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Depressive Symptoms Are Associated With Blunted Cortisol Stress Responses in Very Low-Income Women

From the University of California, San Francisco, San Francisco, CA (H.M.B.); the University of California, Berkeley, Berkeley, CA (L.C.F.); the University of California, Berkeley, Instituto Nacional de Salud Publica, Berkeley, CA (P.J.G.); and Mexico University of California, San Francisco, CA (N.E.A.).

Address correspondence and reprint requests to Heather M. Burke, PhD, Health Psychology Program, Department of Psychiatry, University of California, San Francisco, 3333 California St., Ste. 465, San Francisco, CA 94143. E-mail: hburke{at}itsa.ucsf.edu

Objective: The purpose of this study was to examine the association between depressive symptoms and salivary cortisol responses to stress in a high-risk population of very poor Mexican women.

Methods: Adult women (N = 1109) between the ages of 18 and 44 years (mean age, 29) were identified in a house-to-house survey in low-income areas (income <20th percentile nationally) of urban Mexico. An interview containing the Spanish version of the Center for Epidemiologic Studies—Depression Scale (CES-D) was administered to all women. The naturalistic stressor was defined as the unexpected arrival of a team of researchers at the participants’ homes followed by an in-depth interview and physical assessment, with saliva samples taken at time of arrival (baseline), 25 minutes, and 50 minutes after arrival.

Results: The mean CES-D score was 19.42 (range, 0–53). Results of hierarchical linear modeling analyses revealed no effect of depressive symptoms on baseline salivary cortisol levels. However, a significant depressive symptom by time interaction revealed that women with elevations in depressive symptoms (CES-D scores = 35) failed to exhibit a cortisol response to the stressor. In contrast, in women with lower CES-D scores, cortisol levels significantly increased in response to the stressor.

Conclusion: Consistent with research on individuals with major depressive disorder, results of this study demonstrate that women with very high levels of depressive symptoms exhibit blunted cortisol responses to a naturalistic psychological stressor. Results also contribute to previous research by generalizing findings to a high risk, underserved population of women.

Key Words: depression • salivary cortisol • stress • poverty • HPA axis

Abbreviations: HPA = hypothalamic-pituitary-adrenal; MDD = major depressive disorder; SES = socioeconomic status; CES-D = Center for Epidemiological Studies—Depression Scale; PSS = Perceived Stress Scale.

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