Bibian van der Voorn

171 GENDER-SPECIFIC HPA AXIS REACTIVITY IN CHILDHOOD effect modifier (n=3), 5) analyses of sex differences were performed with cases and controls combined (n=2) or (5) cortisol reactivity was defined as the variability of cortisol concentrations over several days to months (n=3). Several articles reported on the same cohort. Provided that extra information was presented, all articles were included in the review. Two articles were excluded as no new information was provided compared to other articles describing the same cohort. With respect to case- control studies, we included only the control group. 6,923 records identified through database searching 3 additional articles identified through other sources 6,158 records, after removal of duplicates 5,744 records were not eligible for inclusion based on title/abstract 414 full-text articles assessed for eligibility 81 studies included in systematic review 305 full-text articles were not eligible for inclusion 28 full-text articles excluded due to: 1. No analysis sex-specific reactivity 2. Gender only analyzed as effect modifier or confounder or was only stratified for. 3. No use of CRH and/or ACTH in pharmacological stress tests 4. Only variability of cortisol over several days to months assessed 5. Articles reported on the same cohort, without providingextra information 6. Cases and controls analyzed combined 7. 109 full-text articles were eligible for inclusion FIGURE 1. This flow chart presents the different phases of the systematic review, conform the PRISMA-statement. (www.prisma- statement.org) DATA ANALYSIS HPAaxis reactivitywas classified as follows: (1) diurnal rhythm, (2) cortisol awakening response (CAR), (3) protocolled social stress tests similar or equal to the Trier Social Stress Test for children (TSST-C), (4) pharmacological (ACTH and/or CRH) tests, or (5) miscellaneous stress tests. One assessor (JJH) assessed all the articles and sorted them according to the categories above. Data were extracted from the articles and systematically summarized. If more than one type of reactivity was assessed within one article, the data were included in all applicable categories.