Elsevier

Biological Psychiatry

Volume 61, Issue 8, 15 April 2007, Pages 957-965
Biological Psychiatry

Original article
Salivary Cortisol and Psychopathology in Children Bereaved by the September 11, 2001 Terror Attacks

https://doi.org/10.1016/j.biopsych.2006.07.037Get rights and content

Background

Studies suggest that stressful events increase risk for childhood anxiety and depression and hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This prospective longitudinal study evaluated relationships among severe psychosocial stress, psychiatric morbidity, and HPA axis function in children.

Methods

Forty-five children (mean age: 8.9 ± 2.9 years) suffering parent death from September 11, 2001 terror attacks and 34 nonbereaved children (mean age: 9.3 ± 2.5 years) were evaluated prospectively at 6-month intervals in this 2-year study. Assessments involved diagnostic interviews (Child Schedule for Affective Disorders and Schizophrenia [K-SADS]) for psychopathology and 3 days of baseline salivary cortisol and a salivary dexamethasone suppression test for HPA axis function.

Results

Bereaved children, but not nonbereaved children, had significantly increased rates of psychiatric disorders involving anxiety disorders, especially posttraumatic stress disorder (PTSD), after September 11, 2001 compared with retrospective assessments before September 11, 2001. Morning (AM) and 4:00 pm baseline cortisol were significantly and persistently higher for bereaved than nonbereaved children. Compared with bereaved children without psychopathology, bereaved children with PTSD had significantly lower 4:00 pm baseline cortisol and significantly greater 4:00 pm cortisol suppression. Children with generalized anxiety disorder had significantly less AM cortisol suppression than children without psychopathology.

Conclusions

Children bereaved by sudden, unexpected parent death had persistent psychological dysfunction and HPA axis dysregulation in this study.

Section snippets

Subjects

Seventy-nine children (45 bereaved from 23 families, 34 nonbereaved from 25 families) were recruited from the community near New York City metropolitan area after the terrorist attacks on September 11, 2001. Bereaved children suffered sudden, unexpected death of one parent during the September 11, 2001 terrorist attacks. To compare rates of psychopathology before and after September 11, 2001 in a representative sample of bereaved and nonbereaved children, those with psychopathology prior to

Psychiatric Disorders

Prior to September 11, 2001, 31.8% of bereaved children had at least one lifetime psychiatric disorder, a rate similar to that for nonbereaved children (35.3%). Most frequent psychiatric disorders were anxiety and attention-deficit/hyperactivity disorder for bereaved (13.6% and 13.6%, respectively) and nonbereaved (17.7% and 17.7%, respectively) children (Table 1).

After September 11, 2001, during the 2-year study, significantly more bereaved (72.7%) compared with nonbereaved (35.3%) children

Discussion

This prospective longitudinal study identified significant differences in HPA axis function and prevalence of psychiatric disorders throughout this 2-year study among children who experienced sudden, unexpected parent death during the terrorist attacks on the World Trade Center on September 11, 2001 compared with nonbereaved children. This is among the few studies that empirically evaluated longitudinal relationships between bereaved children’s salivary cortisol and psychiatric disorders.

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