Maltreatment and diurnal cortisol regulation: A meta-analysis.
Childhood maltreatment leads to a host of negative physical and mental health outcomes, with cortisol dysregulation implicated as a possible mechanism. Given inconsistencies across in the literature regarding the direction and magnitude of the association between maltreatment and diurnal cortisol regulation, the current meta-analysis of 27 studies aimed to examine the association between maltreatment and at least one of 3 indicators of diurnal cortisol regulation: wake-up cortisol levels, the cortisol awakening response (CAR), and/or the diurnal cortisol slope. Effect sizes were calculated using Hedges' g formula and were pooled using a random effects model. For the association between maltreatment and wake-up cortisol level, the aggregate effect size was g=0.08, p=0.26. Notably, effect sizes between maltreatment and wake-up cortisol were significantly larger (Qbetween=5.18, p=0.02) for studies of agency-referred samples, g=0.24, p=0.006, than studies for which maltreatment status was based on self-report, g=0.00, p=0.97, with maltreatment associated with reduced wake-up cortisol levels. For the association between maltreatment and the CAR and diurnal cortisol slope, the aggregate effect sizes were non-significant and none of the moderator variables were significant. Although results did not indicate a large and robust association between maltreatment and various indicators of diurnal cortisol, studies with more rigorous designs (i.e., agency-referred samples) showed a small, significant association between maltreatment and blunted wake-up cortisol levels, suggesting a pattern of hypocortisolism.
Department of Psychology, Stony Brook University, United States. Electronic address: kristin.bernard@stonybrook.edu.
Kristin
K
Bernard
Department of Psychology, Stony Brook University, United States.
Allison
A
Frost
University of Pittsburgh Medical Center, United States.
Charles B
CB
Bennett
Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
Oliver
O
Lindhiem
D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse; D002648:Child; D002649:Child Abuse; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000503:physiopathology*; D055815:Young Adult
D006854:Hydrocortisone
Child maltreatment; Cortisol; HPA axis; Hypocortisolism; Stress