Secondary Logo

Institutional members access full text with Ovid®

Diurnal Cortisol in a Sample of Socioeconomically Disadvantaged Chinese Children

Evidence for the Shift-and-Persist Hypothesis

Chen, Lihua, MA; Li, Xiaoming, PhD; Imami, Ledina, MA; Lin, Danhua, PhD; Zhao, Junfeng, PhD; Zhao, Guoxiang, PhD; Zilioli, Samuele, PhD

doi: 10.1097/PSY.0000000000000659

Objective Low socioeconomic status (SES) is one of the most well-established social determinants of health. However, little is known about what can protect the health of individuals (especially children) living in low-SES circumstances. This study explored whether the psychological strategy of “shift-and-persist” protects low-SES children from stress-related physiological risks, as measured through blunted (unhealthy) diurnal cortisol profiles.

Methods A sample of 645 children (aged 8–15 years) from low-SES backgrounds and having at least one HIV-positive parent completed a battery of psychological scales. Diurnal cortisol assessments included collection of saliva samples four times a day for 3 days, from which three cortisol parameters (cortisol at awakening, cortisol awakening response, and cortisol slope) were derived.

Results Higher levels of shift-and-persist, considered as a single variable, were associated with higher cortisol at awakening (B = 0.0119, SE = 0.0034, p < .001) and a steeper cortisol slope (B = −0.0007, SE = 0.0003, p = .023). These associations remained significant after adjusting for covariates and did not vary by age. In supplementary analyses, where shifting and persisting were treated as separate variables, the interaction between these two coping strategies significantly predicted cortisol at awakening (B = 0.0250, SE = 0.0107, p = .020) and the cortisol slope (B = −0.0022, SE = 0.0011, p = .040), suggesting that the combination of shift-and-persist is important for predicting diurnal cortisol profiles.

Conclusions Our findings demonstrate that shift-and-persist is associated with healthier diurnal cortisol profiles among socioeconomically disadvantaged children and introduce the possibility that this coping strategy is protective against other stressors, such as those uniquely faced by children in our study (i.e., being affected by parental HIV).

From the Institute of Developmental Psychology (Chen, Lin), Beijing Normal University, Beijing, China; Department of Health Promotion, Education, and Behavior (Li), University of South Carolina, Columbia, South Carolina; Department of Psychology (Imami, Zilioli), Wayne State University, Detroit, Michigan; Institute of Psychology and Behavior (Zhao), Henan University, Kaifeng, Henan, China; Department of Psychology (Zhao), Henan Normal University, Xinxiang, Henan, China; and Department of Family Medicine and Public Health Sciences (Zilioli), Wayne State University, Detroit, Michigan.

Address correspondence to Samuele Zilioli, PhD, Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI 48202. E-mail: Junfeng Zhao, PhD, Institute of Psychology and Behavior, Henan University, 85 Minglun St, Kaifeng, Henan 475000, China. E-mail:

Received for publication January 29, 2018; revision received October 24, 2018.

Copyright © 2019 by American Psychosomatic Society
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website