Elsevier

Biological Psychiatry

Volume 74, Issue 9, 1 November 2013, Pages 639-646
Biological Psychiatry

Archival Report
Hair Cortisol as a Biomarker of Traumatization in Healthy Individuals and Posttraumatic Stress Disorder Patients

https://doi.org/10.1016/j.biopsych.2013.03.011Get rights and content

Background

Previous evidence on endocrine correlates of posttraumatic stress disorder (PTSD) has been rather inconsistent. The analysis of cortisol in hair is a recent methodological development that may increase the quality of long-term cortisol assessments in such research. Here, we use this method to closely assess hair cortisol relationships with trauma-related characteristics and PTSD symptom patterns.

Methods

Hair cortisol concentrations (HCC), diurnal salivary cortisol, and relevant psychometric data were assessed in matched groups of 28 PTSD patients and 27 traumatized and 32 nontraumatized healthy control subjects. Cortisol levels were quantified by liquid chromatography tandem mass spectrometry.

Results

Posttraumatic stress disorder patients and traumatized control subjects exhibited 59% and 51% lower HCC than nontraumatized control subjects, respectively. Hair cortisol concentrations were found to be negatively related to the severity of intrusion symptoms, the number of different lifetime traumatic events, the frequency of traumatization, and the time interval since traumatization. The overall pattern of HCC associations was not reflected in short-term salivary cortisol findings.

Conclusions

Our results indicate that trauma exposure per se, either in the absence or presence of PTSD, is a crucial correlate of long-term basal cortisol levels. Particularly, the experience of multiple events with a longer time since traumatization and an increased severity of intrusion symptoms may be related to hypocortisolism. The fact that HCC findings were not consistently seen in salivary cortisol data underscores the importance of the method of cortisol assessment and highlights the utility of hair cortisol analyses for future biological psychiatry research.

Section snippets

Participants

Posttraumatic stress disorder patients were recruited from the outpatient unit of the Technische Universität Dresden Institute of Clinical Psychology and Psychotherapy before the start of cognitive-behavioral therapy treatment. In addition, participants were recruited via local advertisements and flyers. Overall, 227 participants were screened for admission to the study. Overall exclusion criteria for all three groups were hair shorter than 3 cm at the posterior vertex region of the scalp,

Results

Groups were well-matched on sociodemographic and hair-related variables (ps>.052; Table 1). Oral contraceptive use, menopausal status, medication intake, or physical illness were unrelated to HCC (ps>.311). As expected, PTSD patients scored significantly higher on measures of PTSD symptoms (PDS sum score, Impact of Event Scale-Revised subscales) than TC participants (p<.001). Similarly, the three groups also differed on measures of frequency and number of traumatization (THQ), depressive

Discussion

This study set out to investigate associations between PTSD, trauma-related characteristics, and patterns of long-term cortisol secretion. Our findings reveal considerably lower HCC in PTSD patients and traumatized healthy control subjects compared with nontraumatized individuals, indicating that trauma exposure constitutes a crucial correlate of basal cortisol secretion even in the absence of PTSD diagnosis. Furthermore, we found reduced HCC to be related to a larger number and frequency of

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