Elsevier

Physiology & Behavior

Volume 225, 15 October 2020, 113088
Physiology & Behavior

Relation between basal cortisol and reactivity cortisol with externalizing problems: A systematic review

https://doi.org/10.1016/j.physbeh.2020.113088Get rights and content

Highlights

  • Cortisol may be biological marker for a severe antisocial subgroup of adolescents.

  • Studies relating low cortisol levels to conduct problems and antisocial behavior.

  • Other factors may offer explanations for externalizing problems.

  • Environmental factors can influence the hypo(re)activity of the HPA axis.

Abstract

Delinquent behavior describes one of the most severe forms of antisocial and aggressive behavior, causing the highest mental health and public expenditures of problematic behavior in adolescence. Literature suggests that different concentrations of cortisol may serve as a biological marker for a severe antisocial subgroup of adolescents, although from the environmental risk factors that play a role in the development of severe delinquent and aggressive behavior, other neurobiological factors may be important. This review aims to analyze the association of cortisol levels with the development of delinquent behavior. Studies related to the topic were obtained from multiple databases, through rigorous exclusion and inclusion criteria. Only papers with empirical and quantitative methodologies from scientific and academic publications were included. Aims, methodological aspects (sample and instruments), and main conclusions were extracted from each study. Overall, the data suggest that regardless of the literature relating low cortisol levels to conduct problems and antisocial behavior, the lack of consensus in the examined studies demonstrates that more studies are needed to reveal the role of biosocial mechanisms in this hormonal-behavior link, and how these mechanisms are involved in establishing and maintaining delinquent behavior.

Section snippets

Method

The literature search was conducted in accordance with PRISMA guidelines [41], which aim to ensure clarity and transparency in systematic reviews, reducing the risk of failures and bias [41]. Given the evidence that conclusions are often misinformed in systematic reviews, the use of a method that helps to overcome this problem brings a number of advantages [33]: PRISMA guidelines foster the quality of the reviews, ensure that the reviews are presented with a defined structure and format, common

Characteristics of included studies and salivary cortisol collection

Details regarding salivary cortisol collection protocols in individual studies are presented in Table 2. The studies included in this systematic review were published from 1991 to 2020, and about 40% of the studies were published in the last decade. Most studies used clinical samples (n = 15, 60%), between four and 18 years of age. A variety of psychometric instruments were used for behavior assessment, as described in Table 2. The most used instrument was the Child Behavior Checklist (CBCL; [1]

Discussion

Researchers have shown a growing interest in factors associated with the development of behavioral problems in children, including biopsychological factors. This review aimed to investigate whether there is an association between cortisol levels and externalizing problems, in order to answer the following research question: are basal cortisol and cortisol reactivity associated with behavioral problems, such as CD and ODD? A total of 25 studies examining possible relationships between cortisol

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    • Childhood violence exposure and externalizing behaviors: A systematic review of the role of physiological biomarkers

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      This may imply that childhood violence exposure is more likely to contribute to dysregulation in HPA-axis responsivity within the context of stress, which in turn leads to more externalizing behavior (Hartman et al., 2013). However, a stronger association between cortisol reactivity (vs. basal cortisol) and externalizing behaviors has not been consistently found across studies (Alink et al., 2008; Figueiredo et al., 2020). Moreover, only one study assessed multi-system biomarkers as potential mediators (Shenk et al., 2010), with significant mediation by asymmetrical HPA-axis and PNS reactivity in adolescence.

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      The finding of the longitudinal association between lower morning cortisol and externalising problems is consistent with the existing literature on hyperactivity/inattention and conduct problems (Angeli et al., 2018; Ibrahim et al., 2016; Salis et al., 2016). For example, systematic reviews suggested that youth with attention-deficit/hyperactivity disorder or conduct disorder have lower basal cortisol levels (Chang et al., 2021; Figueiredo et al., 2020). Importantly, Salis et al (2016) found that a flattened cortisol rhythm could predict a greater increase of conduct and aggressive behaviours over three years in young school-age children.

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      Furthermore, dorsal striatum activity as part of the mesolimbic system, known to be sensitive to environmental adversity, seems to play a role in externalization-specific cortisol stress responses [59,61∗,62]. However, a recent review on the association of basal and reactivity cortisol levels with the development of delinquent behavior did show inconsistent results [63∗]. Finally, sex hormones, specifically testosterone in males, have been related to aggressive behavior and CD [56,61∗].

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    Author Note: Patrícia Figueiredo, Eduarda Ramião, Andreia Azeredo, and Fernando Barbosa, Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto (Portugal). Diana Moreira, Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto and Social and Behavioral Sciences Department, Maia University Institute (Portugal). Ricardo Barroso, University of Trás-os-Montes and Alto Douro (Portugal).

    The authors do not have any interests that might be interpreted as influencing the research. The study was conducted according to APA ethical standards.

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    Shared First Authorship

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    Patrícia Figueiredo, Eduarda Ramião, Andreia Azeredo, and Diana Moreira were supported by doctoral grants (SFRH/BD/133694/2017 – Patrícia Figueiredo, SFRH/BD/137494/2018 - Eduarda Ramião, SFRH/BD/136565/2018 – Andreia Azeredo, SFRH/BD/108216/2015 – Diana Moreira), funded by the Portuguese Foundation for Science and Technology under the POCH/FSE Program.

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