https://orcid.org/0000-0001-9289-7094
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ABSTRACT
Background: Pre-and post-traumatic hypothalamic–pituitary–adrenal (HPA) axis markers have been studied to predict posttraumatic stress disorder (PTSD) risk, but its acute reactivity cannot be measured in real-life settings. Experimental paradigms can depict the cortisol response to stimuli that simulate traumatic events.
Objective: To review experimental studies on the cortisol response to traumatic stimuli and the correlation between cortisol and PTSD symptoms.
Method: Experimental, (un-)published studies in German or English from any year were eligible if they confronted non-traumatized humans with traumatic stimuli, assessed cortisol before, during or after stimulus presentation and subsequent PTSD symptoms. The literature was searched via PubMed, PubPsych, PsychINFO, PsycArticle, Web of Science, EMBASE, ProQuest and ClinicalTrials.gov up to 16th February 2021. Risk of bias was assessed with the Cortisol Assessment List. Multilevel-meta-analyses were conducted under the random effects model. The standardized mean change (dSMC) indicated the cortisol response. Coefficient r indicated the correlations between cortisol and PTSD symptoms.
Results: 14 studies, investigating 1004 individuals, were included. A cortisol response was successfully induced between 21 and 40 min post-presentation onset (kobservations = 25, dSMC = 0.15 [.03; .26]). Cortisol was not associated with overall or cluster-level PTSD symptoms. On a symptom-level, higher pre-presentation onset cortisol was correlated with lower state tension (k = 8, r = −.18 [−.35; −.01]), higher state happiness (k = 8, r = −.34 [−.59; −.03], variable inverted) and lower state anger (k = 9, r = −.14 [−.26; −.01]). Higher post-presentation onset cortisol was correlated with higher state happiness (k = 16, r = −.20 [−.33; −.06]) and lower state sadness (k = 17, r = −.16 [−.25; −.05]), whereas cortisol response was positively correlated with state anxiety (k = 9, r = .16 [0.04; 0.27]).
Conclusions: Experimental paradigms effectively induce a cortisol response. Higher basal cortisol, higher cortisol, as measured after traumatic stimulus presentation, and a lower cortisol response were associated with more adaptive emotional reactions. These markers did not predict longer-term PTSD symptoms.
HIGHLIGHTS
Experimental trauma paradigms successfully induced a cortisol response.
Cortisol was predictive for single state, emotion-related symptoms, but not overall PTSD symptoms.
Trauma paradigms shed light into the immediate post-trauma period that is hard to capture in real life, but the gap between experimental and naturalistic settings is difficult to overcome.
Antecedentes: Se han estudiado los marcadores del eje hipotálamo-pituitario-suprarrenal (HPA) pretraumático y postraumático para predecir el riesgo de trastorno de estrés postraumático (TEPT), pero su reactividad aguda no puede ser medida en escenarios de la vida real. Los paradigmas experimentales pueden representar la respuesta del cortisol a los estímulos que simulan eventos traumáticos.
Objetivo: Revisar los estudios experimentales sobre la respuesta del cortisol a los estímulos traumáticos y la correlación entre el cortisol y los síntomas del TEPT.
Método: Los estudios experimentales (no) publicados en alemán o inglés de cualquier año fueron elegibles si confrontaron a humanos no traumatizados con estímulos traumáticos, evaluaron el cortisol antes, durante o después de la presentación del estímulo y los síntomas de TEPT subsecuentes. Se realizaron búsquedas en la literatura a través de PubMed, PubPsych, PsychINFO, PsycArticle, Web of Science, EMBASE, ProQuest y ClinicalTrials.gov hasta el 16 de febrero de 2021. El riesgo de sesgo se evaluó con la Lista de evaluación de cortisol. Se realizaron metaanálisis multinivel bajo el modelo de efectos aleatorios. El cambio medio estandarizado (dSMC) indicó la respuesta del cortisol. El coeficiente r indicó las correlaciones entre el cortisol y los síntomas de TEPT.
