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Stephanie J. Woods, PhD, RN Rosalie J. Hall, PhD Gayle G. Page, DNSc, RN, FAAN

Trajectories of Change and Predictors of Diurnal Cortisol Patterns in Women Who Are or Had Experienced Intimate Partner Violence. Stephanie J. Woods, PhD, RN Rosalie J. Hall, PhD Gayle G. Page, DNSc, RN, FAAN The University of Akron Johns Hopkins University

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Stephanie J. Woods, PhD, RN Rosalie J. Hall, PhD Gayle G. Page, DNSc, RN, FAAN

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  1. Trajectories of Change and Predictors of Diurnal Cortisol Patterns in Women Who Are or Had Experienced Intimate Partner Violence Stephanie J. Woods, PhD, RN Rosalie J. Hall, PhD Gayle G. Page, DNSc, RN, FAAN The University of Akron Johns Hopkins University Research supported by NINR/NICHHD (R01 009286)

  2. Background • Alterations in the HPA system and cortisol dysregulation have been found in survivors of various types of trauma, and with depression and PTSD. • Diurnal patterns of cortisol levels may be attenuated or absent under chronic stress (Miller, Chen, & Zhou, 2007).

  3. Purpose of Study Describe trajectories of change in diurnal cortisol over two years in women who are or had experienced intimate partner violence Examine predictors of cortisol change from: Time-invariant co-variates: demographics, child trauma, baseline intimate partner violence. Time-varying co-variates: BMI, post-traumatic stress symptoms, depression, co-morbid PTSD/depression.

  4. Method Latent growth curve models (LGCM) were used to estimate empirically-based change trajectories for AM cortisol and for PM cortisol over time, using longitudinal data collected at 7 equally spaced time periods over 2 years

  5. Measures • Intimate partner violence • Physical, sexual and threats of violence (Severity of Violence Against Women Scale, Marshall, 1992), Cronbach’s α = .90 -.94 • Emotional abuse (The Index of Spousal Abuse – Non Physical Subscale, Hudson & McIntosh, 1981); Cronbach’s α = .94 • Risk of homicide (The Danger Assessment Scale, DA; Campbell, 1995); alpha = .81 • Childhood Maltreatment (Childhood Trauma Questionnaire, Bernstein & Fink, 1998); Cronbach’s α = .84 • Post-Traumatic Stress Symptoms (PSS) (Foa et al., 1993); Cronbach’s α = .90 • Depression: Trauma Symptom Inventory (TSI) Depression subscale (Briere, 1995); Cronbach’s α = .90

  6. At Study Entry: 157 Women Currently in an Intimately Abusive Relationship

  7. Childhood Trauma Items ask about childhood abuse, neglect, and witnessing violence (6 events) Women in this sample had a mean score of 3.5 out of 6 Only 12% - or 19 women – had a score of “0”

  8. Intimate Partner Violence (Baseline)

  9. Mental Health Consequences:Percentage of Women Experiencing PTSD and Depression

  10. Time 1 (baseline): Mean AM and PM Salivary Cortisol Values

  11. AM-PM Cortisol Patterns Over Time At each of the 7 measurement times, 63 to 79% of women had atypical AM-PM cortisol patterns.

  12. Five Consistent, Distinct AM-PM Cortisol Patterns Emerged *in ug/dL

  13. Time 1 (baseline): Mean AM and PM Salivary Cortisol Groups

  14. Time 4 (1 year): Mean AM and PM Salivary Cortisol Groups

  15. Time 7 (2 years): Mean AM and PM Salivary Cortisol Groups

  16. Trends in AM-PM Cortisol Pattern Changes Over 2 Years Women with: a typical AM-PM pattern tended to stay in a typical pattern. blunted high cortisol pattern tended to stay in a blunted high pattern. blunted low cortisol pattern tended to stay in a blunted low pattern. reverse and extremely high AM patterns transitioned to multiple AM-PM cortisol patterns.

  17. LCGM results showed on average a relatively small but significant decline in AM cortisol and a small increase in PM cortisol over time. *raw value, in ug/dL x 100 LGCM: Logistic Change Trajectories for AM and PM Cortisol*

  18. Generic Latent Growth Curve Model for AM and PM Cortisol Both the AM and PM models included an intercept and a linear slope factor.

  19. Predictors of log-transformed AM Cortisol Levels • Time-invariant predictors of Intercept parameter • Age, B = -.011, se = .006, p = .08 • Child maltreatment, B = -.026, se = .015, p = .09 • Time-invariant predictors of Slope parameter • Age, B = .003, se = .002, p = .08 • Child maltreatment, B = .008, se = .004, p = .02. • No significant time-varying predictors

  20. Predictors of log-transformed PM Cortisol Levels • No significant time-invariant predictors • Time-varying predictors (i.e., predicts each PM cortisol once intercept & slope effects have been removed, coefficients are equality constrained across time) • BMI (median is 28.3) • B = -.015, se = .007, p = .04 • Packs smoked (1 unit = ½ pack) • B = .134, se = .054, p = .01.

  21. Discussion/Significance • We identified several distinct atypical AM-PM cortisol patterns over time in a substantial number of study participants. • Overall, women in the sample had statistically significant declines over time in levels of AM cortisol and increases in PM cortisol. About half of these women left abusive relationships by 1 year post-baseline.

  22. Discussion/Significance • Older women and those who had experienced more childhood maltreatment tended to have slightly lower levels of AM cortisol at baseline and less steep decreases of AM cortisol over time. • Women with higher BMI’s tended to have lower PM cortisol at each time period. • For every ½ pack of cigarettes smoked, PM cortisol values increased by about .01 ug/dL.

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