Holland Jason M, Rengifo Johanna, Currier Joseph M, O'Hara Ruth, Sudheimer Keith, Gallagher-Thompson Dolores
Department of Psychology, University of Nevada, Las Vegas, Nevada, USA.
Palo Alto University, Palo Alto, California, USA.
Int Psychogeriatr. 2014 Sep;26(9):1531-1539. doi: 10.1017/S1041610214000489.
Previous studies have identified a number of psychosocial risk factors of dysregulated cortisol (frequently referred to as the "stress hormone") among older adults with depression. However, these studies have typically only examined a handful of risk factors at a time and have sometimes yielded inconsistent results.
This study aims to address this gap in the literature by simultaneously examining a range of relevant psychosocial predictors of diurnal cortisol among 54 older adults with a depressive disorder. Salivary cortisol was assessed upon awakening, at 5 PM, and at 9 PM across two consecutive days. Participants also completed measures of global psychosocial stress, current psychiatric symptomatology, pervasive distress (e.g. history of past depression), and protective factors (e.g. social support, resiliency, extent to which one has "made sense" of a significant stressor).
High levels of current depressive symptoms, psychiatric comorbidities, past depressive episodes, trait anxiety, and poorer ability to make sense of one's stress were found to be associated with flatter (more abnormal) cortisol slopes. However, when all of these variables were entered simultaneously in a multiple regression analysis, only history of past depression and the degree of sense made of stress emerged as unique predictors of cortisol in the model.
These findings have important implications for identifying depressed elderly individuals with dysregulated cortisol patterns who may be most at risk for health complications. Treatments that aim to limit the chronicity of depression and help to increase the sense made of stress could potentially have a positive impact on health.
以往研究已确定了一些患有抑郁症的老年人中皮质醇失调（常被称为“应激激素”）的社会心理风险因素。然而，这些研究通常一次只考察少数风险因素，且有时结果并不一致。
本研究旨在通过同时考察54名患有抑郁症的老年人中一系列昼夜皮质醇相关的社会心理预测因素，来填补文献中的这一空白。在连续两天的早晨、下午5点和晚上9点评估唾液皮质醇。参与者还完成了全球社会心理压力、当前精神症状、普遍困扰（如过去的抑郁病史）以及保护因素（如社会支持、恢复力、个体对重大应激源的“理解”程度）的测量。
发现当前高水平的抑郁症状、精神共病、过去的抑郁发作、特质焦虑以及对应激的理解能力较差与较平坦（更异常）的皮质醇斜率相关。然而，当在多元回归分析中同时纳入所有这些变量时，模型中只有过去的抑郁病史和对应激的理解程度是皮质醇的独特预测因素。
这些发现对于识别皮质醇模式失调且可能最易出现健康并发症风险的老年抑郁症患者具有重要意义。旨在限制抑郁症的慢性化并帮助增强对应激的理解的治疗方法可能会对健康产生积极影响。
