An integrative model linking traumatization, cortisol dysregulation and posttraumatic stress disorder: Insight from recent hair cortisol findings

Steudte-Schmiedgen, Susann; Kirschbaum, Clemens; Alexander, Nina; Stalder, Tobias

doi:10.1016/j.neubiorev.2016.07.015

Cited by 142 publications

(146 citation statements)

References 169 publications

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“…Respective data are available from severely traumatized individuals living in a refugee camp in Uganda (Steudte et al, ), asylum seekers with an insecure residency status in Germany (Mewes, Reich, Skoluda, Seele, & Nater, ), and adolescent Syrian refugees living in Jordan (Dajani, Hadfield, van Uum, Greff, & Panter‐Brick, ). All of these studies show elevated hair cortisol concentrations (HCC) in the group exposed to trauma and ongoing stress compared to controls, which corresponds well with the proposed dose‐ and time‐dependent model of HCC after trauma exposure (Steudte‐Schmiedgen et al, ).…”

Section: Introductionsupporting

confidence: 77%

Victims of war—Psychoendocrine evidence for the impact of traumatic stress on psychological well‐being of adolescents growing up during the Israeli–Palestinian conflict

et al. 2018

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Violent conflicts are severe traumatic stressors with detrimental effects on physical and mental health, with children and adolescents being particularly at risk. For the hypothalamic-pituitary-adrenal (HPA) axis, characteristic patterns of dysregulation in trauma-exposed individuals have been shown. This study set out to investigate self-reported mental well-being in Palestinian adolescents growing up during the Israeli-Palestinian conflict. Hair cortisol concentrations (HCC) as a psychoendocrine marker for long-term HPA axis aberrations along with the potential protective factor sense of coherence (SoC; i.e., the global mindset to interpret the world and emerging stressors as comprehensible, manageable, and meaningful) were examined. Between 2014 and 2016, posttraumatic stress disorder (PTSD), depression, anxiety, HCC, and SoC were examined in 233 adolescents aged 11 to 16 from the West Bank. More than half of the participants reported trauma exposure, with 40% fulfilling the criteria of a preliminary PTSD diagnosis and a high prevalence of anxiety and depression. HCC was significantly elevated in the PTSD subgroup compared to the subgroup not exposed to any traumatic events (p = 0.046), with trauma-exposed individuals in between. HCC was further associated with typical sequelae of traumatic stress. Notably, SoC was inversely related to self-reported psychopathology, as well as to HCC in the trauma group. The results illustrate the situation of adolescents exposed to chronic traumatic stress and extend the literature on aberrant HPA axis functioning under such conditions. They also point out a central role of SoC, which may imply new strategies to aid individuals exposed to ongoing conflicts.

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Section: Introductionsupporting

confidence: 77%

Victims of war—Psychoendocrine evidence for the impact of traumatic stress on psychological well‐being of adolescents growing up during the Israeli–Palestinian conflict

et al. 2018

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“…This maps onto other child and adult data implying that after an initial hyperactive phase, HPA axis hypo-activation may ensue if stress persists (e.g., Jaffee et al, 2015; G. E. Miller, Chen, & Zhou, 2007; Steudte-Schmiedgen, Kirschbaum, Alexander, & Stalder, 2016). Subtype and pervasiveness of maltreatment are also deemed important (Doom, Cicchetti, Rogosch, & Dackis, 2013).…”

Section: Introductionsupporting

confidence: 56%

“…Moreover, our broad sampling strategy carried important benefits, ensuring a wide variance in maltreatment characteristics, which allowed for dimensional testing within maltreated subjects. Finally, compared to other cortisol measurement modalities, hair cortisol remains a relatively new measure that would profit from further validation confirming that it documents cumulative cortisol secretion over several months (Steudte-Schmiedgen et al, 2016), though recent detailed validation efforts have yielded promising results (e.g., Short et al, 2016). …”

Section: Discussionmentioning

confidence: 99%

“…In this regard, the assessment of cortisol in scalp hair may prove a major advance, affording a valid and robust retrospective index of cumulative cortisol secretion over several months (see Stalder & Kirschbaum, 2012; Staufenbiel, Penninx, Spijker, Elzinga, & van Rossum, 2013). Using this method, it has been shown that chronically stressed, severely traumatized and adult psychiatric populations exhibit altered hair cortisol concentrations (HCC) relative to controls (see Steudte-Schmiedgen, et al, 2016). Yet, despite initial data on HCC in traumatized children (Simmons et al, 2016), the unique potential of hair cortisol analysis of determining stable cumulative cortisol secretory patterns over an extended period has yet to be fully realized in a large-scale study on children and adolescents with a broad spectrum of maltreatment experiences.…”

Section: Introductionmentioning

confidence: 99%

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Reduced hair cortisol after maltreatment mediates externalizing symptoms in middle childhood and adolescence

