Ji, Dongying; (2023) From social cognition difficulties to later emotional and behavioural problems: the roles of cortisol and inflammatory markers. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Objective: Deficits in social cognition are associated with a variety of emotional and behavioural problems in youth. It has been suggested that stress may be one of the mechanisms underlying these associations. Therefore, the overall aim of this PhD project is to examine the relationships between social cognition abilities, physiological stress, and mental health problems. Specifically, this project aims to evaluate the associations between different domains of social cognition and stress, investigate the link between stress and various emotional and behavioural problems, and explore the role of stress in the longitudinal association between childhood social cognition deficits and mental health problems in late adolescence. The thesis focused on two indicators of physiological stress, hypothalamic-pituitary-adrenal (HPA) axis activities (i.e., diurnal cortisol patterns) and systemic inflammation. Method: A systematic review and meta-analysis was first conducted to examine the association between social cognition and cortisol in the general population, followed by three empirical studies. The statistical analyses of the empirical studies were based on the secondary data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. In the first empirical study, multiple regression models were fitted to investigate the predictive effect of cortisol and inflammation on emotional and behavioural problems at 17 years old, with the adjustment of the mental health problems at 4 years old and covariates. The second study assessed if chronicity and severity of hyperactivity/inattention problems could predict abnormal cortisol profile in adolescence. Growth mixture models were used to identify classes with distinct developmental trajectories of hyperactivity/inattention symptoms from ages 4 to 13 years. In the third study, Bayesian structural equation modelling was used to investigate the mediating effects of cortisol and inflammation on the links between childhood social cognition abilities and emotional or behavioural problems at 17 years. Results: The meta-analyses showed that emotion control was positively associated with basal cortisol levels, while emotion recognition or theory of mind was not associated with cortisol. The empirical studies found that social communication deficits, but not emotion recognition abilities, were linked with later emotional and behavioural problems. Flattened diurnal cortisol slope and lower morning cortisol levels were associated with hyperactivity/inattention problems two years later. Adolescents with persistently high levels of hyperactivity/inattention symptoms since childhood showed lower total morning cortisol and a smaller diurnal decline. Lower morning cortisol partially mediated the direct association between social communication deficits at 8 years and hyperactivity/inattention and conduct problems at 17 years, even after adjustments for inflammation and confounders. There was no significant association between systemic inflammation and social cognition difficulties, emotional problems, or behavioural problems. Conclusion: The findings of this project provided evidence for the hypoactivity of HPA axis among adolescents with chronic hyperactivity/inattention problems since childhood in the general population. Adolescents with childhood social communication deficits were also at risk of blunted HPA axis activity in the morning. However, as the indirect effect of morning cortisol on the association between social cognition and behavioural problems is very small in magnitude, it may not be clinically or practically significant.

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