Goodman William K, Janson Johanna, Wolf Jutta M
Brandeis University, Psychology Department, 415 South St. MS062, Waltham, MA 02454 USA.
Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 49a, 91052 Erlangen, Germany.
Psychoneuroendocrinology. 2017 Jun;80:26-35. doi: 10.1016/j.psyneuen.2017.02.030. Epub 2017 Mar 1.
The Trier Social Stress Test (TSST) is one of the most widely used laboratory stress tests. Exposure to this psychosocial stressor has been shown to stimulate an acute cortisol stress response in the majority of healthy individuals, while deviations from the typical pattern, i.e., cortisol reactivity dysfunctions have been linked to an ever-increasing number of negative health outcomes. However, significant variability between labs exists in strength of observed cortisol responses in healthy individuals. This variability raises the question of how to distinguish across labs between cortisol stress response patterns that reflect health risk from those that are due to methodological differences. Thus, we propose a systematic review and meta-analysis that aims at quantifying the effects of methodological variation in study and TSST protocol elements on cortisol stress responses in healthy individuals.
Literature searches were conducted using standard databases for English language with key words including Trier Social Stress Test, TSST, Cortisol, and Laboratory Stressor among others. 186 studies met our inclusion criteria of healthy human participants without systemic immunological or endocrine dysfunction and provided sufficient information to compute a total of 237 sub-sample effect sizes.
With regard to study protocol variations that may risk confounding baseline cortisol values and thus influence subsequent reactivity measures, meta-analytical examination revealed that acclimation periods pre-TSST below 30 or perhaps even 15min may suffice, at least as long as no interfering activities, i.e., questionnaires, are taking place during that timeframe. Assessing the effects of TSST protocol variations on cortisol response strength, several observations are noteworthy. First, shortening speech preparation time did not change cortisol responses in any way, nor did including questionnaires during that period show an effect. As such, our findings suggest that speech preparation time is one TSST element that can be used to reduce the burden for participants as well as laboratory logistics. Secondly, having an all female panel and instructing panel members to show negative instead of neutral behavior towards the participants both were associated with considerably reduced cortisol stress response strengths. Thirdly, several variables of interest, such as content of the speech task or gender match between active panel member and participant, were problematic to evaluate due to the large number of studies not reporting those details. This calls for future studies to report more details regarding potentially relevant protocol specifications.
特里尔社会应激测试（TSST）是使用最广泛的实验室应激测试之一。已表明，暴露于这种心理社会应激源会在大多数健康个体中激发急性皮质醇应激反应，而与典型模式的偏差，即皮质醇反应功能障碍，已与越来越多的负面健康结果相关联。然而，不同实验室中健康个体观察到的皮质醇反应强度存在显著差异。这种差异引发了一个问题，即如何在不同实验室之间区分反映健康风险的皮质醇应激反应模式与那些由于方法学差异导致的模式。因此，我们提出一项系统评价和荟萃分析，旨在量化研究和TSST方案要素中的方法学差异对健康个体皮质醇应激反应的影响。
使用标准英文数据库进行文献检索，关键词包括特里尔社会应激测试、TSST、皮质醇和实验室应激源等。186项研究符合我们纳入无系统性免疫或内分泌功能障碍的健康人类参与者的标准，并提供了足够信息以计算总共237个亚样本效应量。
关于可能混淆基线皮质醇值从而影响后续反应性测量的研究方案差异，荟萃分析显示，TSST前低于30分钟甚至15分钟的适应期可能就足够了，至少只要在此时间段内没有干扰活动，即问卷调查。评估TSST方案差异对皮质醇反应强度的影响，有几点值得注意。首先，缩短演讲准备时间对皮质醇反应没有任何影响，在此期间包含问卷调查也没有显示出效果。因此，我们的研究结果表明，演讲准备时间是一个TSST要素，可用于减轻参与者负担以及实验室后勤负担。其次，由全女性小组进行测试，并指示小组成员对参与者表现出消极而非中性行为，这两者都与皮质醇应激反应强度显著降低有关。第三，由于大量研究未报告这些细节，一些感兴趣的变量，如演讲任务的内容或活跃小组成员与参与者之间的性别匹配，难以评估。这就要求未来的研究报告更多关于潜在相关方案规范的细节。
