title: Anxiety and physiological responses to the Trier Social Stress Test for Children in adolescents with cyclic vomiting syndrome.
abstract: This study compared anxiety and physiological responses during the Trier Social Stress Test for Children (TSST-C) in adolescents. 38 subjects (26 females) were enrolled: 11 cyclic vomiting syndrome (CVS), 11 anxiety, and 16 controls. Salivary cortisol, α-amylase and heart rate variability (HRV) were assessed during the TSST-C. Anxiety was measured by the Screen for Childhood Anxiety Related Emotional Disorders (SCARED), Anxiety Disorders Interview Schedule, and State-Trait Anxiety Inventory for Children (STAI-C). 11 anxiety and 7 CVS subjects had ≥1 anxiety disorder. 82% in the anxiety and CVS groups met criteria for an anxiety disorder on the SCARED. Combining groups, cortisol increased from baseline to recovery during the TSST-C (p=0.0004) and the stressor to recovery (p=0.005). α-amylase did not differ during the TSST-C for the total sample, but increased for anxiety compared to controls from baseline to recovery (p=0.01). HRV decreased during the stressor (p=0.0001) and increased at recovery (p=0.004). No associations were found between biomarkers and trait anxiety. Associations were found between baseline HRV and pre-test state anxiety (r=-0.406, p=0.012) and between recovery HRV and post-test state anxiety (r=-0.501, p=0.002) for the total sample. Anxiety is prevalent in CVS warranting screening. HRV may serve as a biomarker for evaluating stress as a potential trigger for CVS episodes. State but not trait anxiety was associated with changes in HRV, suggesting acute anxiety may be more relevant in linking stress and CVS episodes.
authors.affiliation: Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Building 500, F546, 13001 East 17th Place, Aurora, CO 80045, United States; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave., B065, Aurora, CO 80045, United States. Electronic address: sally.tarbell@childrenscolorado.org.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Tarbell
authors.affiliation: Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Building 500, F546, 13001 East 17th Place, Aurora, CO 80045, United States. Electronic address: Amanda.Millar@ucdenver.edu.
authors.forename: Amanda
authors.initials: A
authors.lastname: Millar
authors.affiliation: Department of Psychiatry, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Building 500, F546, 13001 East 17th Place, Aurora, CO 80045, United States. Electronic address: Mark.Laudenslager@ucdenver.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Laudenslager
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave., B065, Aurora, CO 80045, United States. Electronic address: Claire.Palmer@ucdenver.edu.
authors.forename: Claire
authors.initials: C
authors.lastname: Palmer
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave., B065, Aurora, CO 80045, United States. Electronic address: John.Fortunato@vcuhealth.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Fortunato
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis / Q000503:physiopathology*; D015415:Biomarkers / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007406:Interview, Psychological; D008297:Male; D010290:Parents; D010551:Personality / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000378:metabolism; D012919:Social Behavior; D013315:Stress, Psychological / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D000516:alpha-Amylases / Q000378:metabolism
chemical_list: D015415:Biomarkers; D000516:alpha-Amylases; D006854:Hydrocortisone
keywords: Alpha amylase; Child anxiety; Cyclic vomiting syndrome; Heart rate variability; Salivary cortisol; Trier Social Stress Test