Klinger-König Johanna, Hannemann Anke, Friedrich Nele, Nauck Matthias, Völzke Henry, Grabe Hans J
Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
Front Epidemiol. 2023 Feb 17;3:1098822. doi: 10.3389/fepid.2023.1098822. eCollection 2023.
Lower cortisol concentrations in adulthood were repeatedly associated with more severe childhood maltreatment. Additionally, childhood maltreatment was reported to promote health risk behavior, such as smoking or alcohol consumption, and to increase the risk of mental and somatic diseases during adulthood, such as major depressive disorders or obesity. The present study investigated if health risk behavior and disease symptoms in adults mediate the associations between past childhood maltreatment and present basal serum cortisol concentrations.
Data from two independent adult cohorts of the general population-based Study of Health in Pomerania (SHIP-TREND-0: = 3,517; SHIP-START-2: = 1,640) was used. Childhood maltreatment was assessed the Childhood Trauma Questionnaire (CTQ). Cortisol concentrations were measured in single-point serum samples. Health risk behavior and mental and physical symptoms were used as mediators. Mediation analyses were calculated separately for both cohorts; results were integrated meta-analyses.
In mediator-separated analyses, associations between childhood maltreatment and basal serum cortisol concentrations were partly mediated by depressive symptoms (BDI-II: = -.011, = .017, 21.0% mediated) and subjective somatic health complaints (somatic complaints: = -.010, = .005, 19.4% mediated). In the second step, both mediators were simultaneously integrated into one mediation model. The model replicated the mediation effects of the subjective somatic health complaints (whole model: = -.014, = .001, 27.6% mediated; BDI-II: = -.006, = .163, 11.4% mediated, somatic complaints: = -.020, = .020, 15.5% mediated).
The results support the hypothesis that the long-lasting effects of childhood maltreatment on the stress response system are partly mediated through self-perceived disease symptoms. However, no mediation was found for health risk behavior or physically measured mediators. Mediation models with multiple simultaneous mediators pointed to a relevant overlap between the potential mediators. This overlap should be focused on in future studies.
成年期较低的皮质醇浓度反复与更严重的童年期虐待相关。此外，据报道童年期虐待会促进健康风险行为，如吸烟或饮酒，并增加成年期患精神和躯体疾病的风险，如重度抑郁症或肥胖症。本研究调查了成年人的健康风险行为和疾病症状是否介导了过去童年期虐待与当前基础血清皮质醇浓度之间的关联。
使用了来自基于波美拉尼亚健康研究（SHIP - TREND - 0：n = 3517；SHIP - START - 2：n = 1640）的两个独立成年人群队列的数据。通过儿童创伤问卷（CTQ）评估童年期虐待情况。在单点血清样本中测量皮质醇浓度。将健康风险行为以及精神和身体症状用作中介变量。对两个队列分别进行中介分析；结果通过荟萃分析进行整合。
在中介变量分离分析中，童年期虐待与基础血清皮质醇浓度之间的关联部分由抑郁症状介导（BDI - II：β = - 0.011，p = 0.017，介导比例为21.0%）以及主观躯体健康抱怨介导（躯体抱怨：β = - 0.010，p = 0.005，介导比例为19.4%）。在第二步中，将两个中介变量同时纳入一个中介模型。该模型重现了主观躯体健康抱怨的中介效应（整个模型：β = - 0.014，p = 0.001，介导比例为27.6%；BDI - II：β = - 0.006，p = 0.163，介导比例为11.4%，躯体抱怨：β = - 0.020，p = 0.020，介导比例为15.5%）。
结果支持如下假设，即童年期虐待对应激反应系统的长期影响部分通过自我感知的疾病症状介导。然而，未发现健康风险行为或物理测量的中介变量存在中介作用。具有多个同时存在的中介变量的中介模型表明潜在中介变量之间存在相关重叠。这种重叠应在未来研究中予以关注。
