The role of acute cortisol and DHEAS in predicting acute and chronic PTSD symptoms.
BACKGROUND
Decreased activation of the hypothalamus-pituitary-adrenal (HPA) axis in response to stress is suspected to be a vulnerability factor for posttraumatic stress disorder (PTSD). Previous studies showed inconsistent findings regarding the role of cortisol in predicting PTSD. In addition, no prospective studies have examined the role of dehydroepiandrosterone (DHEA), or its sulfate form DHEAS, and the cortisol-to-DHEA(S) ratio in predicting PTSD. In this study, we tested whether acute plasma cortisol, DHEAS and the cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks and 6 months post-trauma.


METHODS
Blood samples of 397 adult level-1 trauma center patients, taken at the trauma resuscitation room within hours after the injury, were analyzed for cortisol and DHEAS levels. PTSD symptoms were assessed at 6 weeks and 6 months post-trauma with the Clinician Administered PTSD Scale.


RESULTS
Multivariate linear regression analyses showed that lower cortisol predicted PTSD symptoms at both 6 weeks and 6 months, controlling for age, gender, time of blood sampling, injury, trauma history, and admission to intensive care. Higher DHEAS and a smaller cortisol-to-DHEAS ratio predicted PTSD symptoms at 6 weeks, but not after controlling for the same variables, and not at 6 months.


CONCLUSIONS
Our study provides important new evidence on the crucial role of the HPA-axis in response to trauma by showing that acute cortisol and DHEAS levels predict PTSD symptoms in survivors of recent trauma.
Department of Psychiatry, Center for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.mouthaan@amc.uva.nl.
Joanne
J
Mouthaan
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands.
Marit
M
Sijbrandij
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Jan S K
JS
Luitse
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
J Carel
JC
Goslings
Department of Psychiatry, Center for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Center, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
Berthold P R
BP
Gersons
Department of Psychiatry, Center for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Center, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
Miranda
M
Olff
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013313:Stress Disorders, Post-Traumatic / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors
D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone
Cortisol; DHEAS; Posttraumatic stress disorder; Predictors; Prospective study; Traumatic injury