Saliva cortisol in posttraumatic stress disorder: a community epidemiologic study

BACKGROUND Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, so it was expected that posttraumatic stress disorder (PTSD) would be associated with activation of this axis; however, studies have found both increased and decreased cortisol in PTSD. To address this question, we collected saliva cortisol at home in a subsample of a longitudinal epidemiologic sample. METHODS Six hundred eighty-four persons randomly selected from the total sample of 913 were requested to collect saliva samples upon awakening and in the early evening. Of these, 538 responded with samples, 516 of whom met inclusion criteria. These were 68 exposed to trauma with lifetime PTSD, 265 exposed to trauma with no PTSD, and 183 never exposed to trauma. RESULTS In a comparison of these three groups, lifetime PTSD revealed elevated evening saliva cortisol compared with exposed/no PTSD. When lifetime comorbidity with major depressive disorder (MDD) was included in the analysis, only persons with comorbid PTSD and MDD showed this evening elevation in cortisol. Persons with PTSD alone (never MDD) showed normal saliva cortisol levels, as did subjects with lifetime MDD alone. CONCLUSIONS Neither exposure to trauma nor PTSD alone is associated with alterations in saliva cortisol; however, elevated cortisol is found in PTSD comorbid with lifetime MDD.

[1]  E. Young,et al.  Cortisol and catecholamines in posttraumatic stress disorder: an epidemiologic community study. , 2004, Archives of general psychiatry.

[2]  E. Young,et al.  Salivary cortisol and posttraumatic stress disorder in a low-income community sample of women , 2004, Biological Psychiatry.

[3]  G. Asnis,et al.  Cortisol secretion in endogenous depression. I. Basal plasma levels. , 1985, Archives of general psychiatry.

[4]  C. Coe,et al.  Abuse-Related Posttraumatic Stress Disorder: Evidence for Chronic Neuroendocrine Activation in Women , 1995, Psychosomatic medicine.

[5]  B. Litz,et al.  PSYCHOMETRIC PROPERTIES OF THE CLINICIAN-ADMINISTERED PTSD SCALE, CAPS-1 , 1994 .

[6]  J W Mason,et al.  Enhanced suppression of cortisol following dexamethasone administration in posttraumatic stress disorder. , 1993, The American journal of psychiatry.

[7]  R. Rubin,et al.  Neuroendocrine aspects of primary endogenous depression. II. Serum dexamethasone concentrations and hypothalamic-pituitary-adrenal cortical activity as determinants of the dexamethasone suppression test response. , 1987, Archives of general psychiatry.

[8]  L. Tiedje,et al.  Pituitary-Adrenal and Autonomic Responses to Stress in Women After Sexual and Physical Abuse in Childhood , 2001 .

[9]  D. Charney,et al.  The development of a Clinician-Administered PTSD Scale , 1995, Journal of traumatic stress.

[10]  E. Giller,et al.  Low urinary cortisol excretion in holocaust survivors with posttraumatic stress disorder , 1994, Biological Psychiatry.

[11]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[12]  W. Coryell,et al.  Anxiety syndromes as epiphenomena of primary major depression: outcome and familial psychopathology. , 1992, The American journal of psychiatry.

[13]  S. Southwick,et al.  Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder. , 1995, The American journal of psychiatry.

[14]  R. Yehuda Current status of cortisol findings in post-traumatic stress disorder. , 2002, The Psychiatric clinics of North America.

[15]  E. Bosmans,et al.  Increased 24‐hour urinary cortisol excretion in patients with post‐traumatic stress disorder and patients with major depression, but not h patients with fibromyalgia , 1998, Acta psychiatrica Scandinavica.

[16]  S. Orr,et al.  Twenty-four hour urinary cortisol and catecholamine excretion in combat-related posttraumatic stress disorder , 1990, Biological Psychiatry.

[17]  E. Young,et al.  Cortisol and Catecholamines in Posttraumatic Stress Disorder , 2004 .

[18]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[19]  H. Akil,et al.  Hormonal Evidence for Altered Responsiveness to Social Stress in Major Depression , 2000, Neuropsychopharmacology.

[20]  R. Yehuda,et al.  The cortisol and glucocorticoid receptor response to low dose dexamethasone administration in aging combat veterans and holocaust survivors with and without posttraumatic stress disorder , 2002, Biological Psychiatry.

[21]  J. Boscarino Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: findings and clinical implications. , 1996, Journal of consulting and clinical psychology.

[22]  R. Rubin,et al.  Neuroendocrine aspects of primary endogenous depression. I. Cortisol secretory dynamics in patients and matched controls. , 1987, Archives of general psychiatry.

[23]  G. Asnis,et al.  Cortisol secretion in endogenous depression. II. Time-related functions. , 1985, Archives of general psychiatry.

[24]  N. Breslau,et al.  Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. , 2003, Archives of general psychiatry.

[25]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[26]  H. Akil,et al.  Increased evening activation of the hypothalamic-pituitary-adrenal axis in depressed patients. , 1994, Archives of general psychiatry.

[27]  Nichole E Carlson,et al.  Twenty-Four-Hour ACTH and Cortisol Pulsatility in Depressed Women , 2001, Neuropsychopharmacology.

[28]  P. Cowen,et al.  Increase in concentration of waking salivary cortisol in recovered patients with depression. , 2003, The American journal of psychiatry.

[29]  P. Clayton,et al.  The comorbidity factor: establishing the primary diagnosis in patients with mixed symptoms of anxiety and depression. , 1990, The Journal of clinical psychiatry.

[30]  M. Stein,et al.  Enhanced Dexamethasone Suppression of Plasma Cortisol in Adult Women Traumatized by Childhood Sexual Abuse , 1997, Biological Psychiatry.

[31]  P. Houck,et al.  Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. , 1996, The American journal of psychiatry.

[32]  D. Grobbee,et al.  Interperson variability but intraperson stability of baseline plasma cortisol concentrations, and its relation to feedback sensitivity of the hypothalamo-pituitary-adrenal axis to a low dose of dexamethasone in elderly individuals. , 1998, The Journal of clinical endocrinology and metabolism.

[33]  P. Diggle,et al.  Analysis of Longitudinal Data , 2003 .

[34]  E. Young,et al.  Similarity in saliva cortisol measures in monozygotic twins and the influence of past major depression , 2000, Biological Psychiatry.

[35]  N. Breslau,et al.  219. A second look at comorbidity in victims of trauma: the PTSD—major depression connection , 2000, Biological Psychiatry.

[36]  Ronald C. Kessler,et al.  Post‐traumatic stress disorder assessment with a structured interview: reliability and concordance with a standardized clinical interview , 1998 .

[37]  Steven M. Southwick,et al.  Increased pituitary and adrenal reactivity in premenopausal women with posttraumatic stress disorder , 2001, Biological Psychiatry.