Resultados: Se incluyeron 14 estudios que investigaron a 1004 personas. Se indujo con éxito una respuesta de cortisol entre 21 y 40 minutos después del inicio de la presentación (Kobservaciones = 25, dSMC = 0,15 [0,03; 0,26]). El cortisol no se asoció con síntomas generales o a nivel de grupos sintomáticos de TEPT. A nivel de síntomas, un nivel más alto de cortisol antes de la presentación se correlacionó con un estado de tensión más bajo (k = 8, r = −0,18 [−0,35; −0,01]), estado de felicidad más alto (k = 8, r = − .34 [−.59; −.03], variable invertida) y menor estado de ira (k = 9, r = −.14 [−.26; −.01]). Un nivel más alto de cortisol posterior a la presentación se correlacionó con un estado de felicidad más alto (k = 16, r = −0,20 [−0,33; −0,06]) y un estado de tristeza más bajo (k = 17, r = −0,16 [−0,25]; −0,05]), mientras que la respuesta de cortisol se correlacionó positivamente con el estado de ansiedad (k = 9, r = 0,16 [0,04; 0,27]).
Conclusiones: Los paradigmas experimentales inducen efectivamente una respuesta de cortisol. El cortisol basal más alto, el cortisol más alto, medido después de la presentación del estímulo traumático, y una respuesta de cortisol más baja se asociaron con reacciones emocionales más adaptativas. Estos marcadores no predijeron los síntomas del TEPT a largo plazo.
背景：已经研究了创伤前和创伤后下丘脑-垂体-肾上腺 (HPA) 轴标志物来预测创伤后应激障碍 (PTSD) 风险，但无法在现实生活中测量其急性反应性。实验范式可以描述皮质醇对模拟创伤事件刺激的反应。
目的：综述关于皮质醇对创伤性刺激的反应以及皮质醇与 PTSD 症状之间相关性的实验研究。
方法：任何一年以德语或英语发表的实验性、（未）发表、让未受创伤的人受到创伤性刺激并在刺激呈现之前、期间或之后评估皮质醇以及随后的 PTSD 症状的研究都是合格的。 通过 PubMed、PubPsych、PsychINFO、PsycArticle、Web of Science、EMBASE、ProQuest 和 ClinicalTrials.gov 搜索了截至 2021 年 2 月 16 日的文献。使用皮质醇评估列表评估了偏倚风险。 在随机效应模型下进行了多水平元分析。标准化平均变化 (dSMC) 表示皮质醇反应。系数 r 表示皮质醇和 PTSD 症状之间的相关性。
结果：纳入了 14 项研究，考查了 1,004 人。在出现后 21–40 分钟期间成功诱导皮质醇反应（kobservations = 25，dSMC = 0.15 [0.03; 0.26]）。皮质醇与整体或症状簇水平的 PTSD 症状无关。在症状水平上，较高的呈现前初始皮质醇与较低的状态紧张 (k = 8, r = −.18 [−.35; −.01])、较高的状态幸福感 (k = 8, r = − .34 [−.59; −.03]，变量反向计分）和较低的状态愤怒（k = 9，r = −.14 [−.26; −.01]）相关。较高的呈现后初始皮质醇与较高的幸福状态 (k = 16, r = −.20 [−.33; −.06]) 和较低的悲伤状态 (k = 17, r = −.16 [−.25]; −.05]) 相关，而皮质醇反应与状态焦虑呈正相关 (k = 9, r = .16 [.04; .27])。
结论：实验范式有效地诱导皮质醇反应。较高的基线皮质醇、较高的皮质醇（在呈现创伤性刺激后测量）和较低的皮质醇反应与更适应性的情绪反应相关。这些标志物不能预测长期的 PTSD 症状。
Acknowledgements
All authors would like to thank Sophie Kill (SK) for her support in the literature research, study selection and data extraction. We are also grateful to all primary study authors who provided us with the data for the meta-analyses. Their effort clearly increased the informative value of this study.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Author contribution
SE designed the study. SK and SE performed the literature search, study selection and data extraction. SL supported the extraction process in case of disagreements. SE contacted the authors of the primary studies for which relevant data were missing. SL and SE performed the risk of bias rating. LS and SE planned and performed the meta-analyses. SE drafted the manuscript. SL, HK, LS, SSch and CK revised the manuscript for important intellectual content.
Data availability statement
All data is available here: https://osf.io/tbgch/