Cullen Alexis E, Rai Sushma, Vaghani Meghna S, Mondelli Valeria, McGuire Philip
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Front Psychiatry. 2020 Jun 11;11:513. doi: 10.3389/fpsyt.2020.00513. eCollection 2020.
Individuals with established psychosis and those at high-risk for the disorder have been found to show abnormalities within the hypothalamic-pituitary-adrenal (HPA) axis, including elevations in basal and diurnal cortisol, but a blunted cortisol awakening response. However, the extent to which these features are associated with psychosocial stressors encountered in the natural environment (which are known to be more commonly experienced by these groups, and more distressing) is currently unclear. We therefore conducted a systematic review and meta-analysis to investigate the concordance between naturally-occurring psychosocial stressors and cortisol levels in these populations.
PubMed, PsycINFO, and EMBASE were searched up to November 2019 to identify studies examining the concordance between psychosocial stressors and cortisol in healthy controls and individuals on the psychosis spectrum (patients with established psychosis and/or high-risk individuals). An overall meta-analysis (including data for all stressor-cortisol pairings) was performed to determine the degree of concordance irrespective of group status, with meta-regression employed to test whether the degree of concordance differed in established psychosis and high-risk groups compared to controls. Planned stratified analyses were then performed to examine group differences (where established psychosis and high-risk groups were combined) within individual stressor-cortisol pairings.
Eighteen studies (16 datasets) were eligible for inclusion. The overall model, comprising 134 effect sizes, showed that stressors and cortisol measures were only weakly correlated [0.05 (95% CI: -0.00 to 0.10), =0.059] and that neither established psychosis status (0.01, =0.838) nor high-risk status (0.02, =0.477) had a significant effect of the strength of correlation. In stratified analyses, significant differences between healthy controls and psychosis spectrum groups were observed for only one of the six stressor-cortisol pairings examined, where life event exposure and diurnal cortisol were positively correlated in controls [0.25 (95% CI: 0.01 to 0.46)], but negatively correlated in the psychosis spectrum group [-0.28 (95% CI: -0.49 to -0.04)].
Overall, we observed poor concordance between naturally-occurring psychosocial stressors and cortisol irrespective of stressor type, cortisol measure, or group status. We consider a range of methodological factors that may have obscured the ability to detect "true" associations and provide recommendations for future studies in this field.
已发现患有精神分裂症的个体以及该疾病的高危个体在下丘脑 - 垂体 - 肾上腺（HPA）轴存在异常，包括基础和昼夜皮质醇升高，但皮质醇觉醒反应迟钝。然而，目前尚不清楚这些特征与自然环境中遇到的心理社会压力源（已知这些群体更常经历且更痛苦）的关联程度。因此，我们进行了一项系统综述和荟萃分析，以研究这些人群中自然发生的心理社会压力源与皮质醇水平之间的一致性。
检索了截至2019年11月的PubMed、PsycINFO和EMBASE，以识别研究健康对照以及精神病谱系个体（患有精神分裂症的患者和/或高危个体）中心理社会压力源与皮质醇之间一致性的研究。进行了一项总体荟萃分析（包括所有压力源 - 皮质醇配对的数据），以确定一致性程度，而不考虑组状态，采用荟萃回归来检验与对照组相比，在患有精神分裂症和高危组中一致性程度是否不同。然后进行计划的分层分析，以检查个体压力源 - 皮质醇配对中的组间差异（将患有精神分裂症和高危组合并）。
18项研究（16个数据集）符合纳入标准。总体模型包含134个效应量，结果显示压力源与皮质醇测量之间仅存在弱相关性[0.05（95%CI： - 0.00至0.10），P = 0.059]，并且精神分裂症状态（P = 0.838）和高危状态（P = 0.477）对相关性强度均无显著影响。在分层分析中，在所检查的六个压力源 - 皮质醇配对中，仅观察到健康对照与精神病谱系组之间存在显著差异，其中生活事件暴露与昼夜皮质醇在对照组中呈正相关[0.
