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David Baxter PhD

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Persistent anxiety in children linked to high morning cortisol levels
15 August 2007

Children with persistent anxiety problems have higher morning cortisol levels and cortisol awakening response than children without anxiety, Dutch researchers report.

"Alterations in the hypothalamic-pituitary-adrenal (HPA)-axis might underlie persistent anxiety problems, or result from the stress accompanied by persistent anxiety problems," the authors write in the Acta Psychiatrica Scandinavica.

The HPA-axis is activated under stress, and this causes the adrenal cortex to secrete more cortisol.

Recent research has suggested that children vulnerable to anxiety problems have a lower threshold for HPA-axis activation and increased cortisol concentrations, but the association between anxiety problems and basal cortisol levels in children is not clear, the team says.

Robert Ferdinand, from the Erasmus Medical Center Rotterdam, and colleagues evaluated the association between cortisol levels and anxiety in 1768 children, aged 10 to 12 years, from the general population, participating in the Tracking Adolescents' Individual Lives Survey (TRAILS).

All the children completed the Revised Child Anxiety and Depression Scale (RCADS) to assess current symptoms, and their parents completed the TRAILS preschool-behavior questionnaire (TPBQ) to assess anxiety problems at age 4.

Cortisol levels were analyzed from saliva samples taken immediately after waking up (cortisol 1), 30 minutes later (cortisol 2), and at 8 pm (cortisol 3).

The team classified the participants into three groups: those with no anxiety problems, as defined by TPBQ and RCADS scores below the 50th percentile (P50); those with only current anxiety problems, with a TPBQ score P90; and those with persistent anxiety problems, with a score >P90 in both scales.

Regression analysis revealed that cortisol levels were not associated with current anxiety symptoms.

Children with persistent anxiety problems, however, had significantly higher cortisol 1 levels compared with the other groups. They also showed higher levels of cortisol 2, but this difference was non-significant. The groups had similar cortisol 3 levels.

Children with persistent anxiety also had a significantly higher cortisol awakening response compared with other children, which indicates higher levels of HPA-axis activity.

Ferdinand et al conclude: "Only persistent, and not current, anxiety problems are associated with higher HPA-axis activity."

They add: "Longitudinal research is needed to gain more insight in the direction of the causal chain between HPA-axis functioning and anxiety problems."

Source: Acta Psychiatr Scand 2007; 116: 137-144
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