Trajectories of Change and Predictors of Diurnal Cortisol Patterns in Women Who Are or Had...
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Trajectories of Change and Predictors of Diurnal Cortisol Patterns in Women Who Are or Had Experienced Intimate Partner Violence
Stephanie J. Woods, PhD, RN
Rosalie J. Hall, PhDGayle G. Page, DNSc, RN, FAAN
The University of AkronJohns Hopkins University
Research supported by NINR/NICHHD (R01 009286)
Background
Alterations in the HPA system and cortisol dysregulation have been found in survivors of various types of trauma, and with depression and PTSD.
Diurnal patterns of cortisol levels may be attenuated or absent under chronic stress (Miller, Chen, & Zhou, 2007).
Purpose of Study
Describe trajectories of change in diurnal cortisol over two years in women who are or had experienced intimate partner violence
Examine predictors of cortisol change from:• Time-invariant co-variates: demographics, child
trauma, baseline intimate partner violence.
• Time-varying co-variates: BMI, post-traumatic stress symptoms, depression, co-morbid PTSD/depression.
Method
Latent growth curve models (LGCM) were used to estimate empirically-based change trajectories for AM cortisol and for PM cortisol over time, using longitudinal data collected at 7 equally spaced time periods over 2 years
Measures
Intimate partner violence• Physical, sexual and threats of violence (Severity of Violence Against
Women Scale, Marshall, 1992), Cronbach’s α = .90 -.94
• Emotional abuse (The Index of Spousal Abuse – Non Physical Subscale, Hudson & McIntosh, 1981); Cronbach’s α = .94
• Risk of homicide (The Danger Assessment Scale, DA; Campbell, 1995); alpha = .81
Childhood Maltreatment (Childhood Trauma Questionnaire, Bernstein & Fink, 1998); Cronbach’s α = .84
Post-Traumatic Stress Symptoms (PSS) (Foa et al., 1993); Cronbach’s α = .90
Depression: Trauma Symptom Inventory (TSI) Depression subscale (Briere, 1995); Cronbach’s α = .90
At Study Entry: 157 Women Currently in an Intimately Abusive Relationship
Mean Range
Age
Race/Ethnicity
Caucasian
African-American
Other
33.7 yrs (SD 9.5 yrs)
72 (46%)
74 (47%)
11 (6.9%)
18-64
Education High School 8th grade – BS
Annual income $10,000 - $14,999 <$10K to >50K
Length of abusive relationship
5.35 yrs (SD 6.7 yrs) <1 mo to 34 yrs
Childhood Trauma
Items ask about childhood abuse, neglect, and witnessing violence (6 events)
Women in this sample had a mean score of
3.5 out of 6
Only 12% - or 19 women – had a score of “0”
Intimate Partner Violence (Baseline)
Dimension Mean SD Observed Range
Physical violence (SVAWS)
(possible range: 21-84)
53.09 15.38 21-84
Emotional abuse (ISA-NP)
(possible range: 18-90)
63.03 18.56 18-90
Sexual violence (SVAWS)
(possible range: 6-24)
11.32 5.42 6-24
Threats of Violence (SVAWS)
(possible range: 19-76)
54.61 13.26 22-76
Risk of Homicide
(possible range: 0-21)
9.79 4.09 0-19
Mental Health Consequences:Percentage of Women Experiencing
PTSD and Depression
Baseline Year 1 Year 2
PTSD 92.4% 61.8% 52.3%
Depression 56.6% 21.2% 14.8%
Co-morbid PTSD/depression
57.7% 18.3% 12.5%
AM-PM Cortisol Patterns Over Time
At each of the 7 measurement times,
63 to 79% of women
had atypical AM-PM cortisol patterns.
Five Consistent, Distinct AM-PM Cortisol Patterns Emerged
Mean AM* Mean PM*
Typical AM-PM pattern .44 .075
Extremely high AM pattern
1.198 .156
Blunted high AM-PM pattern
.681 .511
Blunted low AM-PM pattern
.203 .091
Reverse AM-PM pattern .205 .463*in ug/dL
Trends in AM-PM Cortisol Pattern Changes Over 2 Years
Women with:• a typical AM-PM pattern tended to stay in a typical
pattern.
• blunted high cortisol pattern tended to stay in a blunted high pattern.
• blunted low cortisol pattern tended to stay in a blunted low pattern.
• reverse and extremely high AM patterns transitioned to multiple AM-PM cortisol patterns.
LGCM: Logistic Change Trajectories for AM and PM Cortisol*
LCGM results showed on average a relatively small but significant decline in AM cortisol and a small increase in PM cortisol over time.
*raw value, in ug/dL x 100
Generic Latent Growth Curve Model for AM and PM Cortisol
Both the AM and PM models included an intercept and a linear slope factor.
Predictors of log-transformed AM Cortisol Levels
Time-invariant predictors of Intercept parameterAge, B = -.011, se = .006, p = .08Child maltreatment, B = -.026, se = .015, p = .09
Time-invariant predictors of Slope parameterAge, B = .003, se = .002, p = .08Child maltreatment, B = .008, se = .004, p = .02.
No significant time-varying predictors
Predictors of log-transformed PM Cortisol Levels
No significant time-invariant predictors
Time-varying predictors (i.e., predicts each PM cortisol once intercept & slope effects have been removed, coefficients are equality constrained across time)
BMI (median is 28.3)B = -.015, se = .007, p = .04
Packs smoked (1 unit = ½ pack)B = .134, se = .054, p = .01.
Discussion/Significance
We identified several distinct atypical AM-PM cortisol patterns over time in a substantial number of study participants.
Overall, women in the sample had statistically significant declines over time in levels of AM cortisol and increases in PM cortisol. About half of these women left abusive relationships by 1 year post-baseline.
Discussion/Significance
Older women and those who had experienced more childhood maltreatment tended to have slightly lower levels of AM cortisol at baseline and less steep decreases of AM cortisol over time.
Women with higher BMI’s tended to have lower PM cortisol at each time period.
For every ½ pack of cigarettes smoked, PM cortisol values increased by about .01 ug/dL.