Saavedra Pérez Heidi C, Direk Nese, Milic Jelena, Ikram Mohammed Arfan, Hofman Albert, Tiemeier Henning
From the Department of Epidemiology (Saavedra Pérez, Direk, Milic, Ikram, Hofman, Tiemeier), Erasmus Medical Centre, Rotterdam, the Netherlands, Department of Radiology (Ikram), Erasmus Medical Centre, Rotterdam, the Netherlands, Department of Child and Adolescent Psychiatry (Tiemeier), Erasmus Medical Centre, Rotterdam, the Netherlands, and Department of Psychiatry (Tiemeier), Erasmus Medical Centre, Rotterdam, the Netherlands.
Psychosom Med. 2017 May;79(4):426-433. doi: 10.1097/PSY.0000000000000422.
Few studies have focused on the effect of complicated grief-unresolved and prolonged grief-on the neuroendocrine systems. The present study examined the association of complicated grief and normal grief with the diurnal cortisol patterns in a large population-based study.
This study was set in the Rotterdam Study and comprised 2084 persons aged older than 55 years (mean [SD] age, 64.9 [5.5] years). Participants were assessed with the Complicated Grief Inventory and classified into no grief (n = 1922), normal grief (n = 131), or complicated grief (n = 31) if they experienced the loss in the past 2 years. Saliva samples were collected to measure cortisol levels. Morning cortisol and summary measures (area under the curve and the slope) were studied to account for the diurnal pattern of cortisol. Persons with depressive disorders were excluded, and analyses were additionally adjusted for depressive symptoms.
Compared to normal grievers, participants with complicated grief showed lower levels of morning cortisol (11.26 vs 15.51 nmol/L; difference, -4.24; 95% confidence interval [CI] = -7.87 to -0.62; p = .022), and lower levels of overall diurnal cortisol (6.89 vs 8.98 nmol/L; difference, -2.09; 95% CI = -3.81 to -0.37; p = .017). No difference was observed in slope between both groups. Participants with complicated grief also showed lower levels of morning cortisol than the nongrievers (11.26 vs 14.71; difference, -3.46; 95% CI = -6.78 to -0.13; p = .042). In contrast, cortisol secretion patterns did not differ between persons with normal grief and nongrieving controls.
Participants with complicated grief showed low levels of morning cortisol and low overall diurnal cortisol levels characteristic for a chronic stress reaction.
很少有研究关注复杂性悲伤（未解决的和长期的悲伤）对神经内分泌系统的影响。在一项基于大规模人群的研究中，本研究调查了复杂性悲伤和正常悲伤与昼夜皮质醇模式之间的关联。
本研究以鹿特丹研究为背景，纳入了2084名年龄在55岁以上的人群（平均[标准差]年龄为64.9[5.5]岁）。参与者通过复杂性悲伤量表进行评估，如果他们在过去2年中经历了丧亲之痛，则被分为无悲伤组（n = 1922）、正常悲伤组（n = 131）或复杂性悲伤组（n = 31）。收集唾液样本以测量皮质醇水平。研究了早晨皮质醇水平以及总结指标（曲线下面积和斜率），以考虑皮质醇的昼夜模式。排除患有抑郁症的人，并对抑郁症状进行额外调整后进行分析。
与正常悲伤者相比，复杂性悲伤参与者的早晨皮质醇水平较低（11.26对15.51 nmol/L；差异为-4.24；95%置信区间[CI]=-7.87至-0.62；p = 0.022），总体昼夜皮质醇水平也较低（6.89对8.98 nmol/L；差异为-2.09；95% CI=-3.81至-0.37；p = 0.017）。两组之间的斜率没有差异。复杂性悲伤参与者的早晨皮质醇水平也低于非悲伤者（11.26对14.71；差异为-3.46；95% CI=-6.78至-0.13；p = 0.042）。相比之下，正常悲伤者与非悲伤对照组之间的皮质醇分泌模式没有差异。
复杂性悲伤参与者表现出早晨皮质醇水平低和总体昼夜皮质醇水平低的特征，这是慢性应激反应的表现。
