title: Psychological coping in depressed outpatients: association with cortisol response to the combined dexamethasone/CRH test.
abstract: BACKGROUND
  Depression is associated with dysfunctional coping styles and dysregulated hypothalamic-pituitary-adrenal (HPA) axis function. Studies have shown that maladaptive coping strategies relate to abnormal HPA axis function; however, such a relationship has been under-studied in patients with depression. We aimed to examine whether dysfunctional coping styles in depression would be associated with abnormal cortisol reactivity.
  
  
  METHODS
  Seventy-four outpatients with major depressive disorder and 133 age- and sex-matched healthy individuals were recruited. Coping was assessed by the Ways of Coping Checklist. Psychological distress was assessed by the Hopkins Symptom Checklist. Cortisol reactivity was measured by the combined dexamethasone/corticotropin-releasing hormone test.
  
  
  RESULTS
  Compared to healthy individuals, depressed patients demonstrated significantly less use of problem-solving, positive reappraisal and social support coping styles and more use of self-blame and wishful thinking styles. Such a pattern of coping styles was significantly associated with patients' greater distress. Partial correlation analysis in patients, controlling for age and sex, revealed a significant correlation between more use of escape-avoidance coping and lower levels of reactive cortisol measures. A stepwise multiple regression analysis predicting cortisol reactivity from age, sex, distress, symptom severity and coping styles revealed that escape-avoidance coping was a significant predictor.
  
  
  CONCLUSIONS
  The neuroendocrine challenge test was administered only once, based on a simple test protocol.
  
  
  CONCLUSIONS
  More use of escape-avoidance coping in depressed patients was associated with less cortisol reactivity. Our findings shed light on the heterogeneity of depression in terms of low and high levels of avoidance associated with exaggerated and blunted HPA axis reactivity, respectively.
authors.affiliation: Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8502, Japan; CREST (Core Research of Evolutional Science & Technology), JST (Japan Science and Technology Agency), Tokyo, Japan. Electronic address: hori@ncnp.go.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hori
authors.forename: Toshiya
authors.initials: T
authors.lastname: Teraishi
authors.forename: Miho
authors.initials: M
authors.lastname: Ota
authors.forename: Kotaro
authors.initials: K
authors.lastname: Hattori
authors.forename: Junko
authors.initials: J
authors.lastname: Matsuo
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Ikki
authors.initials: I
authors.lastname: Ishida
authors.forename: Anna
authors.initials: A
authors.lastname: Nagashima
authors.forename: Norie
authors.initials: N
authors.lastname: Koga
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Higuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kunugi
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000494:pharmacology; D003865:Major Depressive Disorder / Q000097:blood / Q000503:physiopathology* / Q000523:psychology; D003907:Dexamethasone / Q000494:pharmacology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000097:blood / Q000503:physiopathology; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
keywords: Coping; Cortisol; DEX/CRH test; Depression; Stress