The Trier Social Stress Test in first episode psychosis patients: Impact of perceived stress, protective factors and childhood trauma

Psychoneuroendocrinology. 2019 Jul;105:155-163. doi: 10.1016/j.psyneuen.2019.01.010. Epub 2019 Jan 11.


Psychosis has been associated with abnormalities in hypothalamic-pituitary-adrenal axis functioning, which may emerge through heightened stress sensitivity following early life adversity - ultimately resulting in illness onset and progression. The present study assessed cortisol levels during an established psychosocial stress task and their association with current stress perception, putative protective factors and adverse childhood experiences in patients with a first episode of psychosis (FEP). A total of 100 volunteers participated in the study, 57 of whom were patients with a FEP (mean age 23.9 ± 3.8) and 43 healthy community controls (mean age 23.2 ± 3.9). Salivary cortisol, heart rate and blood pressure were measured at eight time points before and after the Trier Social Stress Test. Subjective stress and protective factors were assessed with the Perceived Stress Scale, the Self-Esteem Rating Scale and the Brief COPE. Early life adversity was assessed with the Childhood Trauma Questionnaire. Patients compared to controls showed significantly lower cortisol levels (F = 7.38; p = .008) throughout the afternoon testing period, but no difference in the cortisol response to the TSST. Heart rate was elevated and protective factors were lower in patients compared to controls. Attenuated cortisol levels were associated with higher levels of perceived stress, poor protective factors and more physical neglect during childhood. Our results suggest that attenuated baseline cortisol levels and not a blunted response during an acute stress task might be an indicator of heightened stress vulnerability and poor resilience in psychosis. The possible influence of childhood adversity and antipsychotic medication is discussed.

Keywords: Childhood trauma; Coping; Cortisol; First episode psychosis; Hypothalamus-pituitary-adrenal axis; Perceived stress; Self-esteem; Social support; Trier social stress test.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological* / physiology
  • Adult
  • Adverse Childhood Experiences*
  • Female
  • Humans
  • Hypothalamo-Hypophyseal System* / metabolism
  • Hypothalamo-Hypophyseal System* / physiopathology
  • Male
  • Protective Factors
  • Psychological Tests
  • Psychological Trauma* / complications
  • Psychological Trauma* / metabolism
  • Psychological Trauma* / physiopathology
  • Psychotic Disorders* / etiology
  • Psychotic Disorders* / metabolism
  • Psychotic Disorders* / physiopathology
  • Self Concept*
  • Social Support*
  • Stress, Psychological* / etiology
  • Stress, Psychological* / metabolism
  • Stress, Psychological* / physiopathology
  • Young Adult