Background

Cortisol hypersecretion in depressed adolescents and adults is associated with more persistent illness and may signal a lower response to psychological therapies. A meta-analysis of small and heterogenous studies demonstrated that higher pre-treatment basal cortisol levels were associated with poorer response specifically to psychological therapy for depression. The objective of this study was to investigate the relationship between both morning and evening salivary cortisol levels and response to psychological therapy in depressed adolescents participating in one large randomised controlled trial.

Methods

We tested the association between morning and evening salivary cortisol levels at baseline and improvement in depressive symptoms in response to psychological therapies in depressed adolescents at 6 time points: baseline, 6, 12, 36, 52- and 86-weeks post-randomisation, using the self-reported Mood and Feelings Questionnaire (MFQ).

Results

High evening cortisol was associated with a slower initial decline in depressive symptoms (cortisol x quadratic time p = .022); however it was not associated with total change in depressive symtoms over the whole course of the study. Morning cortisol was not associated with change in depressive symptoms. These effects were not significantly different across the three psychological therapies.

Limitations

Results may not generalize to adolescents receiving other treatments (medication) or no treatment, and may not generalize to adults. Only a minority of eligible participants collected valid cortisol samples.

Conclusions

Higher pretreatment evening cortisol may impair a depressed adolescent's ability to use psychological therapy.

中文翻译：

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接受心理治疗的抑郁青少年的基线皮质醇水平与症状改善轨迹之间的关联

背景

抑郁的青少年和成年人的皮质醇分泌过多与病情持续发展有关，可能预示着对心理疗法的反应较低。对小型和异构研究的荟萃分析表明，治疗前基础皮质醇水平升高与抑郁症心理治疗的反应较差有关。这项研究的目的是调查参加一项大型随机对照试验的抑郁青少年的早晚唾液皮质醇水平与心理治疗反应之间的关系。

方法

我们测试了基线时早，晚唾液皮质醇水平与抑郁症患者因心理治疗而产生的抑郁症状改善在以下六个时间点之间的关联：在随机化后的基线，第6、12、36、52和86周，使用自我报告的情绪和情感问卷（MFQ）。

结果

傍晚皮质醇水平升高与抑郁症状的初始下降较慢有关（皮质醇x二次时间p  = .022）；然而，在整个研究过程中，这与抑郁症状的总变化无关。早晨皮质醇与抑郁症状的改变无关。在三种心理疗法中，这些作用没有显着差异。

局限性

结果可能不会推广到接受其他治疗（药物）或未接受治疗的青少年，也可能不会推广到成年人。只有少数合格的参与者收集了有效的皮质醇样品。

结论

较高的夜间夜间皮质醇预处理可能会削弱沮丧的青少年使用心理疗法的能力。