sites in the top ACEs-associated correlated methylated regions (CMRs), as well as across all CMRs and all remaining CpGs (that did not fall into CMRs). Possible DNAm patterns in infants, thus, might capture a signature of maternal intergenerational trauma, and this effect appears to be more dependent on maternal perinatal distress and CAR in blood relative to BECs.

Correlates of Aggression in Men With Methamphetamine Use Disorder: Childhood Trauma and Methamphetamine-Use Characteristics

BACKGROUND

Aggression is common among individuals with methamphetamine use disorder (MAUD) and constitutes a serious public health issue. The current study aimed to examine associations of methamphetamine-use characteristics and childhood trauma with aggression in men with MAUD.

METHODS

This cross-sectional study was conducted from December 2017 to August 2018. MAUD patients recruited from a compulsory drug rehabilitation center (n = 360) and healthy comparison subjects (n = 604) completed a survey that measured aggression and childhood trauma, using the Chinese version of Buss-Perry Aggressive Questionnaire (AQ-CV), and the short form of Childhood Trauma Questionnaire (CTQ-SF), respectively. MAUD patients also provided information on methamphetamine-use characteristics such as the age of MAUD onset, MAUD severity, and co-occurring alcohol use disorder (AUD) and tobacco use disorder (TUD) using standard or self-designed questionnaires. Chi-square tests and t-tests were used to compare childhood trauma and aggression between the MAUD and comparison groups. Multiple linear regressions were conducted to determine correlates of overall aggression and its five sub-scales among the MAUD group.

RESULTS

The MAUD group had higher childhood trauma and aggression scores than the comparison group. Within the MAUD group, age of MAUD onset, having severe MAUD, co-occurring AUD, co-occurring TUD, and childhood trauma were associated with overall aggression, with slightly different correlates found for its five sub-scales.

CONCLUSIONS

Our study shows a high level of childhood trauma and aggression in the MAUD group. Both methamphetamine-use characteristics (age of MAUD onset, severe MAUD, co-occurring AUD/TUD) and childhood trauma were associated with aggression in MAUD. Our findings provide useful information on potential risk factors for aggression and inform future longitudinal research to establish causal relationships between these factors and aggression to guide further prevention and treatment programs.

Physiological behavior during stress anticipation across different chronic stress exposure adaptive models

Anticipation of stress induces physiological, behavioral and cognitive adjustments that are required for an appropriate response to the upcoming situation. Additional research examining the response of cardiopulmonary parameters and stress hormones during anticipation of stress in different chronic stress adaptive models is needed. As an addition to our previous research, a total of 57 subjects (16 elite male wrestlers, 21 water polo player and 20 sedentary subjects matched for age) were analyzed. Cardiopulmonary exercise testing (CPET) on a treadmill was used as the laboratory stress model; peak oxygen consumption (VO₂) was obtained during CPET. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol, alpha-melanocyte stimulating hormone (alpha-MSH) and N-terminal-pro-B type natriuretic peptide (NT-pro-BNP) were measured by radioimmunometric, radioimmunoassay and immunoassay sandwich technique, respectively, together with cardiopulmonary measurements, 10 minutes pre-CPET and at the initiation of CPET. The response of diastolic blood pressure and heart rate was different between groups during stress anticipation (p = 0.019, 0.049, respectively), while systolic blood pressure, peak VO₂ and carbon-dioxide production responses were similar. ACTH and cortisol increased during the experimental condition, NT-pro-BNP decreased and alpha-MSH remained unchanged. All groups had similar hormonal responses during stress anticipation with the exception of the ACTH/cortisol ratio. In all three groups, ΔNT-pro-BNP during stress anticipation was the best independent predictor of peak VO₂ (B = 36.01, r = 0.37, p = 0.001). In conclusion, the type of chronic stress exposure influences the hemodynamic response during anticipation of physical stress and the path of hormonal stress axis activation. Stress hormones released during stress anticipation may hold predictive value for overall cardiopulmonary performance during the stress condition.

Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis

Studies of early life stress (ELS) demonstrate the long-lasting effects of acute and chronic stress on developmental trajectories. Such experiences can become biologically consolidated, creating individual vulnerability to psychological and psychiatric issues later in life. The hippocampus, amygdala, and the medial prefrontal cortex are all important limbic structures involved in the processes that undermine mental health. Hyperarousal of the sympathetic nervous system with sustained allostatic load along the Hypothalamic Pituitary Adrenal (HPA) axis and its connections has been theorized as the basis for adult psychopathology following early childhood trauma. In this review we synthesize current understandings and hypotheses concerning the neurobiological link between childhood trauma, the HPA axis, and adult psychiatric illness. We examine the mechanisms at play in the brain of the developing child and discuss how adverse environmental stimuli may become biologically incorporated into the structure and function of the adult brain via a discussion of the neurosequential model of development, sensitive periods and plasticity. The HPA connections and brain areas implicated in ELS and psychopathology are also explored. In a targeted review of HPA activation in mood and psychotic disorders, cortisol is generally elevated across mood and psychotic disorders. However, in bipolar disorder and psychosis patients with previous early life stress, blunted cortisol responses are found to awakening, psychological stressors and physiological manipulation compared to patients without previous early life stress. These attenuated responses occur in bipolar and psychosis patients on a background of increased cortisol turnover. Although cortisol measures are generally raised in depression, the evidence for a different HPA activation profile in those with early life stress is inconclusive. Further research is needed to explore the stress responses commonalities between bipolar disorder and psychosis in those patients with early life stress.

Neuroendocrine and autonomic stress systems activity in young adults raised by mothers with mental health and substance abuse problems: A prospective cohort study

Among the well-known physiological consequences of early adverse environments is dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. A number of studies demonstrate that negative parenting and living with parents with a history of substance abuse and mental health problems may be associated with HPA axis dysregulation in children. In contrast, studies of more delayed effects in adult offspring, especially prospective, are still scarce. This study was a prospective longitudinal investigation of the association between maternal mental illnesses/substance abuse and maternal negative parenting/parental stress on one side and, on the other side, adult offspring outcomes 10 years later-specifically, we studied the activity of offspring's neuroendocrine (cortisol) and autonomic (heart rate) systems when exposed to a mild psychological stressor. Children of mothers with mental illnesses and/or substance abuse were exposed to more disadvantaged conditions (higher negative parenting and community violence). Despite this, maternal risk groups (having a mother with mental illnesses and/or substance abuse) were not associated with any of the indicators of stress systems activity. Regardless of the risk group, participants with dysregulated HPA axis activity experienced a higher level of negative parenting. Altogether, our study provides evidence that negative parenting may have long-lasting effects on stress-sensitive physiological mechanisms.

Attachment and stress regulation in socioeconomically disadvantaged children: Can public childcare compensate?

Children growing up in families experiencing socioeconomic disadvantage (SED) are at greater risk for deficits in attachment and stress regulation as compared to peers in families with more socioeconomic resources. The present study hypothesized that care providers in out-of-home care might help these children to compensate. We therefore investigated 60 children (n = 30 from SED, n = 30 matched counterparts from middle class) and assessed children's Attachment Q-Sort (AQS) toward the mother and the primary care provider in childcare centers. Moreover, children's diurnal cortisol rhythm was measured based on 12 saliva samples taken across three days a week. The disadvantaged children showed lower AQS scores with their mothers than their care providers. Compared to their counterparts, disadvantaged children also displayed heightened cortisol release and flatter cortisol profiles reflecting overall high hypothalamic-pituitary-adrenocortical activities and lower capacities to regulate stress. Most notably however, multilevel path modeling linked higher care provider AQS scores to decreasing cortisol release throughout the week.

