Relations among Posttraumatic Stress Disorder, Comorbid Major Depression, and HPA Function: A Systematic Review and Meta-Analysis

Details

• Alternative Title:
  Clin Psychol Rev
• Personal Author:
  Morris, Matthew C. ; Compas, Bruce E. ; Garber, Judy
• Description:
  Exposure to traumatic stress is associated with increased risk for posttraumatic stress disorder (PTSD) and alterations of hypothalamic-pituitary-adrenocortical (HPA) function. Research linking traumatic stress with HPA function in PTSD has been inconsistent, however, in part due to (a) the inclusion of trauma-exposed individuals without PTSD (TE) in control groups and (b) a failure to consider comorbid major depressive disorder (MDD) and moderating variables. This meta-analysis of 47 studies (123 effect sizes, N=6008 individuals) revealed that daily cortisol output was lower for PTSD (d=-.36, SE=.15, p=.008) and PTSD+MDD (d=-.65, SE=.25, p=.008) groups relative to no trauma controls (NTC); TE and NTC groups did not differ significantly from each other. Afternoon/evening cortisol was lower in TE (d=-.25, SE=.09, p=.007) and PTSD (d=-.27, SE=.12, p=.021) groups and higher in PTSD+MDD groups (d=.49, SE=.24, p=.041) relative to NTC. Post-DST cortisol levels were lower in PTSD (d=-.40, SE=.12, p<.001), PTSD+MDD (d=-.65, SE=.14, p<.001), and TE groups (d=-.53, SE=.14, p<.001) relative to NTC. HPA effect sizes were moderated by age, sex, time since index event, and developmental timing of trauma exposure. These findings suggest that enhanced HPA feedback function may be a marker of trauma-exposure rather than a specific mechanism of vulnerability for PTSD, whereas lower daily cortisol output may be associated with PTSD in particular.
• Subjects:
  Circadian Rhythm Depressive Disorder, Major Dexamethasone Female Humans Hydrocortisone Hypothalamo-Hypophyseal System Male Pituitary-Adrenal System Stress Disorders, Post-Traumatic
• Keywords:
  Comorbidity Cortisol Depression PTSD Trauma
• Source:
  Clin Psychol Rev. 2012; 32(4):301-315
• Pubmed ID:
  22459791
• Pubmed Central ID:
  PMC3340453
• Document Type:
  Journal Article
• Funding:
  R01 MH069940/MH/NIMH NIH HHSUnited States/ ; R01 MH064735/MH/NIMH NIH HHSUnited States/ ; RC1MH088329/MH/NIMH NIH HHSUnited States/ ; T32MH18921/MH/NIMH NIH HHSUnited States/ ; KL2 RR024977/RR/NCRR NIH HHSUnited States/ ; R01MH64735/MH/NIMH NIH HHSUnited States/ ; 1 UL1RR024975/RR/NCRR NIH HHSUnited States/ ; R01 MH069940-05/MH/NIMH NIH HHSUnited States/ ; R01 DA017805/DA/NIDA NIH HHSUnited States/ ; UL1RR024975-01/RR/NCRR NIH HHSUnited States/ ; R01HM069940/HM/NCHM CDC HHSUnited States/ ; R01 MH068391/MH/NIMH NIH HHSUnited States/ ; R01MH068391/MH/NIMH NIH HHSUnited States/ ; T32 MH018921-20/MH/NIMH NIH HHSUnited States/ ; UL1 RR024975-01/RR/NCRR NIH HHSUnited States/ ; R01 MH068391-06/MH/NIMH NIH HHSUnited States/ ; 1 F31 MH084425-01A1/MH/NIMH NIH HHSUnited States/ ; F31 MH084425-01A1/MH/NIMH NIH HHSUnited States/ ; G12 RR003032/RR/NCRR NIH HHSUnited States/ ; TL1 RR024978/RR/NCRR NIH HHSUnited States/ ; F31 MH084425/MH/NIMH NIH HHSUnited States/ ; T32 MH018921/MH/NIMH NIH HHSUnited States/ ; UL1 RR024975/RR/NCRR NIH HHSUnited States/ ; R01 MH064735-04/MH/NIMH NIH HHSUnited States/ ; RC1 MH088329-02/MH/NIMH NIH HHSUnited States/ ; RC1 MH088329/MH/NIMH NIH HHSUnited States/
• Volume:
  32
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:8c1aeada9d4f9344f98f62cd258e5df745dbe308be9574cd8b863b65a6624e7c36499860ef6975e202789834c597e4b7075246a8fa2b8a3bdf38715f834dbfd7
• Download URL:
  https://stacks.cdc.gov/view/cdc/33357/cdc_33357_DS1.pdf
• File Type:
  [PDF - 454.06 KB ]