Salivary Cortisol and Psychopathology in Children Bereaved by the September 11, 2001 Terror Attacks
Received 28 September 2005; received in revised form 14 June 2006; accepted 28 July 2006. published online 30 November 2006.
Background
Studies suggest that stressful events increase risk for childhood anxiety and depression and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This prospective longitudinal study evaluated relationships among severe psychosocial stress, psychiatric morbidity, and HPA axis function in children.
Methods
Forty-five children (mean age: 8.9 ± 2.9 years) suffering parent death from September 11, 2001 terror attacks and 34 nonbereaved children (mean age: 9.3 ± 2.5 years) were evaluated prospectively at 6-month intervals in this 2-year study. Assessments involved diagnostic interviews (Child Schedule for Affective Disorders and Schizophrenia [K-SADS]) for psychopathology and 3 days of baseline salivary cortisol and a salivary dexamethasone suppression test for HPA axis function.
Results
Bereaved children, but not nonbereaved children, had significantly increased rates of psychiatric disorders involving anxiety disorders, especially posttraumatic stress disorder (PTSD), after September 11, 2001 compared with retrospective assessments before September 11, 2001. Morning (AM) and 4:00 pm baseline cortisol were significantly and persistently higher for bereaved than nonbereaved children. Compared with bereaved children without psychopathology, bereaved children with PTSD had significantly lower 4:00 pm baseline cortisol and significantly greater 4:00 pm cortisol suppression. Children with generalized anxiety disorder had significantly less AM cortisol suppression than children without psychopathology.
Conclusions
Children bereaved by sudden, unexpected parent death had persistent psychological dysfunction and HPA axis dysregulation in this study.
Department of Psychiatry, Weill Medical College of Cornell University, New York, New York.
Address reprint requests to Cynthia R. Pfeffer, M.D., Professor of Psychiatry at Weill Medical College of Cornell University, New York Presbyterian Hospital, Westchester Division, Department of Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605
ABSTRACT