To examine whether HPA-axis activity mediates the relationship between obstetric complications (OCs) and externalizing behavior problems, and to investigate whether this model is different for boys and girls. In a population-based cohort of 1,768 10- to 12-year-old early adolescents, we assessed the cortisol awakening response and evening cortisol levels. Externalizing behavior problems were assessed using the Child Behavior Checklist and the Youth Self-Report. OCs were retrospectively assessed in a parent interview. OCs significantly predicted externalizing behavior problems, but OCs did not predict HPA-axis activity. Thus, the mediation model was not supported. In addition to the relationship between HPA-axis activity and externalizing behavior problems, which is specific for girls, there is also a relationship between OCs and externalizing behavior problems. However, these two mechanisms are not related to each other indicating that HPA-axis activity is not a mediator in the relationship between OCs and externalizing behavior problems. Future research should focus on understanding the mechanism through which OCs cause externalizing behavior problems.

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doi.org/10.1007/s00787-009-0014-y, hdl.handle.net/1765/16895
European Child and Adolescent Psychiatry
Erasmus MC: University Medical Center Rotterdam

Marsman, R., Rosmalen, J., Oldehinkel, A., Ormel, J. H., & Buitelaar, J. (2009). Does HPA-axis activity mediate the relationship between obstetric complications and externalizing behavior problems? the TRAILS study. European Child and Adolescent Psychiatry, 18(9), 565–573. doi:10.1007/s00787-009-0014-y