title: The Very Low-Dose Dexamethasone Suppression Test in the General Population: A Cross-Sectional Study.
abstract: Determinants of the hypothalamic-pituitary-adrenal (HPA) axis functioning are increasingly explored in population-based studies. However, functional tests measuring the negative feedback of the HPA axis cannot easily be implemented into large observational studies. Furthermore, high doses of dexamethasone often completely suppress the HPA axis in healthy persons. This study aimed to detect the effects of the health, lifestyle and sociodemographic factors, psychiatric problems and cognitive functions on the negative feedback of the HPA axis using a very low-dose (0.25 mg) dexamethasone suppression test (DST).We evaluated the associations of several determinants with the saliva cortisol concentrations after dexamethasone intake in a confounder-adjusted model also corrected for baseline saliva cortisol concentrations in the Rotterdam Study, a large population-based study (N = 1822). We found that female sex, low income, lack of exercise, instrumental disability and smoking were all independently associated with stronger suppression of the HPA axis. Even though there were no linear associations between psychiatric measures and cortisol suppression, we found that depressive symptoms and anxiety disorders were more common in persons with non-suppression of cortisol. Conversely, psychotropic medication use was related to enhanced suppression of cortisol after DST. In this large study, we found that female gender, low socioeconomic status and poor health were all related to suppression of the HPA axis. Non-linear associations were detected between the suppression of the HPA axis and common psychiatric disorders in community-dwelling persons.
authors.affiliation: Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands.|Department of Psychiatry, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Nese
authors.initials: N
authors.lastname: Direk
authors.affiliation: Department of Internal Medicine, VU Medical Centre, Amsterdam, the Netherlands.
authors.forename: Marieke J H J
authors.initials: MJ
authors.lastname: Dekker
authors.affiliation: Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Annemarie I
authors.initials: AI
authors.lastname: Luik
authors.affiliation: Department of Biological Psychology, Technical University of Dresden, Dresden, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
authors.affiliation: Department of Clinical Chemistry, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: de Rijke
authors.affiliation: Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Witte J G
authors.initials: WJ
authors.lastname: Hoogendijk
authors.affiliation: Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands.|Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands.|Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands.
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003907:Dexamethasone / Q000008:administration & dosage* / Q000494:pharmacology; D025461:Feedback, Physiological / Q000187:drug effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism; D012307:Risk Factors; D012463:Saliva / Q000187:drug effects* / Q000378:metabolism
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone