Cortisol Evaluation in Abuse Survivors

NCT ID: NCT01632553

Last Updated: 2015-12-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Total Enrollment

214 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-08-31

Study Completion Date

2014-10-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This study looks at the biological effect of domestic violence and abuse (DVA) on women's mental health. The mechanisms through which DVA causes mental disorders are very poorly understood. Similar to other demands, DVA activates the biological stress system, of which the chief component is the hypothalamic-pituitary-adrenal (HPA) axis, which produces chemical cortisol. Cortisol levels increase in response to short-term demand and help organisms deal with it by changing the processes of getting energy from food and also mental function. However constant activation of the HPA axis can cause damage and accelerate disease.

This study tests the hypothesis that compared to non-abused women all abuse victims have altered diurnal rhythm in cortisol secretion and that the pattern of this alteration is predicted by abuse characteristics, such as its type, severity, duration, and cessation. To examine the hypothesis the following research questions will be addressed: 1) whether cortisol levels are related to mental health state; 2) whether cortisol levels are related to type, severity, duration and cessation of DVA; 3) whether there is any difference in cortisol concentrations between those women exposed to both childhood abuse and DVA and those who have experienced only the latter; 4) whether cortisol levels vary between women, living in refuge and those not living in refuge?

To answer these research questions 214 women will be recruited in a domestic violence agency. Baseline and 3-monthly follow-up measures will be taken over 6 months after recruitment. Women will be asked to fill in a questionnaire to evaluate their demographics, health, experience of childhood abuse and DVA. Women's weight and height will be taken. In addition participants will be asked to take three saliva samples: 1st in the evening in bed, 2nd - next morning immediately upon awakening, and the 3rd - in thirty minutes after awakening. Saliva will be collected by chewing (for 2 minutes) the cotton pledget provided with plastic tube and returned by post or via collection by the researcher. Then the saliva samples will be tested for cortisol and cortisone.

Results of the study will increase our understanding of the biological mechanisms of DVA impact on a woman's health and tell researchers and practitioners about the possibility of using cortisol as an indicator to diagnose abuse-related health problems and assess effectiveness of medical care for abuse survivors.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Domestic violence and abuse (DVA) is threatening behavior, violence or abuse (psychological, physical, sexual, financial or emotional) used by one person to control the other. Life time prevalence of DVA is 28% for women and 18% for men, although severity and consequences of abuse are less for men (1). Over and above damage to physical and reproductive health DVA has long-term detrimental effects on mental health for women consulting in primary care (2, 3). A meta-analysis of studies measuring the relationship between DVA and mental disorders reported increased risk for depression, anxiety, psychosomatic disorders, posttraumatic stress disorder (PTSD), alcohol abuse, and suicidal behavior (4). Kernic et al (5) have established that cessation of DVA among survivors is associated with decreased prevalence of depression; whereas Anderson and Sounders (6) have found that some women out of the abusive relationship may have greater psychological difficulties than those who are still in it. However the mechanisms through which DVA causes mental disease are very poorly understood. Similar to other stressors, DVA activates the biological stress system, of which the principal component is the hypothalamic-pituitary-adrenal (HPA) axis, which produces cortisol. Chronic activation of this system can result in dendritic retraction and hippocampal loss of function (7, 8). The results of existing cross-sectional studies testing the impact of DVA on women's HPA axis functioning are contradictory. Pico-Alfonso et al (9) have reported an increase in cortisol levels, whilst Seedat et al (10) have established reduction in cortisol levels in DVA subjects compared to controls. This disparity may relate to differential development of PTSD and/or depression within DVA-exposed samples (11). Currently, there is a hypothesis that DVA survivors may be characterized by alterations in the HPA axis (12) and that further longitudinal studies are needed to identify specific stress system disturbances in this group (1, 13). The aim of the study is to increase understanding of the role of hypothalamic-pituitary-adrenal (HPA) axis activity in DVA impact on women's mental health.

Study objectives:

* To evaluate the profiles of the awakening response of cortisol, the diurnal variation and the mean salivary cortisol concentration in women with experience of DVA and in non-abused controls
* To estimate whether cortisol secretion is associated with type, severity, duration and cessation of DVA
* To investigate whether cortisol acts as mediator between DVA and mental health state
* To examine whether there is any distinction in cortisol levels between those women exposed to both childhood abuse and DVA and those experienced only the latter
* To explore whether cortisol secretion differs between women, living in a domestic violence refuge/safe house and those still living in the community (after adjustment for confounding effects of abuse severity and continuing contact with abuser).

This 6-month study will consist of 3 measurements every 3 months. Each assessment will last approximately 30-45 minutes and will include:

1. Numerous standardized self-administered psychological questionnaires
2. Weight and height measurement
3. Self-completion of 3 saliva samples using Salivette tubes:

1. evening sample - at bedtime
2. awakening sample - in the morning immediately upon wakening
3. post-awakening sample - 30 mins after awakening sample

Tubes with saliva will be returned by post or by researcher to an accredited laboratory for cortisol assay. The analysis also simultaneously measures cortisone a breakdown product of cortisol. This measurement is used to confirm the integrity of the sample.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Domestic Violence Depression Anxiety Panic Disorder Posttraumatic Stress Disorders

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Cases

women who have experienced DVA

No interventions assigned to this group

Controls

women who have not experienced DVA

No interventions assigned to this group

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* age ≥ 18 y.o.

