Jopling Ellen, LeMoult Joelle
University of British Columbia, Canada.
J Mood Anxiety Disord. 2023 Jul 14;2:100014. doi: 10.1016/j.xjmad.2023.100014. eCollection 2023 Aug.
Although cortisol awakening response (CAR) dysregulation is frequently documented among individuals with depression, there is conflicting evidence regarding the direction and degree of dysregulation, which impedes our ability to provide personalized and efficacious treatment. Childhood adversity is posited to explain variability within the CAR-depression literature, but the effect of childhood adversity on the CAR in depression has not yet been quantified. We meta-analyzed 19 studies ( = 2053) examining the association between childhood adversity and the CAR among individuals with depression. Data were pooled using random-effects models for childhood adversity overall, childhood adversity characterized by threat, and childhood adversity characterized by deprivation. Among individuals with depression, greater exposure to childhood adversity was associated with a steeper CAR. Further, in line with hypotheses, among individuals with depression, greater exposure to childhood adversity characterized by threat was associated with a steeper CAR, whereas greater exposure to adversity characterized by deprivation was not. These results support the proposition that greater childhood adversity, and in particular adversity characterized by threat, could lead to a distinct presentation of depression characterized by dysregulated diurnal HPA axis activity, as evidenced by a steeper CAR. These findings suggest specificity in the associations between types of childhood adversity and the CAR and could inform growing efforts towards personalized medicine in the treatment of depression.
尽管在抑郁症患者中经常有皮质醇觉醒反应（CAR）失调的记录，但关于失调的方向和程度存在相互矛盾的证据，这妨碍了我们提供个性化有效治疗的能力。童年逆境被认为可以解释CAR-抑郁症文献中的变异性，但童年逆境对抑郁症患者CAR的影响尚未得到量化。我们对19项研究（n = 2053）进行了荟萃分析，这些研究考察了童年逆境与抑郁症患者CAR之间的关联。使用随机效应模型对童年总体逆境、以威胁为特征的童年逆境和以剥夺为特征的童年逆境的数据进行合并。在抑郁症患者中，童年逆境暴露程度越高，CAR越陡峭。此外，与假设一致，在抑郁症患者中，以威胁为特征的童年逆境暴露程度越高，CAR越陡峭，而以剥夺为特征的逆境暴露程度越高则不然。这些结果支持这样的观点，即童年逆境程度越高，尤其是以威胁为特征的逆境，可能导致以昼夜下丘脑-垂体-肾上腺（HPA）轴活动失调为特征的抑郁症表现，CAR越陡峭就证明了这一点。这些发现表明童年逆境类型与CAR之间的关联具有特异性，并可为抑郁症治疗中日益增多的个性化医疗努力提供参考。