White

Ising

Klitzing

et al. 2017

Child Psychology Psychiatry

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Background The enduring impact of childhood maltreatment on biological systems and ensuing psychopathology remains incompletely understood. Long-term effects of stress may be reflected in cumulative cortisol secretion over several months, which is now quantifiable via hair cortisol concentrations (HCC). We conducted a first comprehensive investigation utilizing the potential of hair cortisol analysis in a large sample of maltreated and nonmaltreated children and adolescents. Method Participants included 537 children and adolescents (3 to 16 years; 272 females) with maltreatment (n = 245) or without maltreatment histories (n = 292). Maltreated subjects were recruited from child protection services (CPS; n = 95), youth psychiatric services (n = 56), and the community (n = 94). Maltreatment was coded using the Maltreatment Classification System drawing on caregiver interviews and complemented with CPS records. Caregivers and teachers reported on child mental health. HCC were assessed in the first 3 cm hair-segment. Results Analyses uniformly supported that maltreatment coincides with a gradual and dose-dependent reduction of HCC from 9-10 years onwards relative to nonmaltreated controls. This pattern emerged consistently from both group-comparisons between maltreated and nonmaltreated subjects (27.6% HCC reduction in maltreated 9 to 16-year-olds) and dimensional analyses within maltreated subjects, with lower HCC related to greater maltreatment chronicity and number of subtypes. Moreover, both group comparisons and dimensional analyses within maltreated youth revealed that relative HCC reduction mediates the effect of maltreatment on externalizing symptoms. Conclusions From middle childhood onwards, maltreatment coincides with a relative reduction of cortisol secretion, which, in turn, may predispose to externalizing symptoms.

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“…Furthermore, Salivettes (Sarstedt, Rommelsdorf, Germany) are collected at various time-points before (two samples) and after (three samples) stress induction with the SECPT and MA task, to assess stress-related changes in cortisol and alpha-amylase concentrations. To obtain long-term endocrine correlates of PTSD symptoms and traumatization, levels of cortisol and other steroid hormones are assessed in hair, both at wave 1 and wave 2 (Stalder & Kirschbaum, 2012; Steudte-Schmiedgen, Kirschbaum, Alexander, & Stalder, 2016). We collect 3 cm hair strand from the lower part of the back of the head, reflecting cumulative secretion over the previous three-month period.…”

Section: Methodsmentioning

confidence: 99%

The role of automatic defensive responses in the development of posttraumatic stress symptoms in police recruits: protocol of a prospective study

Koch

Klumpers

Zhang

et al. 2017

European Journal of Psychotraumatology

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Background: Control over automatic tendencies is often compromised in challenging situations when people fall back on automatic defensive reactions, such as freeze – fight – flight responses. Stress-induced lack of control over automatic defensive responses constitutes a problem endemic to high-risk professions, such as the police. Difficulties controlling automatic defensive responses may not only impair split-second decisions under threat, but also increase the risk for and persistence of posttraumatic stress disorder (PTSD) symptoms. However, the significance of these automatic defensive responses in the development and maintenance of trauma-related symptoms remains unclear due to a shortage of large-scale prospective studies. Objective: The ‘Police-in-Action’ study is conducted to investigate the role of automatic defensive responses in the development and maintenance of PTSD symptomatology after trauma exposure. Methods: In this prospective study, 340 police recruits from the Dutch Police Academy are tested before (wave 1; pre-exposure) and after (wave 2; post-exposure) their first emergency aid experiences as police officers. The two waves of data assessment are separated by approximately 15 months. To control for unspecific time effects, a well-matched control group of civilians (n = 85) is also tested twice, approximately 15 months apart, but without being frequently exposed to potentially traumatic events. Main outcomes are associations between (changes in) behavioural, psychophysiological, endocrine and neural markers of automatic defensive responses and development of trauma-related symptoms after trauma exposure in police recruits. Discussion: This prospective study in a large group of primary responders enables us to distinguish predisposing from acquired neurobiological abnormalities in automatic defensive responses, associated with the development of trauma-related symptoms. Identifying neurobiological correlates of (vulnerability for) trauma-related psychopathology may greatly improve screening for individuals at risk for developing PTSD symptomatology and offer valuable targets for (early preventive) interventions for PTSD.

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An integrative model linking traumatization, cortisol dysregulation and posttraumatic stress disorder: Insight from recent hair cortisol findings

Cited by 142 publications

References 169 publications

Victims of war—Psychoendocrine evidence for the impact of traumatic stress on psychological well‐being of adolescents growing up during the Israeli–Palestinian conflict

Victims of war—Psychoendocrine evidence for the impact of traumatic stress on psychological well‐being of adolescents growing up during the Israeli–Palestinian conflict

Reduced hair cortisol after maltreatment mediates externalizing symptoms in middle childhood and adolescence

The role of automatic defensive responses in the development of posttraumatic stress symptoms in police recruits: protocol of a prospective study

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