Resting Hypothalamic-Pituitary-Adrenal Axis Activity in Childhood Following Maltreatment: A Meta-Analysis

Abstract

The experience of maltreatment in childhood is associated with poorer developmental and health outcomes. This may be explained by the capacity for maltreatment to dysregulate stress-responsive neurophysiological systems, including the hypothalamic-pituitary-adrenal (HPA) axis. This study presents the results of the first meta-analysis that examines the association between maltreatment and resting HPA-axis activity in children and the role of "third variables" in accounting for observed heterogeneity in this association. Analyses of 18 studies, including N = 2216 children, indicated that although there was no difference in resting HPA-axis activity between children who had been maltreated and those who had not (standardized mean difference [SMD] = 0.04), there was substantial heterogeneity in the association between maltreatment and HPA-axis activity across studies (I² = 58.60%, p = 0.001). Further analyses revealed that the association between maltreatment and resting HPA-axis activity was contingent upon the source of information regarding maltreatment (B = 0.33, p = 0.002) and the degree to which maltreated and comparison groups differed in their socioeconomic status (B = 0.39, p = 0.037).

Keywords: abuse; cortisol; hypothalamic–pituitary–adrenal (HPA) axis; maltreatment; maltreatment source; meta‐analysis; neglect; socioeconomic status.