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Persistent Heightened Cortisol Awakening Response and Adolescent Internalizing Symptoms: A 3-year Longitudinal Community Study

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Abstract

An atypical Cortisol Awakening Response (CAR) has been related to adult anxiety and depression, but little is known about the association between long-term atypical CAR and adolescent anxiety and depression. This study aimed to longitudinally identify subgroups of adolescents with distinct levels of CAR (i.e., adolescents with and without persistent atypical CAR) and to examine their development of anxiety and depressive symptoms over 3 successive years. A community sample of 184 Dutch adolescents (M age = 14.99 at T1, 57 % boys) completed annual salivary cortisol assessments at home at time of awakening, and 30 and 60 min post-awakening (i.e., CAR) for 3 successive years. Adolescents also reported annually on their anxiety and depressive disorder symptoms. Latent Class Growth Analysis suggested two subgroups of adolescents with respect to CAR: a “low” group with stable low levels of AUCg (Area Under the Curve with respect to the ground) over time and a “high” group with high and increasing levels of AUCg over time. Controlling for sex, the high and low CAR groups significantly differed in depressive symptoms only, but none of the anxiety disorder symptoms. More specifically, adolescents in the high CAR group showed significantly higher mean levels of depressive symptoms over time compared to adolescents in the low CAR group. These results suggest that persistent heightened CAR is a more consistent, yet modest, correlate of adolescent depressive symptoms than anxiety disorder symptoms.

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Notes

  1. It is noted, for example, by Spijker and Van Rossum (2012) that “it is complex to properly measure and assess the functioning of the HPA axis in humans” (p. 179). They also note that one of the most common approaches to evaluate HPA axis functioning is the measurement of basal cortisol levels in response to awakening, as a model for an endogenous stress response. Although CAR is more than simply a measure of HPA axis activity, we would refer the reader to Clow et al. (2010) and Fries et al. (2009) for a more detailed discussion of this issue, since this is beyond the scope of the present article.

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Acknowledgments

Data of the RADAR study were used. RADAR has been financially supported by main grants from the Netherlands Organisation for Scientific Research (GB-MAGW 480-03-005, GBMAGW 480-08-006), and Stichting Achmea Slachtoffer en Samenleving (SASS), and various other grants from the Netherlands Organisation for Scientific Research, the VU University Amsterdam and Utrecht University. The authors would like to thank all schools and families for their participation.

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Authors and Affiliations

  1. Research Centre Adolescent Development, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands

    Stefanie A. Nelemans, William W. Hale III, Susan J. T. Branje & Wim H. J. Meeus

  2. Department of Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands

    Pol A. C. van Lier & Hans M. Koot

  3. Department of Child and Adolescent Psychiatry, VU Medical Center, Amsterdam, Netherlands

    Lucres M. C. Jansen & Evelien Platje

  4. Trimbos Institute, Utrecht, The Netherlands

    Tom Frijns

  5. Department of Developmental Psychology, Tilburg University, PO Box 90.153, 5000 LE, Tilburg, The Netherlands

    Wim H. J. Meeus

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  1. Stefanie A. Nelemans
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Nelemans, S.A., Hale, W.W., Branje, S.J.T. et al. Persistent Heightened Cortisol Awakening Response and Adolescent Internalizing Symptoms: A 3-year Longitudinal Community Study. J Abnorm Child Psychol 42, 767–777 (2014). https://doi.org/10.1007/s10802-013-9820-2

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