Bernard Kristin, Frost Allison, Bennett Charles B, Lindhiem Oliver
Department of Psychology, Stony Brook University, United States.
Department of Psychology, Stony Brook University, United States.
Psychoneuroendocrinology. 2017 Apr;78:57-67. doi: 10.1016/j.psyneuen.2017.01.005. Epub 2017 Jan 10.
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 (Q=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.
童年期受虐会导致一系列负面的身心健康后果，其中皮质醇调节失调被认为是一种可能的机制。鉴于文献中关于虐待与昼夜皮质醇调节之间关联的方向和程度存在不一致之处，当前对27项研究的荟萃分析旨在检验虐待与昼夜皮质醇调节的3项指标中至少一项之间的关联：醒来时的皮质醇水平、皮质醇觉醒反应（CAR）和/或昼夜皮质醇斜率。效应量使用Hedges' g公式计算，并使用随机效应模型进行汇总。对于虐待与醒来时皮质醇水平之间的关联，汇总效应量为g = 0.08，p = 0.26。值得注意的是，对于由机构转介样本的研究，虐待与醒来时皮质醇之间的效应量显著更大（Q = 5.18，p = 0.02），g = 0.24，p = 0.006，而对于虐待状况基于自我报告的研究，g = 0.00，p = 0.97，虐待与醒来时皮质醇水平降低相关。对于虐待与CAR和昼夜皮质醇斜率之间的关联，汇总效应量不显著，且没有一个调节变量显著。尽管结果并未表明虐待与昼夜皮质醇的各种指标之间存在强大的关联，但设计更严谨的研究（即机构转介样本）显示，虐待与醒来时皮质醇水平降低之间存在小而显著的关联，表明存在低皮质醇血症模式。
