Abstract
Adopting a multi-level approach, this study examined risk factors for adolescent suicidal ideation, with specific attention to (a) hypothalamic-pituitary-adrenal (HPA) axis stress responses and (b) the interplay between HPA-axis and other risk factors from multiple domains (i.e., psychological, interpersonal and biological). Participants were 138 adolescent females (M age = 14.13 years, SD = 1.40) at risk for suicidal behaviors. At baseline, lifetime suicidal ideation and a number of risk factors were assessed (i.e., depressive symptoms, impulsiveness, pubertal status and peer stress). Participants were exposed to a psychosocial stress task and HPA-axis responses were assessed by measuring cortisol levels pre- and post-stressor. At 3 months post-baseline, suicidal ideation again was assessed. Using group-based trajectory modeling, three groups of cortisol stress-response patterns were identified (i.e., hyporesponsive, normative, and hyperresponsive). As compared to females in the normative and hyporesponsive group, females in the hyperresponsive group were more likely to report a lifetime history of suicidal ideation at baseline, above and beyond the effects of the other predictors. Moreover, as compared to females in the normative group, females in the hyperresponsive group were at increased risk for reporting suicidal ideation 3 months later, after controlling for prior ideation. No interactions between cortisol group and the other risk factors were significant, with the exception of a non-significant trend between impulsiveness and cortisol group on lifetime suicidal ideation. Findings highlight the importance of HPA-axis responses to acute stressors as a risk factor for suicidal ideation among adolescents.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Clinical scores were identified by calculating appropriate female and age normed T-scores. T-scores equal or higher than 70 indicated clinically relevant scores (Reynolds and Kamphaus 1992).
Group-based trajectory models also were conducted controlling for psychotropic medication usage, in addition to birth control and corticosteroids. Although these models supported a four-class solution over a three-class solution, logistic regression models examining the effect of cortisol trajectory membership on suicidal ideation provided identical results, with increased risk for suicidal ideation among adolescents in the hyperresponsive group as compared to adolescents in the other cortisol groups
To ensure that the exclusion of pre-task cortisol data collected using the passive drool saliva procedure (see Measures) did not bias results, additional group-based trajectory models were conducted including in the analyses pre-task cortisol data collected using the passive drool saliva procedure. High similar results emerged as when excluding these pre-task cortisol values. Specifically, a three-class trajectory model was supported, including a normative, a hyporesponsive and a hyperresponsive group. These cortisol groups showed identical patterns to those depicted in Fig. 1. Moreover, 137 of the 138 participants were found to belong to the same cortisol trajectory group when estimating models with and without these cortisol values. Despite the similarity across results, models estimated with pre-task cortisol assessed via passive drool procedure as missing are presented as primary analyses, due to significant differences in cortisol concentration that can emerge by using different methods of saliva collection (i.e., salivette vs. passive drool; Poll et al. 2007).
In this study, the relatively broad age range, including participants between 12 and 16 years, was not ideal for examining the effect of pubertal timing (i.e., pubertal status adjusted by chronological age). However, it should be acknowledged that pubertal timing also may be a relevant predictor of adolescent suicidal ideation (see Wichstrøm 2000). To explore this hypothesis, additional models were estimated in which the effect of pubertal status on suicidal ideation (lifetime and at follow-up) was replaced by pubertal timing. Like pubertal status, pubertal timing predicted lifetime suicidal ideation (OR = 1.71, p = 0.046, 95 % CI [1.01, 2.90]), suggesting that early maturing females were more likely to report a lifetime history of suicidal ideation as compared to their peers. However, as pubertal status, no effect of pubertal timing was found on suicidal ideation at follow-up (OR = 0.63, p = 0.220, 95 % CI [0.30, 1.32]).
References
Bearman, P. S., & Moody, J. (2004). Suicide and friendships among American adolescents. American Journal of Public Health, 94, 89–95.
Brezo, J., Paris, J., & Turecki, G. (2006). Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review. Acta Psychiatrica Scandinavica, 113, 180–206.
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.
Burke, H. M., Davis, M. C., Otte, C., & Mohr, D. C. (2005). Depression and cortisol responses to psychological stress: a meta-analysis. Psychoneuroendocrinology, 30, 846–856.
Calhoun, C. D., Franklin, J. C., Adelman, C. B., Guerry, J. D., Hastings, P. D., Nock, M. K., et al. (2012). Biological and cognitive responses to an in vivo interpersonal stressor: longitudinal associations with adolescent depression. International Journal of Cognitive Therapy, 5, 283–299.
Centers for Disease Control and Prevention. (2010). Web-Based Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html
Cicchetti, D., & Rogosch, F. A. (2002). A developmental psychopathology perspective on adolescence. Journal of Consulting and Clinical Psychology, 70, 6–20.
Conley, C. S., Rudolph, K. D., & Bryant, F. B. (2012). Explaining the longitudinal association between puberty and depression: sex differences in the mediating effects of peer stress. Development and Psychopathology, 24, 691–701.
Costello, E. J., & Angold, A. (1988). Scales to assess child and adolescent depression: checklists, screens, and nets. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 726–737.
Dalley, J. W., & Roiser, J. P. (2012). Dopamine, serotonin and impulsivity. Neuroscience, 215, 42–58.
Daviss, W. B., Birmaher, B., Melhem, N. A., Axelson, D. A., Michaels, S. M., & Brent, D. A. (2006). Criterion validity of the mood and feelings questionnaire for depressive episodes in clinic and non–clinic subjects. Journal of Child Psychology and Psychiatry, 47, 927–934.
De Los Reyes, A., & Prinstein, M. J. (2004). Applying depression-distortion hypotheses to the assessment of peer victimization in adolescents. Journal of Clinical Child and Adolescent Psychology, 33, 325–335.
Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355–391.
Duval, F., Mokrani, M. C., Correa, H., Bailey, P., Valdebenito, M., Monreal, J., et al. (2001). Lack of effect of HPA axis hyperactivity on hormonal responses to d-fenfluramine in major depressed patients: implications for pathogenesis of suicidal behaviour. Psychoneuroendocrinology, 26, 521–537.
Guerry, J. D., & Hastings, P. D. (2011). In search of HPA axis dysregulation in child and adolescent depression. Clinical Child and Family Psychology Review, 14, 135–160.
Gunnar, M., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145–173.
Gunnar, M. R., Wewerka, S., Frenn, K., Long, J. D., & Griggs, C. (2009). Developmental changes in hypothalamus-pituitary-adrenal activity over the transition to adolescence: normative changes and associations with puberty. Development and Psychopathology, 21, 69–85.
Heilbron, N., & Prinstein, M. J. (2010). Adolescent peer victimization, peer status, suicidal ideation, and nonsuicidal self-injury: examining concurrent and longitudinal associations. Merrill-Palmer Quarterly, 56, 388–419.
Hostinar, C. E., Sullivan, R. M., & Gunnar, M. R. (2014). Psychobiological mechanisms underlying the social buffering of the hypothalamic–pituitary–adrenocortical axis: a review of animal models and human studies across development. Psychological Bulletin, 140, 256–282.
Jokinen, J., & Nordström, P. (2009). HPA axis hyperactivity and attempted suicide in young adult mood disorder inpatients. Journal of Affective Disorders, 116, 117–120.
Jollant, F., Lawrence, N. L., Olié, E., Guillaume, S., & Courtet, P. (2011). The suicidal mind and brain: a review of neuropsychological and neuroimaging studies. World Journal of Biological Psychiatry, 12, 319–339.
King, C. A., & Merchant, C. R. (2008). Social and interpersonal factors relating to adolescent suicidality: a review of the literature. Archives of Suicide Research, 12, 181–196.
Kirschbaum, C., Pirke, K. M., & Hellhammer, D. (1993). The “trier social stress test”—a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28, 76–81.
Klonsky, E. D., & May, A. (2010). Rethinking impulsivity in suicide. Suicide and Life-Threatening Behavior, 40, 612–619.
Lindqvist, D., Träskman-Bendz, L., & Vang, F. (2008). Suicidal intent and the HPA-axis characteristics of suicide attempters with major depressive disorder and adjustment disorders. Archives of Suicide Research, 12, 197–207.
López, J. F., Vazquez, D. M., Chalmers, D. T., & Watson, S. J. (1997). Regulation of 5–HT receptors and the hypothalamic–pituitary–adrenal axis. Annals of the New York Academy of Sciences, 836, 106–134.
Lupien, S. J., Maheu, F., Tu, M., Fiocco, A., & Schramek, T. E. (2007). The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain and Cognition, 65, 209–237.
Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10, 434–445.
Mann, J. J. (2003). Neurobiology of suicidal behaviour. Nature Reviews Neuroscience, 4, 819–828.
Mann, J. J., Currier, D., Stanley, B., Oquendo, M. A., Amsel, L. V., & Ellis, S. P. (2006). Can biological tests assist prediction of suicide in mood disorders? International Journal of Neuro-Psychopharmacology, 9, 465–474.
Mathew, S. J., Coplan, J. D., Goetz, R. R., Feder, A., Greenwald, S., Dahl, R. E., et al. (2003). Differentiating depressed adolescent 24 h cortisol secretion in light of their adult clinical outcome. Neuropsychopharmacology, 28, 1336–1343.
McEwen, B. S. (2004). Protection and damage from acute and chronic stress: allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Annals of the New York Academy of Sciences, 1032, 1–7.
McGowan, P. O., Sasaki, A., D’Alessio, A. C., Dymov, S., Labonté, B., Szyf, M., et al. (2009). Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience, 12, 342–348.
Miller, A. H., Maletic, V., & Raison, C. L. (2009). Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biological Psychiatry, 65, 732–741.
Miller, G. E., Chen, E., & Parker, K. J. (2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Psychological Bulletin, 137, 959–997.
