Initial urinary epinephrine and cortisol levels predict acute PTSD symptoms in child trauma victims

BACKGROUND: Previous research examining biological correlates of posttraumatic stress disorder (PTSD) in children has suggested that children with chronic PTSD have altered levels of catecholamines and cortisol compared to similarly traumatized children who do not meet diagnostic criteria. The present study extended these findings by examining whether urinary hormone levels collected soon after a trauma were related to subsequent acute PTSD symptoms in child trauma victims. METHODS: Initial 12-h urine samples were collected from 82 children aged 8-18 admitted to a Level 1 trauma center. Collection was begun immediately upon admission, and samples were assayed for levels of catecholamines and cortisol. PTSD and depressive symptomatology were assessed 6 weeks following the accident. RESULTS: Initial urinary cortisol levels were significantly correlated with subsequent acute PTSD symptoms (r=0.31). After removing the variance associated with demographic variables and depressive symptoms, urinary cortisol and epinephrine levels continued to predict a significant percentage (7-10%) of the variance in 6-week PTSD symptoms. Examination of boys and girls separately suggested that significance was primarily driven by the strength of the relationships between hormone levels and acute PTSD symptoms in boys. CONCLUSIONS: The present findings suggest that high initial urinary cortisol and epinephrine levels immediately following a traumatic event may be associated with increased risk for the development of subsequent acute PTSD symptoms, especially in boys.     

Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims.

BACKGROUND: This study was designed to examine the relationship between urinary hormone levels collected upon admission to the trauma unit following a motor vehicle accident and posttraumatic stress disorder symptomatology 1 month later. METHODS: Fifteen-hour urine samples were collected from 63 male and 36 female motor vehicle accident victims and were used to assess levels of catecholamines and cortisol reflecting peritraumatic and acute-phase posttraumatic levels. Presence of posttraumatic stress disorder symptomatology was assessed 1 month after the accident. RESULTS: Motor vehicle accident victims subsequently diagnosed with acute posttraumatic stress disorder excreted significantly lower levels of cortisol in 15-hour urines collected upon admission to the hospital. In addition, urinary levels of cortisol predicted a significant percentage of the variance in intrusive and avoidant thoughts 1 month after the accident. CONCLUSIONS: The results of our study suggest that initial cortisol levels in the immediate aftermath of a traumatic event contribute, in part, to subsequent symptoms of posttraumatic stress disorder.     

Posttraumatic stress symptoms and salivary cortisol levels

OBJECTIVE: This study assessed the relationship between posttraumatic stress symptoms and salivary cortisol levels after a severe ice storm. METHOD: Posttraumatic stress symptoms (Impact of Event Scale scores) and salivary cortisol levels were determined in 115 victims of an ice storm and in 27 healthy comparison subjects 1 month and approximately 1 year after the ice storm. RESULTS: One month after the storm, Impact of Event Scale scores for the victims (mean=20.31, SD=15.23) exceeded those of the comparison subjects (mean=5.30, SD=9.78) but were reduced approximately 1 year later (mean=14.01, SD=13.68). A quadratic relation was found to exist between Impact of Event Scale scores and cortisol levels. CONCLUSIONS: One month after the storm, cortisol levels were found to be elevated among the victims but were diminished among those with the highest Impact of Event Scale scores. This relationship was found not to exist approximately 1 year later.     

Increased waking salivary cortisol levels in young people at familial risk of depression

