title: Cortisol response to acute trauma and risk of posttraumatic stress disorder.
abstract: This study sought to characterize the variability of the acute cortisol response following trauma and its relationship to posttraumatic stress disorder (PTSD). Forty eight participants were recruited within 24h of a traumatic accident requiring hospital admission. A saliva sample was collected at 08.00 h and 16.00 h 2 days, 1 month and 6 months after hospital admission, together with 24-h urine collection. Participants completed a dexamethasone suppression test (0.5mg DEX at 21.00 h) at each follow up, together with self-report questionnaires. The Clinician Administered PTSD Scale (CAPS) was administered at 1 and 6 months to identify PTSD. Prevalence of PTSD was 27% at 1 month and 21% at 6 months. PTSD symptoms at 6 months were negatively correlated with salivary cortisol at 08.00 h on day 2 (r=-0.36, p=0.04), but positively correlated with 16.00 h cortisols (r=0.41, p=0.03). A lower rise in cortisol at 08.00 h on day 2 was associated with an increase in risk of PTSD at both 1 month (OR=1.411 (1.017, 1.957)) and 6 months (OR=1.411 (1.066, 1.866)). At 1 month, 70% of participants with PTSD suppressed cortisol to more than 90% of pre-dex levels compared with 25% without PTSD (χ(2)=6.77, p=0.034). Urinary cortisol excretion was not different between groups at any time point. The findings support a hypothesis that sensitization of the HPA axis and enhanced suppression of cortisol following the dexamethasone suppression test are established early in the disease process.
authors.affiliation: Centre for Military and Veterans’ Health, School of Population Health and Clinical Practice, The University of Adelaide, SouthAustralia, Australia.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Barton
authors.forename: Rachel
authors.initials: R
authors.lastname: Yehuda
authors.forename: Gary
authors.initials: G
authors.lastname: Wittert
mesh_terms: D000328:Adult; D000465:Algorithms; D003907:Dexamethasone / Q000008:administration & dosage; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry / Q000378:metabolism; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D014947:Wounds and Injuries / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism*; D055815:Young Adult
chemical_list: D003907:Dexamethasone; D006854:Hydrocortisone