Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder.
OBJECTIVE
The authors' objective was to compare the urinary cortisol excretion of Holocaust survivors with posttraumatic stress disorder (PTSD) (N = 22) to that of Holocaust survivors without PTSD (N = 25) and comparison subjects not exposed to the Holocaust (N = 15).


METHODS
Twenty-four-hour urine samples were collected, and the following day, subjects were evaluated for the presence and severity of past and current PTSD and other psychiatric conditions.


RESULTS
Holocaust survivors with PTSD showed significantly lower mean 24-hour urinary cortisol excretion than the two groups of subjects without PTSD. Multiple correlation analysis revealed a significant relationship between cortisol levels and severity of PTSD that was due to a substantial association with scores on the avoidance subscale.


CONCLUSIONS
The present findings replicate the authors' previous observation of low urinary cortisol excretion in combat veterans with PTSD and extend these findings to a non-treatment-seeking civilian group. The results also demonstrate that low cortisol levels are associated with PTSD symptoms of a clinically significant nature, rather than occurring as a result of exposure to trauma per se, and that low cortisol levels may persist for decades following exposure to trauma among individuals with chronic PTSD.
Yehuda
R
R
Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA.
Kahana
B
B
Binder-Brynes
K
K
Southwick
S M
SM
Mason
J W
JW
Giller
E L
EL
D000367:Age Factors; D000368:Aged; D002940:Circadian Rhythm; D003130:Combat Disorders / Q000175:diagnosis / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D017767:Holocaust; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D007585:Jews / Q000523:psychology; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000652:urine*; D013315:Stress, Psychological / Q000523:psychology / Q000652:urine
D006854:Hydrocortisone