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The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history

Published online by Cambridge University Press:  01 June 2012

S. Vrshek-Schallhorn ,
L. D. Doane ,
S. Mineka ,
R. E. Zinbarg ,
M. G. Craske  and
E. K. Adam
S. Vrshek-Schallhorn*
Affiliation:
Department of Psychology, Northwestern University, Evanston, IL, USA
L. D. Doane
Affiliation:
Department of Psychology, Arizona State University, Tempe, AZ, USA
S. Mineka
Affiliation:
Department of Psychology, Northwestern University, Evanston, IL, USA
R. E. Zinbarg
Affiliation:
Department of Psychology, Northwestern University, Evanston, IL, USA The Family Institute at Northwestern University, Evanston, IL, USA
M. G. Craske
Affiliation:
Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
E. K. Adam
Affiliation:
School of Education and Social Policy, Northwestern University, Evanston, IL, USA Cells to Society Center, Institute for Policy Research, Northwestern University, Evanston, IL, USA
*
*Address for correspondence: S. Vrshek-Schallhorn, Ph.D., Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, USA. (Email: [email protected])
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Abstract

Background

The cortisol awakening response (CAR) has been shown to predict major depressive episodes (MDEs) over a 1-year period. It is unknown whether this effect: (a) is stable over longer periods of time; (b) is independent of prospective stressful life events; and (c) differentially predicts first onsets or recurrences of MDEs.

Method

A total of 270 older adolescents (mean age 17.06 years at cortisol measurement) from the larger prospective Northwestern-UCLA Youth Emotion Project completed baseline diagnostic and life stress interviews, questionnaires, and a 3-day cortisol sampling protocol measuring the CAR and diurnal rhythm, as well as up to four annual follow-up interviews of diagnoses and life stress.

Results

Non-proportional person-month survival analyses revealed that higher levels of the baseline CAR significantly predict MDEs for 2.5 years following cortisol measurement. However, the strength of prediction of depressive episodes significantly decays over time, with the CAR no longer significantly predicting MDEs after 2.5 years. Elevations in the CAR did not significantly increase vulnerability to prospective major stressful life events. They did, however, predict MDE recurrences more strongly than first onsets.

Conclusions

These results suggest that a high CAR represents a time-limited risk factor for onsets of MDEs, which increases risk for depression independently of future major stressful life events. Possible explanations for the stronger effect of the CAR for predicting MDE recurrences than first onsets are discussed.

Keywords

Cortisol awakening responsediurnal rhythmlate adolescencemajor depressive disordernon-proportional hazards modelsstressful life events
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 3 , March 2013 , pp. 483 - 493
Copyright
Copyright © Cambridge University Press 2012

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