Monroe, S. M., & Simons, A. D. (1991). Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychological Bulletin, 110, 406–425.
Muthén & Muthén (1998–2010). Mplus user’s guide. Sixth edition. Los Angeles, CA: Muthén & Muthén.
Nagin, D. S. (2005). Group-based modeling of development. Cambridge: Harvard University Press.
Nock, M. K., & Banaji, M. R. (2007). Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. Journal of Consulting and Clinical Psychology, 75, 707–715.
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19, 309–317.
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., et al. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70, 300–310.
Obradović, J. (2012). How can the study of physiological reactivity contribute to our understanding of adversity and resilience processes in development? Development and Psychopathology, 24, 371–387.
Parker, J. G., Rubin, K. H., Erath, S. A., Wojslawowicz, J. C., & Buskirk, A. A. (2006). Peer relationships, child development, and adjustment: A developmental psychopathology perspective. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology, Vol 1: Theory and method (2nd ed., pp. 419–493). Hoboken: Wiley.
Petersen, A. C., Crockett, L., & Richards, M. (1988). A self-report measure of pubertal status: reliability, validity, and initial norms. Journal of Youth and Adolescence, 17, 117–133.
Poll, E. M., Kreitschmann-Andermahr, I., Langejuergen, Y., Stanzel, S., Gilsbach, J. M., Gressner, A., et al. (2007). Saliva collection method affects predictability of serum cortisol. Clinica Chimica Acta, 382, 15–19.
Prinstein, M. J., Boergers, J., & Spirito, A. (2001). Adolescents’ and their friends’ health-risk behavior: factors that alter or add to peer influence. Journal of Pediatric Psychology, 26, 287–298.
Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S., & Spirito, A. (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology, 76, 92–103.
Reynolds, C. R., & Kamphaus, R. W. (1992). BASC: Behavior Assessment System for Children: Manual. Circle Pines: American Guidance Service.
Rudolph, K. D. (2008). Developmental influences on interpersonal stress generation in depressed youth. Journal of Abnormal Psychology, 117, 673–679.
Rudolph, K. D. (2009). The interpersonal context of adolescent depression. In S. Nolen-Hoeksema & L. M. Hilt (Eds.), Handbook of depression in adolescents (pp. 377–418). New York: Routledge.
Rudolph, K. D. (2014). Puberty as a developmental context of risk for psychopathology. In M. Lewis & K. D. Rudolph (Eds.), Handbook of developmental psychopathology (3rd ed., pp. 331–354). New York: Plenum Press.
Rudolph, K. D., Kurlakowsky, K. D., & Conley, C. S. (2001). Developmental and social–contextual origins of depressive control-related beliefs and behavior. Cognitive Therapy and Research, 25, 447–475.
Sapolsky, R. M., Romero, L. M., & Munck, A. U. (2000). How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocrine Reviews, 21, 55–89.
Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: a social signal transduction theory of depression. Psychological Bulletin, 140, 774–815.
Sourander, A., Helstelä, L., Haavisto, A., & Bergroth, L. (2001). Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study. Journal of Affective Disorders, 63, 59–66.
Starcke, K., & Brand, M. (2012). Decision making under stress: a selective review. Neuroscience & Biobehavioral Reviews, 36, 1228–1248.
Turecki, G., Ernst, C., Jollant, F., Labonté, B., & Mechawar, N. (2012). The neurodevelopmental origins of suicidal behavior. Trends in Neurosciences, 35, 14–23.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600.
Van Ryzin, M. J., Chatham, M., Kryzer, E., Kertes, D. A., & Gunnar, M. R. (2009). Identifying atypical cortisol patterns in young children: the benefits of group-based trajectory modeling. Psychoneuroendocrinology, 34, 50–61.
Viau, V. (2002). Functional cross–talk between the hypothalamic–pituitary–gonadal and–adrenal axes. Journal of Neuroendocrinology, 14, 506–513.
Whiteside, S. P., & Lynam, D. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689.
Wichstrøm, L. (2000). Predictors of adolescent suicide attempts: a nationally representative longitudinal study of Norwegian adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 603–610.
Williams, J. M. G., Barnhofer, T., Crane, C., & Beck, A. T. (2005). Problem solving deteriorates following mood challenge in formerly depressed patients with a history of suicidal ideation. Journal of Abnormal Psychology, 114, 421–431.
Acknowledgments
This work was supported in part by a grant from the National Institute of Mental Health (R01-MH085505). Correspondence concerning this article should be addressed to Matteo Giletta or Mitch Prinstein, Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, NC 27599.
Conflict of Interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Giletta, M., Calhoun, C.D., Hastings, P.D. et al. Multi-Level Risk Factors for Suicidal Ideation Among at-Risk Adolescent Females: The Role of Hypothalamic-Pituitary-Adrenal Axis Responses to Stress. J Abnorm Child Psychol 43, 807–820 (2015). https://doi.org/10.1007/s10802-014-9897-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-014-9897-2