Associations Among Perceived Stress, Cortisol, and Adolescent Depressive Symptoms

Category/Date Clinical Research Podium Presentations: Research on Adolescents: Depression, Diabetes, Drugs. Presented at NAPNAP's 43rd National Conference on Pediatric Health Care, April 29th, 2022 Purpose for research study The purpose of this study is to examine the neuroendocrine pathway by which perceived stress is associated with adolescent depressive symptoms. Background and significance Depression rates sharply increase during adolescence, with an estimated 13% of adolescents diagnosed with depression in 2017. Studies have shown negative effects of perceived stress on depression during adolescence. Yet, the mechanistic pathway by which perceived stress is linked to adolescent depression is unclear. Conceptual framework: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated as one such mechanism involved with the pathophysiology of depression. Since the negative feedback loop is impaired, the HPA axis is continually activated and an excess of cortisol is released, which has been reported among patients with many years of mood disorders. Objectives 1.) This study was conducted to determine the feasibility of salivary cortisol collection procedures, a non-invasive method of cortisol collection, in a home setting. 2.) To examine the relationships between perceived stress and diurnal cortisol levels (change in levels throughout the day) on adolescent depressive symptoms. Methods This was a cross-sectional study. Adolescents 13–19 years of age were recruited from a primary care clinic and through advertisements. Following assent and consent, participants were instructed to answer questionnaires about depressive symptoms (Patient Health Questionnaire-9), perceived stress (Perceived Stress Scale), and sociodemographics. Participants self-collected four salivary cortisol samples (upon waking, 45 minutes post awakening, at 4pm, and prior to bedtime). This study was approved by the UCSF IRB on 05/25/21. Four methods of diurnal cortisol (average, CAR, diurnal slope, and AUC) were calculated. We used separate multiple linear regression models to examine the associations between the diurnal cortisol measurements, perceived stressed, and depressive symptoms. Results The sample consisted of 72 adolescents (35 females and 37 males). The mean age was 16.82 years. Participants were predominantly White (55.7%) and not Hispanic (68.1%). Most families (44.3%) earned $100,000-$150,000, and a total of 21.4% of the families received some form of government health insurance. There were no associations between perceived stress and the diurnal cortisol measurements, as well as diurnal cortisol measurements with depressive symptoms. Higher perceived stress was associated with more depressive symptoms (Beta=0.11, p-value<0.001). Discussion/conclusion Outcomes support the overall feasibility of our procedures for self-collection of salivary cortisol throughout the day in the home setting, and samples were intact and analyzed without any issues. Our findings support that perceived stress (subjective measure), but not diurnal cortisol levels (objective measure), is associated with adolescent depressive symptoms. Adolescent depressive symptoms have multiple pathophysiological pathways, not limited to the neuroendocrine system, but may involve the immune or metabolic pathways. Moreover, perceived stress was not associated with diurnal cortisol levels, possibly because the two measure different levels of stress chronicity. Nonetheless, perceived stress is a predictor of adolescent depressive symptoms, therefore warrants further research identifying the different types of stressors inflicted upon this age group. Results indicate the need for depression screening, with a focus on risk factor assessment, of adolescents, especially in the primary care setting. Clinical Research Podium Presentations: Research on Adolescents: Depression, Diabetes, Drugs. Presented at NAPNAP's 43rd National Conference on Pediatric Health Care, April 29th, 2022 The purpose of this study is to examine the neuroendocrine pathway by which perceived stress is associated with adolescent depressive symptoms. Depression rates sharply increase during adolescence, with an estimated 13% of adolescents diagnosed with depression in 2017. Studies have shown negative effects of perceived stress on depression during adolescence. Yet, the mechanistic pathway by which perceived stress is linked to adolescent depression is unclear. Conceptual framework: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated as one such mechanism involved with the pathophysiology of depression. Since the negative feedback loop is impaired, the HPA axis is continually activated and an excess of cortisol is released, which has been reported among patients with many years of mood disorders. 1.) This study was conducted to determine the feasibility of salivary cortisol collection procedures, a non-invasive method of cortisol collection, in a home setting. 2.) To examine the relationships between perceived stress and diurnal cortisol levels (change in levels throughout the day) on adolescent depressive symptoms. This was a cross-sectional study. Adolescents 13–19 years of age were recruited from a primary care clinic and through advertisements. Following assent and consent, participants were instructed to answer questionnaires about depressive symptoms (Patient Health Questionnaire-9), perceived stress (Perceived Stress Scale), and sociodemographics. Participants self-collected four salivary cortisol samples (upon waking, 45 minutes post awakening, at 4pm, and prior to bedtime). This study was approved by the UCSF IRB on 05/25/21. Four methods of diurnal cortisol (average, CAR, diurnal slope, and AUC) were calculated. We used separate multiple linear regression models to examine the associations between the diurnal cortisol measurements, perceived stressed, and depressive symptoms. The sample consisted of 72 adolescents (35 females and 37 males). The mean age was 16.82 years. Participants were predominantly White (55.7%) and not Hispanic (68.1%). Most families (44.3%) earned $100,000-$150,000, and a total of 21.4% of the families received some form of government health insurance. There were no associations between perceived stress and the diurnal cortisol measurements, as well as diurnal cortisol measurements with depressive symptoms. Higher perceived stress was associated with more depressive symptoms (Beta=0.11, p-value<0.001). Outcomes support the overall feasibility of our procedures for self-collection of salivary cortisol throughout the day in the home setting, and samples were intact and analyzed without any issues. Our findings support that perceived stress (subjective measure), but not diurnal cortisol levels (objective measure), is associated with adolescent depressive symptoms. Adolescent depressive symptoms have multiple pathophysiological pathways, not limited to the neuroendocrine system, but may involve the immune or metabolic pathways. Moreover, perceived stress was not associated with diurnal cortisol levels, possibly because the two measure different levels of stress chronicity. Nonetheless, perceived stress is a predictor of adolescent depressive symptoms, therefore warrants further research identifying the different types of stressors inflicted upon this age group. Results indicate the need for depression screening, with a focus on risk factor assessment, of adolescents, especially in the primary care setting.