title: Cortisol response to social stress in parentally bereaved youth.
abstract: BACKGROUND
  Parental bereavement is associated with increased risk for psychiatric illness and functional impairment in youth. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning may be one pathway through which bereaved children experience increased risk for poor outcomes. However, few studies have prospectively examined the association between parental bereavement and cortisol response while accounting for psychiatric disorders in both youth and their caregivers.
  
  
  METHODS
  One-hundred and eighty-one bereaved and nonbereaved offspring and their caregivers were assessed at multiple time points over a 5-year period after parental death. Offspring participated in an adaptation of the Trier Social Stress Task (TSST), and salivary cortisol samples were collected before and after exposure to social stressors. Mixed models for repeated measures were used to analyze the effects of bereavement status, psychiatric disorder in both offspring and caregiver, and demographic indices on trajectories of cortisol response.
  
  
  RESULTS
  After controlling for demographic variables and offspring depression, bereaved offspring demonstrated significantly different trajectories of cortisol response compared with nonbereaved offspring, characterized by higher total cortisol output and an absence of cortisol reactivity to acute social stress. Within the bereaved group, offspring of parents who died by sudden natural death demonstrated significant cortisol reactivity to social stress compared with offspring whose parents died by suicide, who demonstrated more blunted trajectory of cortisol response.
  
  
  CONCLUSIONS
  Parentally bereaved youth demonstrate higher cortisol output than nonbereaved youth but are less able to mount an acute response in the face of social stressors.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Dietz
authors.forename: Samuel
authors.initials: S
authors.lastname: Stoyak
authors.forename: Nadine
authors.initials: N
authors.lastname: Melhem
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Monica
authors.initials: M
authors.lastname: Walker Payne
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D000328:Adult; D001601:Bereavement; D017028:Caregivers / Q000523:psychology; D002648:Child; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D012463:Saliva / Q000737:chemistry; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology* / Q000523:psychology; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology
chemical_list: D006854:Hydrocortisone