Table 2.
Representation of selected articles examining the relationship between PTSD and diurnal cortisol.
| Authors | N | Study Population | Trauma Type(s) | Design | Aim | PTSD Diagnostic Method | Cortisol Sampling | Findings (Significant p values) |
|---|---|---|---|---|---|---|---|---|
| Cordero et al. (2017) | 36 | F; PTSD (18) and HC (18) | IPV |
|
To examine maternal IPV-PTSD diurnal cortisol compared with controls and in relation to their child's distress | CAPS structured interview and PCL-S | Salivary cortisol collected 30 min after waking, between 2 and 3pm and bedtime. Cortisol was also collected around the laboratory stressor at baseline (before stressor), immediately after stressor, 30 min and 60 min post-stressor |
Maternal PTSD vs. No PTSD 30 min post-awakening: p < 0.021 Bedtime: p < 0.014 Group x time interaction: p < 0.001 |
| Pierce and Pritchard (2016) | 52 | F; controls without PTSD (20), controls with PTSD (19), veterans without PTSD (6), veterans with PTSD (7) | War zone |
|
To examine cortisol concentrations in female veterans and civilians both with and without PTSD | PDS self-report questionnaire | Salivary cortisol collected at bedtime, awakening and after the TSST |
Cortisol after TSST Veterans PTSD+ and PTSD__ Time 1: p = 0.006 Time 2: p = 0.017 Time 3: p = 0.018 |
| Labonte et al. (2014) | 46 | M and F; Lifetime PTSD (30) and controls never exposed to trauma (16) | MVA, war, armed assault, adulthood physical/sexual abuse, childhood physical/sexual abuse, other |
|
To investigate HPA function in subjects with lifetime PTSD vs. healthy controls | CAPS structured interview and the IES-R self-report | Salivary cortisol taken at six-time points throughout the day – awakening, awakening+30 min, awakening+45 min, awakening+60 min, awakening+8 h, and bedtime |
PTSD vs. No PTSD Overall: p < 0.0005 30–45 min post-awakening: p < 0.01 45–60 min post-awakening: p < 0.05 |
| Van Liempt et al. (2013) | 45 | M; PTSD (13), TC (17) and HC (15) | War zone |
|
To examine sympathetic activity and HPA axis activity during sleep in PTSD | SCID and CAPS structured interview with consensus by two clinicians | Plasma cortisol determined every 20 min from 10pm to 8am and 20 min, 40 min and 60 min post-awakening |
PTSD vs. Trauma Controls and Healthy Controls No relevant significant results |
| Wahbeh and Oken (2013) | 71 | M; PTSD (51) and No PTSD (20) | War zone |
|
To measure cortisol in combat veterans with and without PTSD | CAPS structured interview | Salivary cortisol collected upon waking, 30 min after waking and bedtime on two consecutive days |
PTSD vs. No PTSD Waking: p < 0.05 Waking +30 min: p < 0.01 Bedtime: p < 0.05 |
| Eckart et al. (2009) | 30 | M; PTSD (17) and Control (13) | Highly traumatized adult males from Rwanda with and without PTSD |
|
To evaluate the diurnal cortisol profile secretion in a population of Rwandan refugees | PDS self-report questionnaire | Salivary cortisol concentrations taken at 7:30am, 8am, 8:30am, 9:30am, 11:30am, 1:30pm, 3:30pm, 5:30pm, 7:30pm and 9pm |
PTSD vs. No PTSD No relevant significant results |
| Metzger et al. (2008) | 83 | F; Current PTSD (40) and Never PTSD (43) | War zone |
|
To assess cortisol levels at 8am and 4pm and the cortisol response to DEX in female Vietnam nurse veterans | CAPS-DX and SCID structured interviews | Salivary cortisol concentrations |
PTSD vs. No PTSD No relevant significant results |
| DE Kloet et al. (2007) | 83 | M; PTSD (28), TC (27), and HC (28) | War zone |
|
To determine the effects of trauma exposure and PTSD on diurnal cortisol rhythm and HPA-axis feedback regulation using low dose DEX | Dutch Self Inventory for PTSD (self-report), CAPS structured interview and consensus by three clinicians | Salivary and plasma cortisol concentrations taken on 2 day at 8am, 4pm (1st day) and 8am and 4pm post-DEX (2nd day) |
PTSD vs. Trauma Controls and Healthy Controls 4pm Post-DEX: p < 0.001 |
| Gill et al. (2008) | 71 | F; PTSD group (26), TC (24), NTC (21) | Childhood physical/sexual abuse, unexpected death of a family member or close friend, adulthood rape or sexual abuse, IPV, physical assault by a non-intimate partner and witnessing physical assault or murder of another person |
|
To compare cortisol, DHEA, sIgA and serum production of TNFα, IL-1β and IL-6 among TC, NTC and PTSD participants | CAPS structured interview | Salivary cortisol measurements collected in the morning and evening |
PTSD vs. Trauma Controls and Healthy Controls Morning: p < 0.05 |
| Bremner et al. (2007) | 43 | F; Abuse + PTSD (19), Abuse Only (11), Controls (no abuse or PTSD) (13) | Early childhood sexual, physical, emotional and/or general abuse |
|
To evaluate cortisol, DHEA and estradiol over 24 h | ETI, SCID and CAPS structured interviews | Plasma cortisol levels across 24 h and divided into time blocks (12pm – 8pm, 4am – 2pm, 8pm – 4am and 7pm–10pm) |
PTSD vs. Trauma Controls and Healthy Controls 12pm - 8pm: p = 0.044* *No longer significant when adjusted for body weight |
Note indicated by “*“; F: Females; M: Males; TSST: Trier Social Stress Test; PTSD: post-traumatic stress disorder; MVA: Motor vehicle accident; HPA axis: hypothalamic-pituitary-adrenal axis; DEX: dexamethasone; IPV: interpersonal violence; TC: traumatized control; HC: healthy control; NTC: non-traumatized controls; CAR: cortisol awakening response; DHEA: dehydroepiandrosterone; sIgA: salivary immunoglobulin A; TNF: tumor necrosis factor; IL: interleukin; LD-DST: low-dose dexamethasone suppression test; CAPS: clinician-administered PTSD scale; PCL-S: Posttraumatic Symptom Checklist – short version; CAPS-DX: clinician-administered PTSD scale: current and lifetime diagnosis version; SCID: structured clinical interview for DSM-IV; PDS: posttraumatic stress diagnostic scale; IES-R: Impact of Event Scale- Revised; ETI: early trauma inventory.