Cortisol response to acute trauma and risk of posttraumatic stress disorder

Abstract

This study sought to characterize the variability of the previous termacute cortisol responsenext term following previous termtraumanext term and its relationship to previous termposttraumatic stress disordernext term (PTSD). Forty eight participants were recruited within 24 h 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 (0.5 mg 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 previous termcortisolnext term at 08.00 h on day 2 (r = −0.36, p = 0.04), but positively correlated with 16.00 h previous termcortisolsnext term (r = 0.41, p = 0.03). A lower rise in previous termcortisolnext term at 08.00 h on day 2 was associated with an increase in previous termrisknext term 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 previous termcortisolnext term to more than 90% of pre-dex levels compared with 25% without PTSD (χ2 = 6.77, p = 0.034). Urinary previous termcortisolnext term 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 previous termcortisolnext term following the dexamethasone suppression test are established early in the disease process.