Early life stress and latent trait cortisol in adolescent girls: a prospective examination

Early life stress (ELS) may become embedded into an individual's stress physiology, changing their hypothalamic-pituitary-adrenal (HPA)-axis in an enduring, trait-like fashion. Cortisol is often utilized to investigate HPA-axis function. However, for "trait" cortisol to be a useful construct, it needs to be internally consistent within measurement occasions and show temporal stability of this reliability. These estimates of physiometrics are rarely tested with biological variables such as cortisol. Identifying reliable and stable individual differences in cortisol may be particularly important when examining questions related to the long-term impact of ELS on HPA-axis function. Using confirmatory factor analysis (CFA) to model latent trait cortisol (LTC) may be a useful statistical approach to capture trait-like indexes of HPA-axis functioning. CFA identifies commonalities among repeated cortisol samples to differentiate characteristic patterns (i.e. a trait) from day-to-day or state variation and measurement error. It is unclear whether LTC estimates are stable prospectively, or if ELS is prospectively associated with LTC. Therefore, we derived LTC factors for 84 adolescent girls (ages 10-17 years) using two-morning salivary cortisol samples, collected sequentially for three days at baseline and again at a one-year follow-up. LTC was internally consistent at both assessments and stable over one year. Greater exposure to ELS was associated with lower LTC over a one-year follow-up. Findings support LTC modeling as a useful strategy to estimate trait-like HPA-axis functioning and suggest that exposure to ELS is associated with lower trait-like cortisol.

Child maltreatment affects fathers’ response to infant crying, not mediated by cortisol or testosterone

Parents' ability to appropriately respond to infant crying is essential for parental care and has been found to relate to parents' own childhood experiences. Additionally, childhood experiences can affect endocrine factors, which may subsequently affect behavior. In the current study, preregistered on https://osf.io/hwgtu, we examined in expectant and new fathers (N = 152) associations between experiences of maltreatment in their own childhood, hair cortisol and testosterone concentrations and their ability to modulate handgrip force when exposed to infant crying. Cortisol and testosterone were quantified from the 1 cm of hair most proximal to the scalp using Liquid chromatography-tandem mass spectrometry. Participants were asked to squeeze a handgrip dynamometer at full and half strength while listening to infant cries and control sounds. Results indicated that fathers who experienced more childhood maltreatment used more excessive handgrip force during infant cry sounds. Hair cortisol and testosterone were not related to either experienced childhood maltreatment or handgrip strength modulation. These findings confirm that fathers’ early experiences of maltreatment reduce their ability to modulate their behavioral responses during infant cries, but suggest that hair cortisol and testosterone concentrations do not identify the underlying mechanism of this association.

•

Childhood maltreatment relates to fathers' behavioural responses to infant crying.

•

Childhood maltreatment is unrelated to fathers' hair cortisol and testosterone.

•

Cortisol and testosterone are unrelated to behavioural responses to infant cries.

Post-Traumatic Bio-Behavioral Rehabilitation of Adult Female Victims

Objective

To determine if low resting basal AM cortisol and flat diurnal cortisol slope that has been reported in female abuse victims, which is dysregulated in the same way in female violent perpetrators, could be corrected and if healthier diurnal cortisol patterns are associated with less aggression in adult female victims.

Design and Methods

A non-experimental, naturalistic study evaluated if bio-behavioral rehabilitation could occur for females living in a Delaware homeless mission and participating in their programs. Basal salivary cortisol (AM, PM & slope), aggression, neurological conditions, general health, alcohol use, having been a victim of abuse, religion, spirituality and forgiveness were evaluated over one month between 2018 and 2019.

Results

T tests revealed significant improvement in mean cortisol (AM, PM & slope), aggression, emotional/ behavioral dyscontrol, and health over one month while participating in the mission’s programs. Paired t-tests however were only significant for aggression and health. Healthier cortisol was significantly correlated with greater time since last alcohol, greater time since last abuse, less aggression, better health and greater religion, spirituality and forgiveness.

Conclusion

Community programs could be cost effective methods of post-traumatic bio-behavioral rehabilitation. Forgiveness may play a critical role for abuse victims. A larger sample and more settings are needed, although these findings are promising.

