ReviewSensitivity to the depressogenic effect of stress and HPA-axis reactivity in adolescence: A review of gender differences
Introduction
The period from preadolescence into adulthood is characterized by major biological, psychological, and social challenges and opportunities (e.g., Dahl and Gunnar, 2009, Greenfield et al., 2003, Nelson et al., 2005, Paus et al., 2008). Interactions between the individual and the environment are intense, and developmental pathways are set in motion or become entrenched. Most adolescents handle these challenges and stressors quite well, but some develop mental health problems. Adolescence is characterized by a substantial rise in mental health problems, which are often associated with significant comorbid problems and impairments (Alloy et al., 2003, Bijl and Ravelli, 2000).
Mental health problems are particularly salient in adolescence; not only because they are the number one burden of disease in young people (World Health Organization, 2003), but also because adolescence is the period that lays the foundation for life as an independent human being. Relational and professional trajectories are shaped and if adolescents miss opportunities because they do not feel or behave well, it is often consequential for the rest of their lives (e.g., Kessler and Forthofer, 1999). In fact, a lot of the problems encountered in adult psychiatric patients are rooted in adolescence (e.g., Ferdinand and Verhulst, 1995, Fergusson et al., 2005, Lewinsohn et al., 2003, Rutter et al., 2006).
To understand pathways leading to mental health problems, we need to know how adolescents respond to stress and how this may affect their emotions and behavior. More specifically, we need to understand individual differences in stress-reactivity. This review focuses on the development of depressive symptoms after stressful experiences in adolescence, and physiological stress systems that may be involved in that process, notably the hypothalamus–pituitary–adrenal cortex (HPA) axis, one of the major stress systems of the body. A salient characteristic of depression is that the increase in prevalence in adolescence is predominant in girls. In spite of considerable progress, there are still a number of puzzles to be resolved regarding the mechanisms underlying the gender difference in prevalence. The research findings presented hereafter may provide additional clues about why depression develops during adolescence and why more often in girls than in boys.
As mentioned, the focus of this review is specifically on – gender differences in – the depressogenic effect of stressful experiences and the possible role of the HPA axis therein. While both of these topics have been described in numerous prior articles, the relative scarcity of information regarding the possible link between short-term HPA-axis responses to stress on the one hand, and long-term depressogenic effects of stressful experiences on the other is remarkable. If such a link does exist, the least we would expect is that these two kinds of responses would have overlapping correlates and risk factors.
This paper starts with a brief outline of (gender differences in) adolescent depression and associated risk factors in Section 2 as an introductory framework. A comprehensive review of these topics is beyond the scope of this article, but has been provided elsewhere by several, excellent, other reviews (e.g., Goodman, 2007, Hankin et al., 2007, Hankin et al., 2009, Kuehner, 2003, Rose and Rudolph, 2006). Section 3 provides a review of literature on stressful life events and adolescent depression, while reasons to suspect the HPA axis to play a possible mediating role in this association are given in Section 4. Research concerning HPA-axis responses to stress is discussed in Section 5. Both the effects of stressful life events and HPA-axis responses are considered in the light of the major risk factors of depression: female gender and familial/genetic vulnerability. General conclusions are drawn in Section 6.
Section snippets
Increasing depression rates in adolescence
While reported rates of depressive disorders in childhood are generally low, they show a sharp increase in adolescence and young adulthood (e.g., Birmaher et al., 1996, Hankin and Abela, 2005, Kessler et al., 2005). Estimated prevalence rates for depression in adolescence vary considerably, due to differences in assessment instruments and diagnostic criteria, sampling and design, and to the time the respective study was conducted. For major depressive disorder according to the Diagnostic and
Depression is a stress-related disorder
Depression is considered a stress-related disorder: stress and stress-sensitivity are generally believed to play an important role in its etiology. This assumption is supported by a large number of studies indicating that the experience of stressful life events increases the probability of the development of depressive symptoms, in adolescence as well as in other phases of life (e.g., Bosch et al., 2009a, Goodyer et al., 2000, Grant et al., 2003, Harris, 2001, Larson and Ham, 1993, Ormel et
From associations between stressful life events and depression to HPA-axis functioning
As mentioned in Section 3.5, the heterogeneous nature of depression may obscure pathways through which stressful experiences can lead to pathological mood disturbances. Studying endophenotypes of depression could partly overcome these problems. Endophenotypes are supposed to represent simpler clues to genetic underpinnings than nosological disease categories, and hence could help to reveal underlying pathological mechanisms. Gottesman and Gould (2003) suggested that endophenotypes should be
Gender differences in HPA-axis functioning during adolescence
Adolescents’ HPA-axis responses to a social stress test show gender differences: we found that boys tend to display larger cortisol responses to social stress than (free-cycling) girls (Bouma et al., 2009), which is consistent with gender differences in cortisol response to similar stress paradigms found in adults (reviewed by Kudielka and Kirschbaum, 2005). It has been postulated that girls might be at increased risk for depression because of a dysregulated HPA-axis (Weiss et al., 1999, Young,
From gender differences in depression rates to etiological mechanisms
Knowledge about gender differences in rates of particular types of disorder and the mechanisms underlying these differences is particularly important because it can provide clues on the etiological processes (Rutter et al., 2003). Adolescent girls have a higher probability to develop depressive symptoms than adolescent boys and preadolescents. As we showed in this review, there are strong indications that girls’ higher risk of depression is partly brought about by an increased sensitivity to
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