OBJECTIVE: Cortisol hypersecretion is one of the most reliable biological abnormalities in major depression, but it is uncertain if it represents an illness marker or a trait vulnerability to mood disorder. The present study sought to answer this question by measuring waking salivary cortisol levels in young people at familial risk of depression but with no personal history of mood disorder. METHOD: The authors studied 49 young people who had not been depressed themselves but who had a parent with a history of major depression (FH+) and a comparison group of 55 participants who had no personal history of depression and no reported depression in a first-degree relative. The authors measured the amount of cortisol secreted in saliva during the first 30 minutes after awakening on a workday and on a nonworkday. RESULTS: The amount of cortisol secreted by the FH+ subjects was greater than that of the comparison subjects on both workdays (mean=698 nmol x minutes/liter, SD=243, versus mean=550, SD=225) and nonworkdays (mean=633 nmol x minutes/liter, SD=216, versus mean=492, SD=166). The increase in cortisol secretion was not accounted for by differences in parental attachment, life events, personality, or current mental state. CONCLUSIONS: Hypersecretion of cortisol can be detected in asymptomatic individuals at genetic risk of depression and may represent an illness endophenotype. Further studies will be needed to find out if increased waking salivary cortisol levels can predict individual risk of illness and whether the increased cortisol secretion has implications for general health and cognitive function.     

Increase in concentration of waking salivary cortisol in recovered patients with depression

OBJECTIVE: Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis with elevated plasma cortisol levels is characteristic of acute major depression. However, it is unclear whether HPA axis abnormalities are present in fully recovered patients. An increase in salivary cortisol levels after waking provides a simple, dynamic measure of HPA axis activity. The authors measured this increase in recovered depressed patients and in a healthy comparison group. METHOD: Salivary cortisol levels were measured upon waking and at 15-minute intervals for the next hour in 31 medication-free, recovered depressed patients and in 31 matched healthy comparison subjects. RESULTS: The increase in salivary cortisol levels that followed waking was significantly higher in the patients. CONCLUSIONS: Greater secretion of cortisol may be present in depressed subjects after clinical recovery and withdrawal of medication. This may put patients at risk of further episodes of depression as well as comorbid medical conditions, such as coronary heart disease.     

Positive life events predict salivary cortisol in pregnant women

Maternal stress during pregnancy has been repeatedly associated with problematic child development. According to the fetal programming hypothesis adverse experiences during pregnancy increase maternal cortisol, which is then assumed to exert a negative effect on fetal development. Recent studies in non-pregnant women report significant associations between positive emotionality and low cortisol levels. We tested in a sample of 60 pregnant women whether both negative and positive life events independently predicted third-trimester baseline awakening cortisol levels. While the effect of negative life events proved unrelated positive life events significantly predicted lower cortisol levels. These findings suggest that positive experiences are of relevance regarding maternal morning cortisol levels in pregnancy reflecting a resource with potentially beneficial effects for the mother and the developing fetus. It might be promising for psychological intervention programs to focus on increasing positive experiences of the expecting mother rather than exclusively trying to reduce maternal stress during pregnancy.     

Gender and PTSD: What can we learn from female police officers?

Studies of civilians typically find that female gender is a risk factor for posttraumatic stress disorder (PTSD). Police and military studies often find no gender differences in PTSD. We compared 157 female police officers and 124 female civilians on several variables including trauma exposure, peritraumatic emotional distress, current somatization, and cumulative PTSD symptoms. We found that despite greater exposure to assaultive violence in the officer group, female civilians reported significantly more severe PTSD symptoms. Elevated PTSD symptoms in female civilians were explained by significantly more intense peritraumatic emotional distress among female civilians. We also found that female officers showed a stronger direct relationship between peritraumatic emotional distress and current somatization. Our findings suggest that apparent gender differences in PTSD may result from differences in peritraumatic emotionality, which influence subsequent PTSD and somatization symptoms. Emotionality may be more important than biological sex in understanding gender differences in PTSD.     

Circadian rhythm of salivary cortisol in Holocaust survivors with and without PTSD

OBJECTIVE: The authors' goal was to determine whether cortisol circadian rhythm alterations observed in younger subjects with posttraumatic stress disorder (PTSD) are also present in geriatric trauma survivors with PTSD. METHOD: Salivary cortisol levels were measured at six intervals from awakening until bedtime in 23 Holocaust survivors with PTSD, 19 Holocaust survivors without PTSD, and 25 subjects who had not been exposed to the Holocaust. Thirty-three of the subjects were men, and 34 were women. RESULTS: Cortisol levels were significantly lower at awakening, at 8:00 a.m., and at 8:00 p.m. in Holocaust survivors with PTSD than in nonexposed subjects, resulting in a flatter circadian rhythm, similar to what has been observed in aging but different from what has been reported in younger subjects with PTSD. CONCLUSIONS: These data provide evidence of differential neuroendocrine alterations in geriatric PTSD.     