Exclusion Criteria

* unable to read English
* current use of steroid-based medications
* pregnancy
* presence of adrenal and/or pituitary gland disorder
* symptomatic psychotic illness.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role collaborator

University Hospitals Bristol and Weston NHS Foundation Trust

OTHER

Sponsor Role collaborator

Survive South Gloucestershire and Bristol

UNKNOWN

Sponsor Role collaborator

University of Bristol

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Gene Feder

Professor of Primary Health Care, Centre for Academic Primary Care

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Gene Feder, Professor

Role: PRINCIPAL_INVESTIGATOR

University of Bristol, Centre for Academic Primary Care

Stafford Lightman, Professor

Role: STUDY_CHAIR

University of Bristol, School of Clinical Sciences

Natalia Lokhmatkina, PhD

Role: STUDY_DIRECTOR

University of Bristol, School of Clinical Sciences

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Survive South Gloucestershire and Bristol

Kingswood, Bristol, United Kingdom

Site Status

Next Link

Bristol, , United Kingdom

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United Kingdom

References

Explore related publications, articles, or registry entries linked to this study.

Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, Kuntze S, Spencer A, Bacchus L, Hague G, Warburton A, Taket A. How far does screening women for domestic (partner) violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria. Health Technol Assess. 2009 Mar;13(16):iii-iv, xi-xiii, 1-113, 137-347. doi: 10.3310/hta13160.

Reference Type BACKGROUND
PMID: 19272272 (View on PubMed)

Campbell JC. Health consequences of intimate partner violence. Lancet. 2002 Apr 13;359(9314):1331-6. doi: 10.1016/S0140-6736(02)08336-8.

Reference Type BACKGROUND
PMID: 11965295 (View on PubMed)

Coid J, Petruckevitch A, Chung WS, Richardson J, Moorey S, Feder G. Abusive experiences and psychiatric morbidity in women primary care attenders. Br J Psychiatry. 2003 Oct;183:332-9; discussion 340-1. doi: 10.1192/bjp.183.4.332.

Reference Type BACKGROUND
PMID: 14519611 (View on PubMed)

Golding JM. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence 14(2):99-132, 1999.

Reference Type BACKGROUND

Kernic MA, Holt VL, Stoner JA, Wolf ME, Rivara FP. Resolution of depression among victims of intimate partner violence: is cessation of violence enough? Violence Vict. 2003 Apr;18(2):115-29. doi: 10.1891/vivi.2003.18.2.115.

Reference Type BACKGROUND
PMID: 12816399 (View on PubMed)

Anderson DK, Saunders DG. Leaving an abusive partner: an empirical review of predictors, the process of leaving, and psychological well-being. Trauma Violence Abuse. 2003 Apr;4(2):163-91. doi: 10.1177/1524838002250769.

Reference Type BACKGROUND
PMID: 14697121 (View on PubMed)

Lightman SL. The neuroendocrinology of stress: a never ending story. J Neuroendocrinol. 2008 Jun;20(6):880-4. doi: 10.1111/j.1365-2826.2008.01711.x.

Reference Type BACKGROUND
PMID: 18601712 (View on PubMed)

Mirescu C, Gould E. Stress and adult neurogenesis. Hippocampus. 2006;16(3):233-8. doi: 10.1002/hipo.20155.

Reference Type BACKGROUND
PMID: 16411244 (View on PubMed)

Pico-Alfonso MA, Garcia-Linares MI, Celda-Navarro N, Herbert J, Martinez M. Changes in cortisol and dehydroepiandrosterone in women victims of physical and psychological intimate partner violence. Biol Psychiatry. 2004 Aug 15;56(4):233-40. doi: 10.1016/j.biopsych.2004.06.001.

Reference Type BACKGROUND
PMID: 15312810 (View on PubMed)

Seedat S, Stein MB, Kennedy CM, Hauger RL. Plasma cortisol and neuropeptide Y in female victims of intimate partner violence. Psychoneuroendocrinology. 2003 Aug;28(6):796-808. doi: 10.1016/s0306-4530(02)00086-0.

Reference Type BACKGROUND
PMID: 12812865 (View on PubMed)

McFarlane AC, Barton CA, Yehuda R, Wittert G. Cortisol response to acute trauma and risk of posttraumatic stress disorder. Psychoneuroendocrinology. 2011 Jun;36(5):720-7. doi: 10.1016/j.psyneuen.2010.10.007. Epub 2010 Nov 19.

Reference Type BACKGROUND
PMID: 21093988 (View on PubMed)

Heim C, Ehlert U, Hanker JP, Hellhammer DH. Abuse-related posttraumatic stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in women with chronic pelvic pain. Psychosom Med. 1998 May-Jun;60(3):309-18. doi: 10.1097/00006842-199805000-00017.

Reference Type BACKGROUND
PMID: 9625218 (View on PubMed)

Dutton MA, Green BL, Kaltman SI, Roesch DM, Zeffiro TA, Krause ED. Intimate partner violence, PTSD, and adverse health outcomes. J Interpers Violence. 2006 Jul;21(7):955-68. doi: 10.1177/0886260506289178.

Reference Type BACKGROUND
PMID: 16731994 (View on PubMed)

Lokhmatkina NV, Feder G, Blake S, Morris R, Powers V, Lightman S. Longitudinal measurement of cortisol in association with mental health and experience of domestic violence and abuse: study protocol. BMC Psychiatry. 2013 Jul 13;13:188. doi: 10.1186/1471-244X-13-188.

Reference Type BACKGROUND
PMID: 23849084 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

NF110946

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

SOCSRG2594

Identifier Type: OTHER

Identifier Source: secondary_id

insurance/CT1349

Identifier Type: OTHER

Identifier Source: secondary_id

1678

Identifier Type: -

Identifier Source: org_study_id