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Cortisol awakening response is decreased in patients with first-episode psychosis and increased in healthy controls with a history of severe childhood abuse

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
JournalSchizophrenia Research
Early online date24 May 2018
Accepted/In press4 May 2018
E-pub ahead of print24 May 2018


  • Cortisol awakening response is_CIUFOLINI_Accepted4May2018_GREEN AAM (CC BY-NC-ND)

    Mondelli_Ciufolini_cortisol_paper_30apr2018.docx, 86 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    Uploaded date:14 May 2018

    Version:Accepted author manuscript

    Licence:CC BY-NC-ND

    © <2018> This manuscript version is made available under the CC-BY-NC-ND 4.0 license

King's Authors


Background: Childhood abuse is highly prevalent in psychosis patients, but whether/how it affects hypothalamic-pituitary-adrenal (HPA) axis at the onset of psychosis remains unclear. We aimed to investigate the effects of severity of childhood abuse on HPA axis activity, in first-episode psychosis (FEP) and healthy controls.

Methods: We recruited 169 FEP patients and 133 controls with different degrees of childhood physical and sexual abuse (i.e. no abuse exposure, non-severe abuse exposure, and severe abuse exposure). Saliva samples were collected to measure cortisol awakening response with respect to ground (CARg), increase (CARi) and diurnal (CDD) cortisol levels. Two-way ANOVA analyses were conducted to test the relationships between severity of childhood abuse and psychosis on cortisol levels in individuals with psychosis and healthy controls with and without childhood abuse history.

Results: A statistically significant interaction between childhood abuse and psychosis on CARg was found (F(2,262) = 4.60, p=0.011, ω2=0.42). Overall, controls showed a U-shaped relationship between abuse exposure and CARg, while patients showed an inverted U-shaped relationship. CARg values were markedly different between patients and controls with either no abuse history or exposure to severe childhood abuse. No significant differences were found when looking at CARi and CDD.

Conclusions: Our results show a divergent effect of severe childhood abuse on HPA axis activity in patients with first-episode psychosis and in controls. In the presence of exposure to severe childhood abuse, a blunted CARg and a less reactive HPA axis may represent one of the biological mechanisms involved in the development of psychosis.

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