The predictive role of hair cortisol concentrations for treatment outcome in PTSD inpatients

Hummel, Katrin; Schellong, Julia; Trautmann, Sebastian; Kummer, Sylvia; Hürrig, Sabine; Klose, Michael; Weidner, Kerstin; Kirschbaum, Clemens; Steudte-Schmiedgen, Susann

doi:10.1016/j.psyneuen.2021.105326

Cited by 6 publications

(31 citation statements)

References 48 publications

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“…Our prognostic null-results on treatment response are in line with a meta-analytic review on traditional cortisol measurements in blood and saliva (Schumacher et al, 2018). Further, the only currently available study using HCC in a comparable inpatient sample did not show a predictive effect on PTSD symptoms, but an association between higher pre-treatment HCC and improvements in general psychopathology (Hummel et al, 2021). This is comparable to a study by Fischer et al (2018) demonstrating in a clinical anxiety and depression population that treatment responders (vs nonresponders) had higher pre-treatment HCC.…”

Section: Discussionsupporting

confidence: 83%

“…This is comparable to a study by Fischer et al (2018) demonstrating in a clinical anxiety and depression population that treatment responders (vs nonresponders) had higher pre-treatment HCC. However, it is unknown whether all patients in the study by Hummel et al (2021) received exposure-based treatment. This might explain the lack of PTSDspecific results, considering the assumptions that the key underlying mechanism of exposure-based treatment is memory consolidation which is facilitated by glucocorticoids (de Quervain et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…To date, there is only one study investigating the predictive effect of HCC in PTSD treatment (Hummel et al, 2021). It was shown that higher pre-treatment HCC predicted greater overall symptom improvement from admission to discharge, but this effect was not observed from admission to five months post-discharge or specifically for PTSD symptomology.…”

Section: Introductionmentioning

confidence: 99%

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The role of long-term hair steroids as diagnostic and intervention-related markers in a multimorbid inpatient sample with posttraumatic stress disorder

Shkreli,

Woud,

Bergunde

et al. 2024

Preprint

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Steroid hormone dysregulations have frequently been implicated in posttraumatic stress disorder (PTSD) pathogenesis. However, the translation into naturalistic clinical settings as markers of symptomatology and treatment success remains complex. Particularly, there is little longitudinal data on steroid secretion over the course of interventions. This study examined the potential of long-term steroid hormone secretion assessed in hair as diagnostic and intervention-related biomarkers among medicated, multimorbid inpatients with PTSD. As part of a secondary analysis of a randomized controlled trial, 54 female inpatients with a primary diagnosis of PTSD receiving standardised treatment provided hair samples at pre-treatment, post-treatment, and 3-months follow-up. Cortisol, cortisone, and dehydroepiandrosterone (DHEA) were determined, alongside clinical assessments. Cross-sectional results showed a negative association of pre-treatment DHEA with anxiety symptoms and a trend-level association with lifetime trauma exposure. While inpatients improved in PTSD symptomatology during treatment, neither pre-treatment steroids, nor treatment-induced steroid changes predicted PTSD symptoms at post-treatment or follow-up. The study highlights the challenges of establishing biomarkers in naturalistic clinical populations. While the association of attenuated DHEA with anxiety symptoms warrants further exploration, our data points towards the potential necessity of patient sub-sample selection to understand, and in the long run clinically target, the endocrine mechanisms in PTSD.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The role of long-term hair steroids as diagnostic and intervention-related markers in a multimorbid inpatient sample with posttraumatic stress disorder

Shkreli,

Woud,

Bergunde

et al. 2024

Preprint

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“…Lower HCC before therapy could predict less improvement in clinical symptoms, but this relationship was no longer statistically significant after adjustment for baseline dissociative symptoms. Thus, there was no clear predictive value of HCC with respect to changes in PTSD symptomatology ( 49 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the context of a multimodal trauma-focused inpatient psychotherapy, there was no predictive value for HCC changes in terms of PTSD symptoms improvement ( 49 ). Various mental training interventions in one study and stress-reduction interventions in two studies led to sustained reductions in HCC ( 38 , 41 , 42 ).…”

Section: Discussionmentioning

confidence: 99%

Hair cortisol as outcome parameter for psychological and neuropsychiatric interventions—a literature review

Botschek,

Hußlein,

Peters

et al. 2023

Front. Psychiatry

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BackgroundStudies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic–pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing’s syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems.AimsThe aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature.MethodsFrom May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias.ResultsThe initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC.DiscussionHCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health.

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Hair glucocorticoid levels decrease after multimodal inpatient treatment and predict therapy outcome in burnout-related depressive disorders

La Marca,

Scheiwiller,

Pfaff

et al. 2024

The World Journal of Biological Psychiatry

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The predictive role of hair cortisol concentrations for treatment outcome in PTSD inpatients

Cited by 6 publications

References 48 publications

The role of long-term hair steroids as diagnostic and intervention-related markers in a multimorbid inpatient sample with posttraumatic stress disorder

The role of long-term hair steroids as diagnostic and intervention-related markers in a multimorbid inpatient sample with posttraumatic stress disorder

Hair cortisol as outcome parameter for psychological and neuropsychiatric interventions—a literature review

Hair glucocorticoid levels decrease after multimodal inpatient treatment and predict therapy outcome in burnout-related depressive disorders

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