Joanne Mouthaan1, Marit Sijbrandij2, Jan S K Luitse3, J Carel Goslings3, Berthold P R Gersons4, Miranda Olff4. 1. Department of Psychiatry, Center for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.mouthaan@amc.uva.nl. 2. Department of Clinical Psychology, VU University, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands. 3. Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Psychiatry, Center for Anxiety Disorders, Research Group Psychotrauma, Academic Medical Center, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands.
Abstract
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.
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.
Authors: Sarah R Lowe; Andrew Ratanatharathorn; Betty S Lai; Willem van der Mei; Anna C Barbano; Richard A Bryant; Douglas L Delahanty; Yutaka J Matsuoka; Miranda Olff; Ulrich Schnyder; Eugene Laska; Karestan C Koenen; Arieh Y Shalev; Ronald C Kessler Journal: Psychol Med Date: 2020-02-03 Impact factor: 7.723