This study's overall aim is to identify relationships among severe psychosocial stress, psychiatric morbidity, growth, and hypothalamic-pituitary-adrenal (HPA) axis functioning in children. Severe stressful events in childhood have been identified as risk factors for childhood and adult psychiatric disorders. Death of a loved one is a stress most likely to be associated with onset of anxiety and depression. In this study, death of a loved one is investigated as a model of severe and often persistent psychosocial stress. Animal and human studies suggest that early stresses produce long-term dysregulation of the HPA axis with resulting effects on emotional and physical development. This study aims to determine whether major acute stress in the form of a death of children's close relative is associated with children's increased HPA axis activity, increased symptoms of psychiatric disability, and reduction in growth. The index sample includes children who suffered the recent death of a parent, sibling, or other close relative as a result of the attack on the World Trade Center on September 11, 2001. These children are compared to children without a recent death of a close relative. Bereaved children and parents will be followed prospectively at six-month intervals for two years. Nonbereaved children and parents will be assessed once. At each assessment, children and parents will be evaluated with standard reliable measures of psychiatric symptoms including K-SADS, SCID, RCMAS, CDI, CPTSRI, SAICA, BDI and HPA axis indices including salivary cortisol and height. Although studies linked HPA axis reactivity and emotional and behavioral problems in normal and psychiatrically impaired children, little longitudinal data exist about effects of stress on children not selected for psychiatric disorders. This study will add to the knowledge of the potential effects of early adversity on the stress-sensitive HPA axis and offer information about the behavioral sequelae of severe stress in children. The findings may suggest improved strategies for prevention and treatment of psychiatric disability among children who experienced severe stressful events. This study will help determine if HPA axis reactivity to stress is a marker of vulnerability to psychiatric disorders. Identification of such children may prevent psychiatric and medical consequences of increased HPA axis activity.
| Pfeffer, Cynthia R; Altemus, Margaret; Heo, Moonseong et al. (2009) Salivary cortisol and psychopathology in adults bereaved by the September 11, 2001 terror attacks. Int J Psychiatry Med 39:215-26 |
| Pfeffer, Cynthia R; Altemus, Margaret; Heo, Moonseong et al. (2007) Salivary cortisol and psychopathology in children bereaved by the september 11, 2001 terror attacks. Biol Psychiatry 61:957-65 |
