title: Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression?
abstract: The study investigated the relationship between the acute psychological and psychobiological trauma response and the subsequent development of posttraumatic stress disorder (PTSD) and depressive symptoms in 53 accident survivors attending an emergency department. Lower levels of salivary cortisol measured in the emergency room predicted greater symptom levels of PTSD and depression 6 months later, and lower diastolic blood pressure, past emotional problems, greater dissociation and data-driven processing predicted greater PTSD symptoms. Heart rate was not predictive. Low cortisol levels correlated with data-driven processing during the accident, and, in female participants only, with prior trauma and prior emotional problems. Higher evening cortisol 6 months after the accident correlated with PTSD and depressive symptoms at 6 months, but this relationship was no longer significant when levels of pain were controlled. The results support the role of the acute response to trauma in the development and maintenance of PTSD and provide promising preliminary evidence for a meaningful relationship between psychobiological and psychological factors in the acute trauma phase.
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. t.w.a.ehring@uva.nl
authors.forename: Thomas
authors.initials: T
authors.lastname: Ehring
authors.forename: Anke
authors.initials: A
authors.lastname: Ehlers
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cleare
authors.forename: Edward
authors.initials: E
authors.lastname: Glucksman
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology; D000328:Adult; D001143:Arousal / Q000502:physiology; D002940:Circadian Rhythm / Q000502:physiology; D003866:Depressive Disorder / Q000097:blood* / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D015601:Injury Severity Score; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D011379:Prognosis; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000097:blood* / Q000175:diagnosis* / Q000523:psychology; D014947:Wounds and Injuries / Q000097:blood / Q000523:psychology
chemical_list: D006854:Hydrocortisone
references.citation: J Sports Sci. 1998 Jan;16 Suppl:S3-7
references.pmid: 22587712
references.citation: Psychoneuroendocrinology. 2005 Nov;30(10):1010-6
references.pmid: 15950390
references.citation: Arch Gen Psychiatry. 2005 Mar;62(3):335-40
references.pmid: 15753247
references.citation: J Trauma. 1974 Mar;14(3):187-96
references.pmid: 4814394
references.citation: Biol Psychiatry. 2001 Dec 15;50(12):986-93
references.pmid: 11750895
references.citation: J Anxiety Disord. 2003;17(2):149-64
references.pmid: 12614659
references.citation: Arch Gen Psychiatry. 1998 Jun;55(6):553-9
references.pmid: 9633675
references.citation: J Trauma Stress. 2006 Oct;19(5):735-40
references.pmid: 17075910
references.citation: J Behav Ther Exp Psychiatry. 2002 Jun;33(2):73-89
references.pmid: 12472172
references.citation: Br J Psychiatry. 2002 Apr;180:363-8
references.pmid: 11925361
references.citation: Biol Psychiatry. 2004 Apr 1;55(7):745-51
references.pmid: 15039004
references.citation: Behav Res Ther. 2006 Dec;44(12):1699-716
references.pmid: 16460669
references.citation: Psychoneuroendocrinology. 2005 Feb;30(2):121-8
references.pmid: 15471610
references.citation: Am J Psychiatry. 1995 Nov;152(11):1675-7
references.pmid: 7485635
references.citation: Psychoneuroendocrinology. 2005 Nov;30(10):974-82
references.pmid: 15964146
references.citation: Biol Psychiatry. 2002 Jun 1;51(11):922-30
references.pmid: 12022966
references.citation: J Trauma Stress. 1999 Jan;12(1):155-65
references.pmid: 10027149
references.citation: Psychosom Med. 1995 Mar-Apr;57(2):105-15
references.pmid: 7792368
references.citation: Biol Psychiatry. 2000 Nov 1;48(9):940-7
references.pmid: 11074232
references.citation: Ann N Y Acad Sci. 1997 Jun 21;821:437-41
references.pmid: 9238224
references.citation: Psychosom Med. 2001 May-Jun;63(3):387-401
references.pmid: 11382266
references.citation: J Consult Clin Psychol. 2008 Apr;76(2):219-30
references.pmid: 18377119
references.citation: J Abnorm Psychol. 2000 May;109(2):341-4
references.pmid: 10895573
references.citation: Biol Psychiatry. 2005 Jan 1;57(1):91-5
references.pmid: 15607305
references.citation: J Trauma Stress. 2004 Aug;17(4):317-24
references.pmid: 15462539
references.citation: Lancet. 1974 Jul 13;2(7872):81-4
references.pmid: 4136544
references.citation: CNS Spectr. 2003 Sep;8(9):651-6, 665-7
references.pmid: 15079139
references.citation: J Trauma Stress. 2003 Oct;16(5):439-43
references.pmid: 14584627
references.citation: Biol Psychiatry. 2004 Mar 15;55(6):627-33
references.pmid: 15013832
references.citation: Behav Res Ther. 2000 Apr;38(4):319-45
references.pmid: 10761279
references.citation: Biomed Instrum Technol. 1990 Jan-Feb;24(1):37-41
references.pmid: 2306564
references.citation: J Consult Clin Psychol. 2003 Jun;71(3):419-31
references.pmid: 12795567
references.citation: J Trauma Stress. 2002 Jun;15(3):199-204
references.pmid: 12092911
references.citation: Psychol Bull. 2003 Jan;129(1):52-73
references.pmid: 12555794
references.citation: J Trauma Stress. 1995 Jan;8(1):75-90
references.pmid: 7712061