Salivary cortisol and psychopathology in adults bereaved by the September 11, 2001 terror attacks.
OBJECTIVE
This prospective study aimed to describe the nature and time course of HPA axis dysregulation and psychopathology among terror-bereaved spouses.


METHODS
Twenty-three spouses bereaved from September 11, 2001 terror attacks and 22 nonbereaved spouses were compared using a psychiatric diagnostic interview (SCID), 3 days of salivary cortisol collection, and a dexamethasone suppression test. Most subjects had repeated assessments at 6 month intervals during the 2 year study.


RESULTS
After September 11, 2001, bereaved compared to nonbereaved had significantly higher rates ofposttraumatic stress disorder (PTSD; 68.1% versus 0%) and major depressive disorder (MDD; 45.5% versus 9.5%). Bereaved had significantly higher morning basal cortisol and less afternoon postdexamethasone cortisol suppression than nonbereaved. Among bereaved, those with PTSD without comorbid MDD had significantly greater afternoon postdexamethasone cortisol suppression than those without psychiatric disorders.


CONCLUSIONS
Terror-related spouse death is a severe stressor associated with persistent HPA axis activation, PTSD, and MDD. However, bereaved spouses who developed PTSD and were not depressed had enhanced postdexamethasone cortisol suppression, evidence of heightened glucocorticoid receptor sensitivity.
Pfeffer
Cynthia R
CR
Weill Cornell Medical College, New York Presbyterian Hospital, White Plains, NY 10605, USA. cpfeffer@med.cornell.edu
Altemus
Margaret
M
Heo
Moonseong
M
Jiang
Hong
H
D000328:Adult; D001601:Bereavement; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D009519:New York City; D011446:Prospective Studies; D012463:Saliva; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D018454:Spouses / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000378:metabolism; D013997:Time Factors
D006854:Hydrocortisone