Cortisol at the emergency room rape visit as a predictor of PTSD and depression symptoms over time

Abstract

Background Dysregulation of the hypothalamic-pituitary-adrenal axis, typically reflected by alterations in cortisol responsivity, has been associated with exposure to traumatic events and the development of stress-related disorders such as posttraumatic stress disorder (PTSD) and depression. Methods Serum cortisol was measured at the time of a post sexual assault medical exam among a sample of 323 female victims of recent sexual assault. Analyses were conducted among 235 participants who provided data regarding history of previous assault as well as PTSD and depression symptoms during at least one of three follow-ups. Results Growth curve models suggested that prior history of assault and serum cortisol were positively associated with the intercept and negatively associated with the slope of PTSD and depression symptoms after controlling for covariates. Prior history of assault and serum cortisol also interacted to predict the intercept and slope of PTSD and depression symptoms such that women with a prior history of assault and lower ER cortisol had higher initial symptoms that decreased at a slower rate relative to women without a prior history and those with higher ER cortisol. Conclusions Prior history of assault was associated with diminished acute cortisol responsivity at the emergency room visit. Prior assault history and cortisol both independently and interactively predicted PTSD and depression symptoms at first follow-up and over the course a six-month follow-up.

Hair cortisol concentrations and cortisol stress reactivity predict PTSD symptom increase after trauma exposure during military deployment

“…Specifically, attenuated baseline cortisol activity was predictive of a substantially greater increase of PTSD symptomatology in those soldiers who had experienced new-onset traumatic events (explaining 5% and 10.3% of variance, respectively). Although this is in line with some previous studies suggesting that reduced basal cortisol levels assessed immediately after traumatization may be a risk factor for subsequent development of PTSD (e.g., Delahanty et al, 2003;Walsh et al, 2013), studies assessing cortisol levels before trauma exposure have not been able to confirm this notion (e.g., Heinrichs et al, 2005;van Zuiden et al, 2011bvan Zuiden et al, , 2012a. As these studies used spot cortisol markers assessed from plasma and saliva samples without prior stimulation, it is likely that respective results were affected by the acute context of the measurement situation (e.g., Stalder et al, 2010).…”

“…Interestingly, prospective research suggests that lower basal cortisol levels immediately after a traumatic event predict a higher risk for developing PTSD symptoms (e.g., Delahanty et al, 2000;Mouthaan et al, 2014) and that prior traumatization may underlie this association (e.g., Delahanty et al, 2003;Walsh et al, 2013). However, as these studies measured cortisol levels immediately after trauma exposure, it is unclear whether observed effects can be attributed to peri-traumatic conditions (cortisol response to the traumatic event) or result from pre-traumatic differences in cortisol secretion.…”

An Overview of Translationally Informed Treatments for Posttraumatic Stress Disorder: Animal Models of Pavlovian Fear Conditioning to Human Clinical Trials

“…Prospective studies suggest that low cortisol in the face of trauma is a predisposing factor for the development of PTSD (87, 89–92). One hypothesis is that reduced cortisol signaling alters normal adaptive responses of the autonomic nervous system, including negative feedback to the pituitary and hypothalamus to terminate the stress response (93).…”

Diagnostic Biomarkers for Posttraumatic Stress Disorder: Promising Horizons from Translational Neuroscience Research

“…Evidence suggests that individuals with PTSD have attenuated levels of basal cortisol (31) and that a low level of cortisol in trauma survivors is associated with increased risk for subsequent development of PTSD (32, 33). However, findings on baseline cortisol levels have been mixed, and a recent meta-analysis concluded that there are no consistent differences between PTSD and controls (34).…”