The cortisol awakening response and anterior cingulate cortex function in maltreated depressed versus non-maltreated depressed youth

Symptomatology of depression among children who have (vs. have not) experienced maltreatment is greater in severity, more resistant to conventional treatment, and associated with elevated risk for suicide. Recent evidence implicates perturbations in stress regulatory systems and heightened negative self-appraisals as factors that increase the severity of psychopathology experienced by depressed maltreated (vs. non-maltreated) youth. Likely explanatory mechanisms for these differences are disturbances in the function of the hypothalamic-pituitary axis (HPA) and persistent negative self-referential biases supported by prefrontal cortex function including the dorsal anterior cingulate cortex (dACC). The cortisol awakening response (CAR) and dACC activity during a self-appraisal task were assessed in maltreated and non-maltreated depressed youth. Hierarchical linear models were employed to model the CAR. Maltreatment group, dACC activity during positive and negative self-appraisals as well as other key predictors, were included in the models. Post hoc analyses explored explanations for significant differences. Results indicated that maltreated depressed youth exhibited a higher CAR compared to non-maltreated youth. At low levels of dACC activity during processing of negative self-descriptors maltreated and non-maltreated depressed youth's CAR did not differ. However, at elevated levels of dACC activity during processing of negative self-descriptors maltreated depressed youth exhibited significantly higher CAR compared to non-maltreated depressed youth.