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The Association Between Salivary Hormone Levels and Children’s Inpatient Aggression: A Pilot Study

Abstract

Aggression is a common management problem for child psychiatry hospital units. We describe an exploratory study with the primary objective of establishing the feasibility of linking salivary concentrations of three hormones (testosterone, dehydroepiandrosterone [DHEA], and cortisol) with aggression. Between May 2011 and November 2011, we recruited 17 psychiatrically hospitalized boys (age 7–9 years). We administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) and Predatory-Affective Aggression Scale (PAAS) upon admission. Saliva samples were collected from the participants during a 24-h period shortly after admission: immediately upon awakening, 30 min later, and again between 3:45 and 7:45 P.M. Nursing staff recorded Overt Aggression Scale ratings twice a day during hospitalization to quantify aggressive behavior. The salivary cortisol concentrations obtained from aggressive boys 30 min after awakening trended higher than levels from the non-aggressive boys (p = 0.06), were correlated with the number of aggressive incidents (p = 0.04), and trended toward correlation with BRACHA scores (p = 0.06). The aggressive boys also showed greater morning-to-evening declines in cortisol levels (p = 0.05). Awakening levels of DHEA and testosterone were correlated with the severity of the nearest aggressive incident (p < 0.05 for both). The BRACHA scores of the aggressive boys were significantly higher than scores of the non-aggressive boys (p < 0.001). Our data demonstrate the feasibility of collecting saliva from children on an inpatient psychiatric unit, affirm the utility of the BRACHA in predicting aggressive behavior, and suggest links between salivary hormones and aggression by children who undergo psychiatric hospitalization.

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Acknowledgments

The project described was supported in part (Mr. Blom) by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8 UL1 TR000077-04. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. This project was in part supported by NIMH P50 MH077138. The authors gratefully acknowledge funding support from the American Academy of Psychiatry and the Law’s Institute for Education and Research.

Conflict of interest

Jeffrey Strawn declares he has received research support from Eli Lilly, Shire, American Academy of Child & Adolescent Psychiatry and honoraria from the American Academy of Child & Adolescent Psychiatry. Drew Barzman declares he has research support either recently or currently from NIMH, Oxley Foundation, Cincinnati Children’s Hospital Medical Center, American Academy of Psychiatry and the Law Institute for Education and Research, and the Center for Clinical and Translational Science and Training (CCTST) (University of Cincinnati Academic Health Center). Bianca Patel declares that she has received funding from the American Physician Institute in association with CMEtoGO. Dr. Geracioti receives research funding from the U.S. Department of Defense and is a shareholder in RxDino, LLC. Melissa DelBello declares that she has received research support from AstraZeneca, Eli Lilly, Johnson & Johnson, Janssen, Pfizer, Otsuka, Sumitomo, NIDA, NIMH, NIAAA, NARSAD, GlaxoSmithKline, Merck, Novartis, and Lundbeck. She is on the lecture bureau of Bristol-Myers Squibb, Merck, and Otsuka. Dr. DelBello declares that she has consulted, been on the advisory board, and/or has received honoraria from Merck, Schering-Plough, and Pfizer. The other authors declare that they have no conflicts of interest.

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Correspondence to Drew H. Barzman.

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Barzman, D.H., Mossman, D., Appel, K. et al. The Association Between Salivary Hormone Levels and Children’s Inpatient Aggression: A Pilot Study. Psychiatr Q 84, 475–484 (2013). https://doi.org/10.1007/s11126-013-9260-8

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  • DOI: https://doi.org/10.1007/s11126-013-9260-8

Keywords

  • Aggression
  • BRACHA
  • Hormones
  • Child
  • Psychiatric hospitalization