Sex Differences in Stress Exposure and Reactivity in Individuals at Clinical High Risk for Psychosis Open Access

Abstract

Abstract

Sex Differences in Stress Exposure and Reactivity in Individuals

at Clinical High Risk for Psychosis

By Carrie Holtzman

Psychosocial stress is presumed to be implicated in the etiology of psychotic disorders, based on an extensive body of literature showing an association between the incidence of psychosis and exposure to multiple forms of stress, including childhood trauma, stressful life events, and minor daily stressors. In normative samples, females report greater reactivity to stress than males, and females outnumber males in the prevalence of stress-related disorders such as depression and PTSD. Previous research has demonstrated sex differences in the clinical presentation of schizophrenia and the psychosis prodrome, the period of functional decline and increasing symptoms preceding clinical illness. The present study investigated sex differences in exposure and reactivity to life event and daily stress, as well as exposure to childhood trauma, in a large sample of individuals at clinical high risk (CHR) for psychosis and controls. A stress sensitization hypothesis was also tested, by which history of childhood trauma would amplify both the psychological and biological response to later stressors; it was predicted this effect would be further moderated by sex. Females reported greater exposure to many forms of childhood trauma, as well as increased reactivity to daily stress. CHR participants endorsed greater exposure and reactivity to life event and daily stress, as well as increased exposure to all forms of childhood trauma assessed. Psychological and biological stress sensitization effects were found, but these associations were not moderated by sex. This study contributes to efforts to better understand the role of stress in the emergence of psychosis, in the hopes of further enhancing predictive models of psychosis risk.

Table of Contents

Table of Contents

Introduction………………………………………………………………………………..1 Method……………………………………………………………...……………………27 Results……………………………………………………………………………………34 Discussion………………………………………………………………………………..38

Table 1: Demographic Characteristics of Included Participants vs. Excluded Participants………………...…………………………………………………………….52

Table 2: Demographic Characteristics by Sex and Diagnostic Group…………………..53

Table 3: Tests of Sex Differences in Exposure and Reactivity to Life Event and Daily Stress………………………………………………………………………………….…54

Table 4: Sex Differences in Exposure to Childhood Trauma……………………………55

Table 5: Diagnostic Group Differences in Exposure and Reactivity to Life Event and Daily Stress………………………………………………………………………………56

Table 6: Diagnostic Group Differences in Exposure to Childhood Trauma……….……57

Figure 1: Diagnostic group differences in exposure to multiple types of childhood trauma………………………………………………………………………………..…..58

Table 7: Results of a Regression Analysis of the Relation of CT and Sex with Symptom Severity in CHR Participants………………………………………59

Figure 2: Sex moderates the association between childhood trauma and positive symptom severity in CHR participants……………………………………………..60

Table 8: Stress Sensitization Model: Results of Regression Analysis of the Relation of CT and Sex with Reactivity to Life Event and Daily Stress in CHR Participants...61

Figure 3: Childhood trauma exposure moderates the association between exposure and reactivity to stressful life events…………..……………..62

Figure 4: Childhood trauma exposure moderates the association between exposure and reactivity to daily stress………………….……………………63

Figure 5: Sex moderates the association between exposure and reactivity to stressful life events.……………………………………………………………………64

Figure 6: Sex moderates the association between exposure and reactivity to daily stress……………………………………………………………………………………65

Table 9: Stress Sensitization Model: Results of a Regression Analysis of the Relation of CT, Sex, and Exposure to Life Event Stress to Mean Baseline Cortisol Levels in CHR Participants….……………………………………………………………………………66

Table 10: Stress Sensitization Model: Results of a Regression Analysis of the Relation of CT, Sex, and Exposure to Daily Stress to Mean Baseline Cortisol Levels in CHR Participants…………………………………...…………………………………………..67

Figure 7: Childhood trauma exposure moderates the association between exposure to daily stress and mean baseline cortisol levels……………………………………………68

Table 11: Stress Sensitization Model: Results of Regression Analysis of the Relation of CT, Sex, and Mean Baseline Cortisol in Relation to Affective Symptom Severity in CHR Participants……………………………………………………………………………….69

References………………………………………………………………………………..70

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School	Laney Graduate School
Department	Psychology
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Psychology, Clinical
Keyword	Stress Prodrome Psychosis
Committee Chair / Thesis Advisor	Walker, Elaine, Emory University
Committee Members	Wallen, Kim, Emory University Bachevalier, Jocelyne, Emory University Bliwise, Nancy G., Emory University Brennan, Patricia, Emory University

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