Classification of Depressed and Nondepressed Girls by Stress Load, Stress Coping, and Activity of HPA Axis

Research Article

Austin Child Adolesc Psychiatry. 2022; 6(1): 1018.

Classification of Depressed and Nondepressed Girls by Stress Load, Stress Coping, and Activity of HPA Axis

Reinhold L* and Ulrike S

University of Trier, Trier, Germany

*Corresponding author: Laessle Reinhold, Frauenstr 7, 54290 Trier, Germany

Received: December 21, 2021; Accepted: January 24, 2022; Published: January 31, 2022


Based on former empirical studies and theoretical considerations the present study investigated differences in stress load and stress coping between adolescent girls with major depression and controls. In addition a biological indicator of chronic stress (the cortisol awakening response) was measured. 148 girls with a mean age of 15 years were studied. 74 fulfilled DSM IV criteria for major depression. Stress symptoms and stress coping was measured with SSKJ 3-8 and SVFKJ which are validated German questionnaires. Depressed girls reported a significantly higher stress load and significantly more destructive stress coping. A classification in depressed and nondepressed girls was done by discriminant analysis. Stress load, stress coping, and cortisol awakening response were used as predictors. Canonical correlation coefficients were used to evaluate classification. When passive avoidance was included in the analysis, the best discriminant function could be obtained.

Keywords: Depression; Stress; Stress coping; Adolescents; Cortisol


Depression in children and adolescents is frequent. Data from Germany show a lifetime prevalence of 17.9% [1].

A concise model for development and maintenance of depression in children and adolescents at present does not exist. Discussed are multifactorial models that take into account social factors such as low socio-economic status [2] also genetic, individual, and familial factors [3]. During the last years the investigation of stress became more and more important.

The frequency of diagnosed depression in girls is greater than in boys by factor 2 [3].

Development and maintenance of depression in adolescents

At present a multifactorial model is favored which takes into account social, familial, genetic, and neuroendocrine determinants for the affective disorder. In addition, the investigation of stress load and stress coping in depressed youth has been focused.

Social factors

The risk to develop a psychiatric disorder in general is heightened for children from families with a low socioeconomic status. This has been already shown in a large epidemiological study by [2]

Children from families with a low income had a threefold greater probability to develop a depressive disorder. This has been confirmed in a recent study by [4].

Factors related to the families of depressed children

The families are characterized by the lack of positive supporting interactions with parents. These may be extremely focusing on conflicts and therefore provoke anger and aggression in children. Such conditions are especially present, when a high degree of parental psychopathology could be identified [5].

Neuroendocrine findings

The severity of depressive symptoms is significantly correlated with cortisol levels during a laboratory stressor [6].

A long duration of depression leads to stress related hyperactivity of HPA axis [7].

A dysregulated feedback of cortisol secretion after stress is reported by [8]. Cortisol does not recover.

A lack of social support results in a hyperactivity of HPA axis. Not seeking social support then is responsible for the maintenance of depression as well as for hyperactivity of the HPA axis [9].

The significance of stress for the depressive disorder

A controlled study of [10] showed that psychosocial stressors reinforce the depression and are also more frequent as a consequence of depression.

This has been supported by a further study of [11] by a longitudinal analysis.

Inadequate stress coping

Destructive stress coping in adolescents diagnosed as depressed has been found in [12,13].

The empirical data seem to suggest that stress load and stress coping may be related to the development and maintenance of depression in adolescents.

The present study is an attempt to replicate the former results and in addition tries to identify psychological and biological predictors for a classification of the adolescents in depressed and nondepressed.


All Patients were recruited from the Department of child and adolescent psychiatry in a general hospital in Trier and fulfilled DSM IV criteria for major depression which was proved by a structured clinical interview.

A control group was recruited by advertisements in the local newspaper.

The study was approved by the ethical committee of the University of Trier (17.2.2010).

All participants were payed for participation.

Patients and controls were assessed twice with a time interval of 6 months between the two measurement points (Table 1).