Interaction Effects of Life Events and Hair Cortisol on Perceived Stress, Anxiety, and Depressive Symptoms Among Chinese Adolescents: Testing the Differential Susceptibility and Diathesis-Stress Models

The differential susceptibility model and the diathesis-stress model on the interaction effect between the individuals’ traits and environmental factors will be conducive to understand in depth whether the psychophysiological traits are the risk factors of child development. However, there is no study focusing on the activity of the hypothalamic-pituitary-adrenal (HPA) axis. We examined whether the HPA activity serves as a physiological marker of the differential susceptibility model or the diathesis-stress model by exploring the interactive effect of life events and hair cortisol on perceived stress, anxiety, and depressive symptoms among Chinese adolescents. The participants were 324 students in senior high school. They reported their psychological states with questionnaires in their first semester after a 3-month adaptation period; 2 weeks later, they provided 1-cm hair segments closest to the scalp. We measured hair cortisol concentration as a biomarker of HPA activity using high-performance liquid chromatography–tandem mass spectrometry. There was a significant interaction effect of academic events and hair cortisol on adolescents’ perceived stress, anxiety, and depression symptoms. We also observed a significant interaction between interpersonal events and hair cortisol on adolescents’ anxiety symptoms. Looking at the region of significance, proportion of interaction index, and proportion affected index, we found that adolescents with higher cortisol levels had a tendency to experience higher perceived stress and anxiety symptoms when they had high academic events scores, but lower perceived stress and anxiety symptoms when they had lower academic events scores. By contrast, adolescents with higher cortisol levels had a greater risk of experiencing high depressive symptoms only when they had higher academic events scores. Adolescents with higher cortisol levels also tended to have lower anxiety symptoms when they had higher interpersonal events scores, but greater anxiety symptoms when they had lower interpersonal events scores. These results suggested that HPA activity might serve as a biomarker of the differential susceptibility model for perceived stress and anxiety symptoms, while for depressive symptoms, it might serve as a marker of the diathesis-stress model.