The root of the problem

Dr Hani Mikhail’s groundbreaking Townsville-based research project is investigating the potential for the measurement of cortisol, a stress-related hormone stored in hair, to help screen children for a range of mental conditions, as well as flag those at risk of developing one.

“The current model of mental health relies on analysing symptoms and their impact on a patient’s life, then trying to figure out what is going on at a psychological level.

“There is no way of looking beneath the surface, and treatment can involve a long process of trial and error,” said the Rockhampton Base Hospital intern, who began his research as an honours student last year.

“Cortisol is the primary chronic stress hormone of the endocrine system, and assists in the fight, flight or freeze response. As a bio marker, it may assist in reducing treatment delays, by helping to flag mental illnesses before symptoms even arise.

“This is particularly important in the context of child psychiatry, as symptoms are a lot more non-specific and early interventions often have life-long ramifications.”

Dr Mikhail’s study is the first Australian research project to trial the collection and analysis of hair cortisol from children visiting a mental health facility.

His primary goal is to see hair cortisol employed as a diagnostic tool to screen and identify children at risk, before they tip over the edge.

“Ultimately, my colleagues and I want to see hair cortisol enable clinicians to detect if a child is brewing a mental health disorder, before they show any symptoms – so they can intervene to prevent something bad happening later on,” he said.

Since December last year, the researcher has collected hair samples and background questionnaire data from over 150 children, aged five to 18, who have attended the Child and Youth Mental Health Service in Townsville. Each child has contributed strands of hair at least three centimetres in length for analysis.

“Just like a tree, when you cut it down and can see the rings which record each year of growth, each centimeter of hair collected is roughly equivalent to one month of growth,” Dr Mikhail said.

“So we can analyse the cortisol level in a particular segment of hair and say, ‘three months ago, this is what your average stress level was like. What was happening then?’”

He said that previous studies have indicated that cortisol levels can change significantly in response to stress imposed by an existing mental health disorder, or due to external stress factors that could herald the onset of a mental health problem. Conditions such as depression and psychosis raise cortisol levels, while anxiety disorders actually do the opposite.

“Bizarrely enough, Post Traumatic Stress Disorder, anxiety and eating disorders all tend to decrease the hair cortisol,” Dr Mikhail said. “The theory is that these people have been chronically stressed for so long that the endocrine system begins to tire and starts to suppress itself.”

About half of the study participants initially assessed by the Townsville clinic were accepted for treatment. The current phase of the researcher’s study will examine hair cortisol samples to see if they predict which children were deemed in need of clinical assistance.

“You would expect the children who didn’t get accepted for treatment to have hair cortisol that was not deranged,” he said.

The study will also investigate whether hair cortisol levels can distinguish differing clinical diagnoses, as well as explore potential links between hair cortisol and mental health risk factors identified in the study questionnaire.

“Does domestic violence, family mental health or issues at school highly correlate with hair cortisol levels?” Dr Mikhail said. “Is there another factor more important than we think it is?”

Dr Mikhail plans to continue and expand the project to recruit more participants, hopefully from additional clinical sites.

His work is being supervised by JCU neuroscientist, Professor Zoltan Sarnyai, and JCU’s Head of Psychiatry, Professor Brett McDermott.