Stress and immune biomarkers interact with parenting behavior to shape anxiety symptoms in trauma-exposed youth

Karen Yirmiya, Amir Djalovski, Shai Motsan, Orna Zagoory-Sharon, Ruth Feldman

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


The relations between stress, HPA-axis, and the immune system have been extensively studied; however, no study to date addressed the joint contribution of immune and HPA biomarkers to the development of anxiety in youth exposed to chronic trauma as mediated by mother-child interaction patterns. A unique cohort of war-exposed children and their mothers, compared to matched controls, were followed from infancy and the current study reports findings from early adolescence (mean age = 11.66, SD = 1.23; N = 111; exposed = 58 control = 53). Youth and mothers’ salivary cortisol (CT) and secretory immunoglobulin (s-IgA) levels were measured three times during a 4-hour lab visit, mother-child interaction patterns were quantified from a joint task, and children's anxiety symptoms diagnosed. Trauma-exposed children had higher levels of CT and s-IgA, exhibited more anxiety symptoms, and showed lower social collaboration with mother during the joint task. Trauma-exposed mothers had higher CT and s-IgA levels and showed less supportive parenting during mother-child interaction. Structural equation modeling defined three bio-behavioral paths by which trauma increases anxiety in youth. While the first path charted a behavioral link from exposure to child anxiety via diminished maternal support, the other two paths described mediated biological paths, one through HPA-axis functioning, the other via the immune system. Paths via the child's HPA and immune system were mediated by the parallel maternal variable. Findings are the first to describe the complex bio-behavioral interplay of stress and immune biomarkers and parenting behavior in shaping to the development of risk and resilience trajectories in youth growing up amidst chronic trauma.

Original languageEnglish
Pages (from-to)153-160
Number of pages8
StatePublished - Dec 2018

Bibliographical note

Funding Information:
Karen Yirmiya is grateful to the Azrieli Foundation for the award of an Azrieli Fellowship. This work was supported by the Brain and Behavior (NARSAD) award to Ruth Feldman and the Simms-Mann Foundation . We are indebted to the mothers and children who participated in this study.

Publisher Copyright:
© 2018 Elsevier Ltd


  • Anxiety
  • Cortisol
  • Maternal behavior
  • S-IgA
  • Trauma
  • War-exposure


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