The effects of maltreatment in childhood and adolescence on HPA axis activity: A meta-analysis

• In Event: The Neurophysiological Embedding of Child Maltreatment: Current State of the Literature and Future Directions for Research

Abstract

Child maltreatment, which encompasses physical, sexual, and emotional abuse and neglect, has pervasive, negative impacts on children’s development, leading the National Scientific Council on the Developing Child to refer to maltreatment as a “toxic stressor.” These impacts are evident in children’s cognitive development (e.g. DePrince et al., 2009), academic achievement (e.g. Carrey, Butter, Persinger, & Bialik, 1995), and physical and mental health (e.g. Rogosch, Dackis, & Cicchetti, 2011). Although many factors may mediate the association between maltreatment and poorer developmental outcomes, chief among these are changes in the activity of the hypothalamic pituitary adrenal (HPA) axis (e.g. Blair et al., 2011) in response to the severe stress of maltreatment, which, while adaptive in the short term, may be maladaptive over time (e.g. Maniam et al., 2014).

A large body of studies has accumulated examining the association between maltreatment and HPA axis activity in children and adolescents. A recent systematic review of 49 studies has shown that HPA axis may be hyperactive in cases of child maltreatment under conditions of homeostasis and hypoactive under conditions of stress, as assessed by differences in basal cortisol and cortisol reactivity (Holochwost et al., 2020). However, differences in study populations and methods may contribute to heterogeneity of effects.
To empirically examine heterogeneity of effects and potential moderators, this meta-analysis will examine key questions that arose from the systematic review. The primary aim is to describe the heterogeneity of effect sizes in basal cortisol between children and adolescents with and without a maltreatment history. An a priori definition of maltreatment was established, such that studies were included if researchers defined maltreatment as exposure to physical, sexual, emotional abuse or neglect, or any combination thereof. Studies were included if the researchers collected salivary or blood plasma cortisol. Group comparisons were converted to standardized mean differences and analyzed using a random effects model, which allows for modeling of heterogeneous true effect sizes, which are expected from studies that have a range of methods and sampling differences. Analysis was conducted using the “metafor" package in R.

Preliminary results of 9 studies (total n = 1189; 50.5% maltreated) found that there was a standardized mean difference of 0.09 [CI: -0.13, 0.31] between maltreated and non-maltreated groups. This suggests that, when pooling across studies, there is no significant difference in basal cortisol levels between the two groups. However, these initial results highlight substantial heterogeneity across studies, as seen in Figure 1, which is hypothesized to result from substantial differences in study methodologies. Additional analyses will be conducted prior to the biennial meeting, where moderation analysis will be performed to examine the effects of population (age; race and ethnicity; socioeconomic status) and methods (maltreatment questionnaire or clinical records; type of stressor; cortisol sampling procedures).

Authors

• Lindsay Ann Gomes, University of North Carolina at Chapel Hill
  Presenting Author

• Amanda Wylie, University of North Carolina at Chapel Hill
  Non-Presenting Author