Suzuki Akiko, Poon Lucia, Papadopoulos Andrew S, Kumari Veena, Cleare Anthony J
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
Affective Disorders Unit and Laboratory, South London and Maudsley NHS Trust, London BR3 3BX, UK.
Psychoneuroendocrinology. 2014 Dec;50:289-99. doi: 10.1016/j.psyneuen.2014.09.007. Epub 2014 Sep 17.
Childhood trauma may have longstanding effects on individuals' propensity to react adversely to stress, and also predisposes individuals to suffer from depression. The current study aimed to examine stress reactivity in individuals with and without a history of childhood trauma by measuring cortisol responses to the passive viewing of stressful images, specifically including images relevant to childhood trauma. In addition, participants with and without a diagnosis of current depression were studied to investigate whether cortisol stress reactivity may underlie resilience or vulnerability to depression.
The study involved 17 healthy participants with and 24 without a history of childhood trauma; and 21 depressed patients with and 18 without a history of childhood trauma. Salivary cortisol was measured before, during and after participants were shown affectively laden images, including standardised scenes from the International Affective Picture System and also images suggestive of childhood abuse. Cortisol stress reactivity to the passive image viewing was compared between groups.
In those who had experienced childhood trauma, cortisol stress responses were overall low and the same in those who were depressed and those who were not (mean stress reactivity variable - depressed: 0.8 nmol/l; non-depressed: 0.72 nmol/l). In contrast, cortisol stress reactivity was raised in depressed subjects relative to those who were not depressed in those without a history of childhood trauma (mean stress reactivity variable - depressed: 3.75 nmol/l; non-depressed: 0.1 nmol/l).
A history of childhood trauma has longstanding effects on adulthood cortisol responses to stress, particularly in that depressed individuals with a history of childhood trauma show blunted cortisol responses. However, there were no differences between abused depressed and abused non-depressed subjects on cortisol stress responses, suggesting that such a finding does not explain subsequent susceptibility to depression. On the other hand, patients who experience depression without a history of childhood trauma show enhanced cortisol stress reactivity, which could help explain the aetiology of their depressive illnesses. Differences between the current findings and those using other pharmacological and stress challenge paradigms may relate to the type of stimuli used and to dysfunction at different levels of the hypothalamic-pituitary-adrenal (HPA) axis.
童年创伤可能对个体对应激产生不良反应的倾向产生长期影响，还会使个体易患抑郁症。本研究旨在通过测量对被动观看应激图像（特别是与童年创伤相关的图像）时的皮质醇反应，来检查有和没有童年创伤史的个体的应激反应性。此外，对有和没有当前抑郁症诊断的参与者进行研究，以调查皮质醇应激反应性是否可能是抵御或易患抑郁症的基础。
该研究纳入了17名有童年创伤史的健康参与者和24名无童年创伤史的健康参与者；以及21名有童年创伤史的抑郁症患者和18名无童年创伤史的抑郁症患者。在参与者观看包含国际情感图片系统的标准化场景以及暗示童年虐待的图像等情感负载图像之前、期间和之后测量唾液皮质醇。比较各小组之间对被动图像观看的皮质醇应激反应性。
在有童年创伤经历的人群中，皮质醇应激反应总体较低，且抑郁症患者和非抑郁症患者的反应相同（平均应激反应变量 - 抑郁症患者：0.8纳摩尔/升；非抑郁症患者：0.72纳摩尔/升）。相比之下，在没有童年创伤史的人群中，抑郁症患者的皮质醇应激反应性相对于非抑郁症患者有所升高（平均应激反应变量 - 抑郁症患者：3.75纳摩尔/升；非抑郁症患者：0.1纳摩尔/升）。
童年创伤史对成年期对应激的皮质醇反应有长期影响，特别是有童年创伤史的抑郁症患者表现出皮质醇反应迟钝。然而，受虐待的抑郁症患者和受虐待的非抑郁症患者在皮质醇应激反应方面没有差异，这表明这一发现并不能解释随后患抑郁症的易感性。另一方面，没有童年创伤史而患抑郁症的患者表现出增强的皮质醇应激反应性，这有助于解释他们抑郁症的病因。当前研究结果与使用其他药理学和应激挑战范式的研究结果之间的差异可能与所用刺激的类型以及下丘脑 - 垂体 - 肾上腺（HPA）轴不同水平的功能障碍有关。