Neurobiology of Female Homicide Perpetrators

Neurobiology of female homicide perpetrators is not well understood. Data from private interviews and examinations of females were re-analyzed comparing those who committed homicide (n = 9); other violent crimes, no known homicide (n = 51); nonviolent crimes, no known violent convictions (n = 49); and noncriminals (n = 12). Homicide perpetrators suffered the most childhood sexual abuse (CSA); most recent abuse; had the most neurological histories, mainly traumatic brain injuries (TBIs); most health care access for abuse-related injuries; lowest AM and PM salivary cortisol; and greatest proportion who committed crime under the influence of alcohol. Only CSA, years since last abuse, TBI, neurological histories, and health care access for abuse-related injuries were significant. Those who committed homicide under the influence of alcohol suffered the most recent abuse and had the lowest AM cortisol and flattest diurnal cortisol slope (DCS) compared with others; though the n precludes determining significance. Amount of time since last abuse, AM cortisol and DCS progressively decreased as crime severity increased; other variables progressively increased as crime severity increased. These preliminary findings suggest that low AM cortisol, flat DCS, greater CSA frequency and severity, recent abuse, TBIs, and health care access for abuse-related injuries could be risk factors for females committing homicide. Further study is needed due to the small n of homicide perpetrators. Abuse victims may be at greater risk for alcohol use and cortisol dysregulation associated with perpetrating violence, especially homicide. Frontal lobe damage from TBIs may decrease ability to control behaviors associated with emotions from the limbic system. Health care providers released these women when their abuse-related injuries were not life-threatening; yet, they were life-threatening for victims of their subsequent homicides. Females accessing health care for abuse-related injuries present a critical opportunity for violent crime prevention interventions.

The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60-64 years of age in the 1946 National Survey of Health and Development

BACKGROUND

Early life adversity is increasingly prevalent and associated with greater morbidity and mortality. It is hypothesised that the link between psychosocial early life adversity and poor health in adulthood is due to abnormal hypothalamic-pituitary-adrenal (HPA) axis functioning (often measured as cortisol patterning) and inflammation (often measured via c-reactive protein (CRP)). This study aimed to investigate the relationship between early life psychosocial adversity and cortisol patterning and CRP at 60-64 years of age.

METHODS

The MRC National Survey of Health and Development (NSHD) was used. The analytic "cortisol sample" included 843 individuals and the "CRP sample" included 1150 individuals. Data on adversity experienced between ages 0-15 years were utilised to compose a cumulative childhood psychosocial early life adversity (ELA) score (0, 1, 2, 3+). CRP and salivary cortisol (waking, 30 min after waking, and evening) were collected at 60-64 years. Associations between the psychosocial ELA score and cortisol outcomes (cortisol awakening response (CAR), diurnal slope (DS), and evening and morning cortisol) were assessed using general linear regression. Tobit regression was used to assess the association between psychosocial ELA score and CRP. Adjustments were made for age at follow-up, sex, childhood maternal education, childhood paternal social class, childhood housing tenure, and birth weight. After testing for sex by ELA score interactions, analyses were repeated stratified by sex for the CRP sample.

RESULTS

In fully adjusted models, individuals who experienced the highest level of childhood psychosocial adversity (3+) had a 24.63 (-41.49, -7.76) % lower waking cortisol and a 7.30 (1.49, 13.12) % lower decline in cortisol across the day compared to those with a psychosocial ELA score of zero. In females, the highest level of childhood psychosocial adversity, compared to the lowest, was associated with 32.61 (2.98, 62.25) % higher CRP at 60-64 years, which attenuated to 20.38% (-9.38, 50.14) upon adjustment for measures of early life socioeconomic position. Conversely, the association between childhood psychosocial adversity and CRP in males was null.

CONCLUSIONS

Our results suggest that high-levels of psychosocial adversity in childhood might result in a lower morning cortisol and flatter DS in mid-to-late-adulthood. The finding that adversity was related to higher CRP in females but not males requires replication and further investigation.