Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610-0165, United States.
Psychoneuroendocrinology. 2013 Feb;38(2):241-9. doi: 10.1016/j.psyneuen.2012.06.001. Epub 2012 Jul 2.
Endometrial cancer (EC) is the most common type of gynecologic cancer affecting women; however, very little research has examined relationships between psychological factors and hypothalamic-pituitary-adrenal (HPA) axis dysregulation in this population. The current study examined relations between depressive/anxious symptoms and salivary cortisol diurnal rhythm and variability in women undergoing surgery for suspected endometrial cancer. Depressive and anxious symptoms were measured prior to surgery using the Structured Interview Guide for the Hamilton Depression Inventory (SIGH-AD). Saliva was collected four times a day for the 3 days prior to surgery and then assayed by ELISA to obtain cortisol concentrations. Cortisol slopes and intraindividual variability were then calculated across subjects. Relations between depressive/anxious symptoms and cortisol indices were examined using multilevel modeling and linear regression analyses. Participants were 82 women with nonmetastatic endometrial cancer. Anxious symptoms were not associated with either cortisol slope or intraindividual variability, and depressive symptoms were unrelated to cortisol slope. However, after controlling for presence of poorer prognosis cancer subtypes, greater depressive symptoms (excluding symptoms possibly/definitely due to health/treatment factors) in the week preceding surgery were significantly related to greater cortisol intraindividual variability (β=.214; p<.05). These results suggest that depressive symptoms prior to surgery for suspected endometrial cancer are related to greater cortisol intraindividual variability, which is suggestive of more erratic HPA axis arousal. Future research should examine whether mood symptoms may be associated with compromised health outcomes via erratic HPA axis arousal in this population.
子宫内膜癌（EC）是影响女性的最常见妇科癌症类型；然而，很少有研究检查过该人群中心理因素与下丘脑-垂体-肾上腺（HPA）轴失调之间的关系。本研究检查了疑似子宫内膜癌手术前女性的抑郁/焦虑症状与唾液皮质醇昼夜节律和可变性之间的关系。使用 Hamilton 抑郁量表的结构化访谈指南（SIGH-AD）在手术前测量抑郁和焦虑症状。在手术前 3 天每天采集 4 次唾液，然后通过 ELISA 测定皮质醇浓度。然后计算受试者的皮质醇斜率和个体内可变性。使用多层建模和线性回归分析检查抑郁/焦虑症状与皮质醇指数之间的关系。参与者为 82 名患有非转移性子宫内膜癌的女性。焦虑症状与皮质醇斜率或个体内可变性均无关，而抑郁症状与皮质醇斜率无关。然而，在控制存在预后较差的癌症亚型后，手术前一周内更严重的抑郁症状（不包括可能/肯定因健康/治疗因素引起的症状）与更大的皮质醇个体内可变性显著相关（β=.214；p<.05）。这些结果表明，疑似子宫内膜癌手术前的抑郁症状与更大的皮质醇个体内可变性相关，这表明 HPA 轴唤醒更不规则。未来的研究应该检查在该人群中，情绪症状是否可能通过不规则的 HPA 轴唤醒与健康结果受损相关。
