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

Abstract

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 (pseverity = 0.002; pfrequency = 0.003), and blunted cortisol response during the TSST-C (pseverity = 0.006; pfrequency = 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.

Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events

“…A total of 187 children and adolescents aged 7 to 17 years participated in our multicentre study of the psychoneurobiological consequences of CM (EPI_young_stress project) [47]. Of these participants, 116 had been diagnosed with a current psychiatric disorder and 71 were healthy controls (see Table 1).…”

“…Details of the assessment of the subjects have been reported elsewhere [47]. Briefly, all the participants and their parents/legal guardians were interviewed separately, face to face, by a trained psychologist or psychiatrist to obtain sociodemographic data, and their medical and psychiatric history, and to explore their CM history.…”

“…According to the recommendations of the National Child Traumatic Stress Network (NCTSN) [50], some key steps for conducting a comprehensive evaluation of complex trauma include the assessment for a wide range of traumatic events, and the gathering of information using a variety of techniques (clinical interviews, standardized measures, and behavioural observations) and a variety of perspectives (that of the child, caregivers, teachers, other providers, etc.). Thus, in this study, the participants and their parents/legal guardians were evaluated by trained psychologists by means of an exhaustive interview following the criteria of the instrument "Tool for assessing the severity of situations in which children are vulnerable" (TASSCV) [51] (available online in Spanish); and adolescents who were older than 12 answered self-reports such as the short version of the Childhood Trauma Questionnaire (CTQ-SF) [52] and the Childhood Experience of Care and Abuse Questionnaire (CECA-Q2) [53], while participants aged 7-11 answered an adapted ad-hoc hetero-administered questionnaire (for details see Supplementary Material in Marques-Feixa, 2021 [47]). Finally, reports from social services or teachers were reviewed by trained psychologists where applicable.…”

The Interplay between Child Maltreatment and Stressful Life Events during Adulthood and Cardiovascular Problems—A Representative Study

“…Early life stress has been shown to affect long-term HPA axis functioning [20]. Consequently, cortisol metabolism [21] and autonomic, neuroendocrine, and inflammatory systems [22] are altered with potential long-term implications for hemodynamic and autonomic dysfunction [23]. This may be one explanation for why stress during childhood is associated with cardiovascular health impairments across the life span [22].…”

“…Altered cortisol responses to stress, such as after the experience of CM, have been shown to be associated with coronary artery calcification [30] and cardiovascular death [31]. As CM leads to long-lasting alterations in the individual stress response, including alterations in HPA-axis functioning and cortisol response to stressors [20,32] in a dose dependence manner [21], this may significantly impact the individual stress response to stressful life events in adulthood and consequently how the experience of stressful events in adulthood is associated with cardiovascular problems.…”