Multi-Level Risk Factors for Suicidal Ideation Among at-Risk Adolescent Females: The Role of Hypothalamic-Pituitary-Adrenal Axis Responses to Stress

Abstract

Adopting a multi-level approach, this study examined risk factors for adolescent suicidal ideation, with specific attention to (a) hypothalamic-pituitary-adrenal (HPA) axis stress responses and (b) the interplay between HPA-axis and other risk factors from multiple domains (i.e., psychological, interpersonal and biological). Participants were 138 adolescent females (Mage=14.13 years, SD=1.40) at risk for suicidal behaviors. At baseline, lifetime suicidal ideation and a number of risk factors were assessed (i.e., depressive symptoms, impulsiveness, pubertal status and peer stress). Participants were exposed to a psychosocial stress task and HPA-axis responses were assessed by measuring cortisol levels pre- and post-stressor. At 3 months post-baseline, suicidal ideation again was assessed. Using group-based trajectory modeling, three groups of cortisol stress-response patterns were identified (i.e., hyporesponsive, normative, and hyperresponsive). As compared to females in the normative and hyporesponsive group, females in the hyperresponsive group were more likely to report a lifetime history of suicidal ideation at baseline, above and beyond the effects of the other predictors. Moreover, as compared to females in the normative group, females in the hyperresponsive group were at increased risk for reporting suicidal ideation 3 months later, after controlling for prior ideation. No interactions between cortisol group and the other risk factors were significant, with the exception of a non-significant trend between impulsiveness and cortisol group on lifetime suicidal ideation. Findings highlight the importance of HPA-axis responses to acute stressors as a risk factor for suicidal ideation among adolescents.

Cortisol reactivity and suicidal behavior: Investigating the role of hypothalamic-pituitary-adrenal axis responses to stress in suicide attempters and ideators

“…This finding is contrary to Giletta et al (2015) who found that heightened cortisol reactivity to stress was the strongest predictor of suicide ideation at three-month follow-up in at-risk adolescent females. This study also found a subsample of adolescents who exhibited a blunted response to stress and high levels of suicide ideation 3-months later (though, this effect was only a trend).…”

“…In the context of suicide research, the majority of previous work has focused on assessing HPA axis functioning through pharmacological manipulation of the stress system (e.g., see Coryell and Schlesser, 2001;Coryell et al, 2006;Mann and Currier, 2007;Pompili et al, 2010). However, recently researchers have turned their attention to investigating other aspects of the cortisol response, such as cortisol reactivity to laboratory stressors (e.g., Giletta et al, 2015;McGirr et al, 2010). McGirr and colleagues (2010) explored the extent to which dysregulation of the HPA axis to a laboratory stressor was a heritable risk factor for suicidal behavior.…”

“…More recently, two studies have been published that have used the TSST to examine HPA axis responses to stress in vulnerable, at risk groups (Giletta et al, 2015;Melhem et al, 2016). Giletta and colleagues explored the extent to which cortisol reactivity to stress was associated with lifetime history of suicide ideation (i.e., developing suicidal thoughts) and whether reactivity predicted future suicidal ideation in at-risk adolescent females.…”

Anxious attachment style predicts an enhanced cortisol response to group psychosocial stress

“…For example an enhanced cortisol response to the TSST has been shown to predict depressive symptoms in young adults (Morris et al, 2012) and suicidal ideation in female adolescents with a history of mental health concerns (Giletta et al, 2014). The results are also consistent with evidence showing greater cortisol reactivity to the TSST in older adults subjected to separation from both parents during childhood (Pesonen et al, 2010) and in young adults exposed to severe pre-natal stress (Entringer et al, 2009).…”

Cortisol levels and suicidal behavior: A meta-analysis

“…Once released, cortisol has several important functions such as increasing access to energy stores, increasing protein and fat mobilisation, as well as regulating the magnitude and duration of inflammatory responses (Sapolsky et al, 2000). Cortisol has also been found to be associated with impairments in cognitive control, decision-making and emotional processing linked to suicidal behavior (Giletta et al, 2015;Turecki et al, 2012). As such, cortisol is the primary effector hormone of the HPA axis stress response system and has received extensive empirical investigation.…”