The relations of age and pubertal development with cortisol and daily stress in youth at clinical risk for psychosis

Abstract

BACKGROUND Prodromal syndromes often begin in adolescence – a period of neurodevelopmental changes and heightened stress sensitivity. Research has shown elevated stress and cortisol in individuals at clinical high risk (CHR) for psychosis. This cross-sectional study examined relations of age and pubertal status with cortisol and self-reported stress in healthy controls (HCs) and CHR adolescents. It was hypothesized that the relations of age and pubertal stage with cortisol and stress would be more pronounced in CHR youth. METHODS Participants were 93 HCs and 348 CHR adolescents from the North American Prodrome Longitudinal Study (NAPLS). At baseline, measures of stress (Daily Stress Inventory – DSI), Tanner stage (TS), and salivary cortisol were obtained. RESULTS ANCOVA revealed increased DSI scores with age for both groups, and higher DSI scores in CHR adolescents than HCs, with a more pronounced difference for females. Contrary to prediction, with age controlled, HCs showed greater TS-related DSI increases. Analysis of cortisol showed no significant interactions, but a main effect of age and a trend toward higher cortisol in the CHR group. Correlations of cortisol with TS were higher in HC than CHR group. CONCLUSIONS Stress measures increased with age in HC and CHR adolescents, and DSI scores also increased with TS in HCs. The results do not support a more pronounced age or TS increase in stress measures in CHR adolescents, but instead suggest that stress indices tend to be elevated earlier in adolescence in the CHR group. Potential determinants of findings and future directions are discussed.

The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities

“…Similarly, CHR patients who later converted to psychosis reported a greater number of life events, and perceived these events as more stressful, compared to healthy controls and CHR subjects whose symptoms remitted (Trotman et al, 2014). Perceived stress levels in CHR patients are generally high (Moskow et al, 2016), and in some studies they even exceed ratings in FEP patients (Pruessner et al, 2011, Palmier-Claus et al, 2012.…”

Cortisol Responses to Naturally Occurring Psychosocial Stressors Across the Psychosis Spectrum: A Systematic Review and Meta-Analysis

“…As dictated by our inclusion criteria, all studies included a healthy control group and at least one psychosis spectrum group. Four studies included both high-risk and established psychosis subgroups (48,51,53,55), eight included established psychosis groups only (46,49,52,54,65,(67)(68)(69), and six examined high-risk groups only (31,47,50,56,60,66). The most commonly-examined established psychosis subgroup was FEP (n=5), a further study examined recent-onset psychosis (49) which included FEP patients, two studies included patients with psychotic disorder where the stage of illness was not indicated (53,67), three studies included patients with schizophrenia (52,54,69), while a further study distinguished between patients with early and chronic schizophrenia (55).…”

“…Control groups varied in size, ranging from 25 (68) to 133 (46), the latter study also comprised the largest established psychosis group (n=169). With regards to high-risk group sizes, the smallest comprised of 21 UHR individuals (48) with the largest including 348 UHR youth from the NAPLS-2 study (66). Participants in the high-risk groups were the youngest on average (mean age = 23.7 years; range: 12.8 to 42.9 years), followed by healthy controls (mean age = 27.2 years; range 13.1 to 43.5 years), with the oldest being those with established psychosis (mean age = 31.1 years; range 20.6 to 43.8 years).…”

“…For childhood trauma, there was less consistency, with the most commonly-used measures being the Childhood Experience of Care and Abuse (CECA) questionnaire (72) and the Childhood Trauma Questionnaire (73). Daily stressors were examined in two studies (albeit using different measures), one reported both exposure and distress scores separately (31), whilst the other reported a single score that accounted for both exposure and associated distress (66); the former study also reported distress scores (both current distress and distress at the time of the event) for negative life events. The experience sampling method (ESM), a structured diary technique in which participants are prompted at multiple time-points throughout the day to report the extent to which their current activity is stressful, was used in two studies (53,60).…”

“…Hair sampling was the second most common method used to determine cortisol levels (n=5), with all studies obtaining at least one 3 cm segment for analysis (47,(54)(55)(56)69). With regards to the timing of cortisol collection, basal samples (saliva, plasma, and serum) were the most commonly-examined, with four studies obtaining a single measure (50,52,67,68), typically in the morning, and a further study deriving a mean cortisol value from three samples obtained at 1-h intervals (66). The cortisol awakening response (CAR) was measured in saliva in seven studies (31,46,(48)(49)(50)(51)65): All of these studies computed the area-under-the-curve with respect to increase (AUCi) which captures the increase in cortisol from awakening levels; one of these studies (46) also calculated the AUC with respect to ground (AUCg) representing the total amount of cortisol secreted in the hour following awakening.…”