Daily salivary cortisol profile: insights from the Croatian Late Adolescence Stress Study (CLASS)

Introduction: The aim of the study was to examine basal hypothalamic-pituitary-adrenal (HPA) axis activity and to determine associations of various covariates (gender, sleep-wake rhythm, demographic, academic, life style and health-related characteristics) with altered daily salivary cortisol profiles in late adolescence. Materials and methods: The total analytic sample consisted of 903 Croatian secondary school students aged 18 - 21 years (median 19 years). Salivary cortisol was sampled at home at three time points over the course of one week and its concentrations were measured by using the enzyme immunoassay. Results: In comparison to males, female students had a higher cortisol awakening response (CAR) (median 4.69, IQR 10.46 and median 3.03, IQR 8.94, respectively; P < 0.001), a steeper (“healthier”) diurnal cortisol slope (DCS) (median 0.51, IQR 0.55 and median 0.44, IQR 0.51, respectively; P = 0.001), and a greater area under curve with respect to ground (AUCG ) (median 206.79, IQR 111.78 and median 191.46, IQR 104.18, respectively; P < 0.001). Those students who woke-up earlier and were awake longer, had a higher CAR (P < 0.001), a flatter (“less healthy”) DCS (P < 0.001), and a greater AUCG (P < 0.001), than students who woke-up later and were awake shorter. Less consistent but still significant predictors of salivary cortisol indexes were age, school behaviour, friendship, diet healthiness and drug abuse. Conclusion: Gender and sleep-wake up rhythm were major determinants of the altered daily salivary cortisol profiles in late adolescence. The predictive power of other covariates, although less clear, has a potential for identifying vulnerable subgroups such as male drug users and females without a best friend. (IN CROATIAN: Cilj rada je bio istražiti bazalnu aktivnost hipotalamičko-pituitarno-adrenalne osi u kasnoj adolescenciji. Istraživanje se temeljilo na probabilističkom dvoetapnom uzorku klastera stratificiranog prema tipu škole (četverogodišnje gimnazije/strukovne škole) iz četiri najveća grada u Hrvatskoj. Nakon postupka isključivanja ispitanika prema standardima istraživanja salivarnog kortizola, uzorak je činilo 903 ispitanika starosti od 18 do 21 godine. Kortizol se uzorkovao tijekom radnog dana u tri različite vremenske točke, po buđenju, 30 do 45 minuta nakon buđenja i neposredno prije spavanja. Spol te ritam buđenja i lijeganja su se pokazali glavnim prediktorima bazalne aktivnosti salivarnog kortizola u istraživanom uzorku. Djevojke su imale više koncentracije jutarnjeg kortizola te više vrijednosti odgovora kortizola po buđenju, izraženije cirkadijalno smanjenje kortizola i veće površine ispod krivulje kortizola u odnosu na mladiće. U ispitivanom uzorku utvrđeno je pet klastera ispitanika različitog ritma buđenja i lijeganja. Ispitanici koji su se ranije ustajali i bili dulje budni („ranoranioci“, „noćobdije“) imali su snažniji odgovor kortizola na buđenje, niže cirkadijalno smanjenje kortizola i veće površine ispod krivulje kortizola u odnosu na ispitanike koji su se ustajali kasnije i bili kraće budni („noćne ptice“, „spavalice“, „trnoružice“). Također, istraživanje je ukazalo na važnost manje izraženih, ali statistički značajnih prediktora bazalnog ritma salivarnog kortizola u otkrivanju ranjivih skupina u kasnoj adolescenciji, primjerice konzumiranje droga kod mladića i izostanak prijateljskih veza kod djevojaka.