High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD

Eye movement desensitization and reprocessing (EMDR) has been shown to be an effective treatment for posttraumatic stress disorder (PTSD). In this study, the authors evaluated the effectiveness and physiological effects of EMDR in police officers involved with on-duty shootings and who had PTSD. Six police officers involved with on-duty shootings and subsequent delayed-onset PTSD were evaluated with standard measures, the Posttraumatic Stress Diagnostic Scale, and high-resolution brain single photon emission computed tomography (SPECT) imaging before and after treatment. All police officers showed clinical improvement and marked reductions in the Posttraumatic Stress Diagnostic Scale Score (PDS). In addition, there were decreases in the left and right occipital lobe, left parietal lobe, and right precentral frontal lobe as well as significant increased perfusion in the left inferior frontal gyrus. In our study EMDR was an effective treatment for PTSD in this police officer group, showing both clinical and brain imaging changes.     

High and low unstimulated salivary cortisol levels correspond to different symptoms of functional gastrointestinal disorders

OBJECTIVE: It was examined whether unstimulated salivary cortisol levels as a psychobiological marker of stress reactivity correspond to psychological assessments of pain perception, depressive mood, and anxiety in patients with functional gastrointestinal disorder (FGD). METHODS: A total of 30 patients was diagnosed according to the Rome diagnostic criteria for irritable bowel syndrome, nonulcer dyspepsia, or both conditions. Psychometric data were assessed by questionnaires, and salivary samples were collected for the measurement of cortisol levels after awakening and during the day. Patients were grouped by their awakening cortisol levels into low (G1), medium (G2), and high cortisol group (G3). RESULTS: Psychiatric comorbidity did not differ between the groups. Analysis of variance (ANOVA) showed significant group differences with respect to pain perception and depressive mood, with the highest pain in G1 and the highest depression in G3. CONCLUSION: The reported results are in line with prior research on hypothalamus-pituitary-adrenal (HPA) axis dysregulation in patients suffering from somatoform disorders on the one hand (low cortisol levels) and high cortisol levels in depression on the other. It is remarkable that our sample of patients of whom all received the same diagnosis, i.e., FGD, can be subdivided according to functional gastrointestinal symptoms, which correspond to the two types of cortisol alterations. The data provide evidence for psychobiological subgroups in FGD patients. As a consequence, the predominant symptoms reported by patients with FGD should carefully be taken into account to specify (psychotherapeutic) treatment.     

Increased serum cortisol and growth hormone levels in earthquake survivors with PTSD or subclinical PTSD

Alteration of neuroendocrine systems has been demonstrated to be involved in the pathology of posttraumatic stress disorder (PTSD). Three months after an earthquake in Northern China, cortisol, growth hormone (GH) and prolactin (PRL) levels were assessed in 34 earthquake survivors with PTSD (according to DSM-IV criteria), 30 earthquake survivors with subclinical PTSD and 34 normal controls. Only earthquake survivors diagnosed with PTSD had significantly higher serum GH levels. Also, we found that earthquake survivors (either with PTSD or subclinical PTSD) had significantly higher serum cortisol levels. We concluded that PTSD might be associated with an increased level of serum GH and traumatic survivors might be associated with a higher level of serum cortisol.     

Changes in cortisol and DHEA plasma levels after psychotherapy for PTSD

Post-traumatic stress disorder (PTSD) has been associated with dysregulation of the neuroendocrine system. In this study we examine the effects of psychotherapy in 21 PTSD patients, with and without coexisting depression, on the levels of six stress-related hormones: cortisol, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone-sulfate (DHEA-S), prolactin, thyrotropin (TSH) and free thyroxin (fT4). The results show that after brief eclectic psychotherapy (BEP) significant changes occurred in levels of cortisol and DHEA. Responders showed an increase in cortisol and DHEA levels, while in non-responders both hormone levels decreased. Differences were only found after controlling for depressive symptoms. In conclusion, effective psychotherapy for PTSD may alter dysregulations in the Hypothalamus-pituitary-adrenal (HPA)-axis, but comorbid depressive symptoms should be taken into account.     

