Background. An investigation of the association between
diurnal
changes in cortisol and DHEA
levels, or in the cortisol/DHEA ratio at five different time points
at presentation, and the occurrence
of undesirable life events (losses, dangers to self and others, disappointments)
during follow-up, and the outcome of major depression at 36 weeks were
investigated.
Methods. Psychosocial and endocrine assessment of a consecutive
cohort
(N=68) of 8- to 16-year-old subjects with first episode major
depression reassessed 12 months after presentation using a repeat measures
design.
Results. Higher cortisol/DHEA ratios at 20.00 or 24.00
h
predicted persistent major depression.
Basal levels of either hormone alone or cortisol/DHEA ratios at the
other three time points (08.00, 12.00 or 16.00 h) did not. High cortisol/DHEA
ratios (i.e. values greater than the 60th percentile)
at both evening points (20.00 and 24.00 h) also predicted the occurrence
of subsequent disappointing life events but no other category of undesirable
event. Both high
evening cortisol/DHEA ratio at
20.00 h and one or more severely disappointing life events between presentation
and follow-up
predicted persistent major depression: 86% of subjects with both of these
factors were still
depressed at 36 weeks whereas 81% with neither factor were not.
Conclusions. The finding that it is depressed subjects with
high cortisol/DHEA ratios at
presentation who are specifically at risk for subsequent disappointing
life events suggests a putative
role for these adrenal steroids in abnormal cognitive or emotional processes
associated with
disturbed interpersonal behaviour.