Department of Health Studies, University of Zadar, Splitska 1, 23000 Zadar, Croatia; Department of Pediatrics, General Hospital Zadar, Boze Pericica 5, 23000 Zadar, Croatia.
Department of Laboratory Diagnostics, General Hospital Zadar, Boze Pericica 5, 23000 Zadar, Croatia.
Psychoneuroendocrinology. 2020 Jul;117:104709. doi: 10.1016/j.psyneuen.2020.104709. Epub 2020 May 19.
This cross-sectional study aims to investigate awakening cortisol indicators and to explore their association with stress perception, advanced glycation end products (AGEs), depression and anxiety in parents of children with chronic conditions. We included five parental groups according to children's diagnoses: Down syndrome (DS; N = 31), autistic spectrum disorder (ASD; N = 29), cerebral palsy (CP; N = 15), diabetes mellitus type 1 (DMT1; N = 38), and a control group of heathy children (CG; N = 33). Salivary cortisol and AGEs were measured, alongside with psychological indices. Partial correlation and multiple linear regression were used in the analysis to identify parental characteristics associated with total awakening cortisol output (area under the curve with respect to the ground, AUC), cortisol awakening response (area under the curve with respect to the increase, AUC), perceived stress, and health outcomes (AGEs, depression and anxiety). There was no difference between groups for AUC, while DS and DMT1 groups showed reduced AUC (β = -0.241, p = 0.040; β = -0.249, p = 0.028, respectively), and ASD parents had a borderline insignificant result (β = -0.205, p = 0.081). Non-smokers had higher AUC and parental sedentary activity and sleep duration were associated with AUC. AUC was positively associated with AGEs (β = 0.218, p = 0.013), anxiety (β = 0.207, p = 0.004), and with depression (β = 0.156, p = 0.034), unlike the AUC. DS parental group showed lower general stress perception (β = -0.260, p = 0.005). Parents of children with DMT1 had more pronounced depressive symptoms (β = 0.183, p = 0.039), while CP parents had a borderline insignificant result for depression (β = 0.143, p = 0.058). Based on these results, parents of children with chronic conditions have altered awaking cortisol response and are under increased risk of adverse health consequences.
本横断面研究旨在调查觉醒皮质醇指标，并探讨其与慢性疾病患儿父母的应激感知、晚期糖基化终产物 (AGEs)、抑郁和焦虑之间的关系。我们根据儿童的诊断将 5 组父母纳入研究：唐氏综合征 (DS; N = 31)、自闭症谱系障碍 (ASD; N = 29)、脑瘫 (CP; N = 15)、1 型糖尿病 (DMT1; N = 38) 和健康儿童对照组 (CG; N = 33)。测量了唾液皮质醇和 AGEs，以及心理指标。在分析中使用偏相关和多元线性回归来识别与总觉醒皮质醇输出 (曲线下面积相对于基础，AUC)、皮质醇觉醒反应 (曲线下面积相对于增加，AUC)、感知压力和健康结果 (AGEs、抑郁和焦虑) 相关的父母特征。各组之间 AUC 没有差异，而 DS 和 DMT1 组 AUC 降低（β = -0.241，p = 0.040；β = -0.249，p = 0.028），ASD 组的结果接近显著（β = -0.205，p = 0.081）。不吸烟者的 AUC 更高，父母的久坐活动和睡眠时间与 AUC 相关。AUC 与 AGEs 呈正相关（β = 0.218，p = 0.013）、焦虑（β = 0.207，p = 0.004）和抑郁（β = 0.156，p = 0.034），与 AUC 不同。DS 父母组的一般应激感知较低（β = -0.260，p = 0.005）。DMT1 患儿的父母抑郁症状更为明显（β = 0.183，p = 0.039），而 CP 患儿的父母抑郁症状接近显著（β = 0.143，p = 0.058）。基于这些结果，患有慢性疾病的儿童的父母皮质醇觉醒反应发生改变，并且面临不良健康后果的风险增加。