Protective factors for posttraumatic stress disorder symptoms in a prospective study of police officers

Although police officers are frequently exposed to potentially traumatic incidents, only a minority will develop chronic posttraumatic stress disorder (PTSD). Identifying and understanding protective factors could inform the development of preventive interventions; however, few studies have examined this. In the present prospective study, 233 police officers were assessed during academy training and again following 2 years of police service. Caucasian race, less previous trauma exposure, and less critical incident exposure during police service as well as greater sense of self-worth, beliefs of greater benevolence of the world, greater social support and better social adjustment, all assessed during academy training, were associated with lower PTSD symptoms after 2 years of service. Positive personality attributes assessed during training with the NEO Five-Factor Personality Inventory were not associated with lower PTSD symptoms. In a hierarchical linear regression model, only Caucasian race, lower critical incident exposure during police service, greater assumptions of benevolence of the world and better social adjustment during training remained predictive of lower PTSD symptoms after 2 years of police service. These results suggest that positive world assumptions and better social functioning during training may protect police officers from critical incident related PTSD.     

Inability to predict postdexamethasone cortisol levels by serum sodium levels

Each of 42 hospitalized patients with unipolar major depression received a dexamethasone suppression test (DST) and had blood drawn for serum sodium and potassium tests within 3 days of admission. Unlike the patients in an earlier report by Tollefson et al., these patients showed no correlations between the DST results and the serum sodium levels. Although the DST identified depressive subtypes accurately, the serum sodium levels did not predict the DST results in this study.     

Basal and suppressed salivary cortisol in female Vietnam nurse veterans with and without PTSD

It has been suggested that discrepant findings regarding low basal cortisol levels and enhanced suppression of cortisol in response to dexamethasone (DEX) administration in post-traumatic stress disorder (PTSD) may reflect individual differences in gender, trauma type, stage of development at trauma occurrence (e.g., childhood vs. adulthood), early pre-traumatic risk factors, or other individual differences. This study examined salivary cortisol levels at 08.00h and 16.00h as well as cortisol response to 0.50 mg DEX in 40 female Vietnam nurse veterans who had current, chronic PTSD (Current) vs. 43 who never had PTSD (Never). Repeated measures analyses of covariance did not reveal significant group differences in cortisol levels or cortisol suppression. Given that nurses who served in Vietnam had similar exposures, ages at exposure, and duration since exposure to previously studied male Vietnam combat veterans, the present lack of evidence for low cortisol and cortisol hyper-suppression in nurses with PTSD suggests that previous findings of low cortisol and cortisol hyper-suppression in male Vietnam veterans, females sexually abused as children, and other populations may reflect risk factors beyond simply having PTSD.     

Comparisons between salivary cortisol levels in six-months-olds and their parents

BACKGROUND: There is a close relation between the psychosocial environment of the infant--including the perception of maternal behaviour--and cortisol levels of the infant. One previous study has also demonstrated a correlation between mother and infant mean cortisol levels. In this study, this relation was further explored, also including father cortisol levels. METHODS: Saliva cortisol samples were collected from 51 six-months-olds and their parents on the same day in the morning, afternoon and evening. Analyses were performed with a radioimmunoassay technique. All mothers were at home with their child at this age and 47/51 mothers were breast feeding. RESULTS: Strong correlations were found between mother and child levels on all sampling occasions whereas weaker correlations were found between father and child levels and only in the afternoon and the evening samples. There was also a strong relation between waking up/bedtime-difference in mother and child and a weaker relation between the corresponding measure in father and child. CONCLUSIONS: The stronger mother-infant than father-infant cortisol level correlations probably mirror that mother and infant not only have genetic similarities but also have been exposed to similar environmental conditions to a higher degree than father and infant.