Salivary cortisol in post-traumatic stress disorder: a systematic review and meta-analysis

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Abstract

Background

Studies investigating salivary cortisol level as susceptibility marker for post-traumatic stress disorder (PTSD) produced inconsistent results. The aim of this study was to compare salivary cortisol concentration levels in PTSD patients with those in controls by synthesizing published data.

Methods

We did a systematic review, meta-analysis and meta-regression of studies comparing concentrations of salivary cortisol between patients with PTSD and controls. The electronic databases of PubMed, Embase, Web of Science and Psyc-ARTICLES were searched for relevant articles. A random-effects model with restricted maximum-likelihood estimator is used to synthesize the effect size (assessed by standardized mean difference).

Results

A total of 784 articles were identified of which 22 were included in the final analysis. A trend of lower salivary cortisol levels was found in PTSD patients when compared with the controls (SMD = − 0.28, 95% CI-0.53;-0.04, p = 0.022). Subgroup analysis showed that the salivary cortisol levels were lower in patients with PTSD than in controls in studies conducted after 2007 or in studies using saliva samples collected in the morning.

Conclusions

The evidence from this meta-analysis supports that salivary samples collected in the morning consistently showed a lower salivary cortisol level in patients with PTSD than in controls, although whether salivary cortisol could be used as a diagnostic tool requires further research.

Electronic supplementary material

The online version of this article (10.1186/s12888-018-1910-9) contains supplementary material, which is available to authorized users.

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Most cited references 57

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Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test.

Jonathan Allen, Gerard Clarke, John F. Cryan … (2013)

Validated biological and psychological markers of acute stress in humans are an important tool in translational research. The Trier Social Stress Test (TSST), involving public interview and mental arithmetic performance, is among the most popular methods of inducing acute stress in experimental settings, and reliably increases hypothalamic-pituitary-adrenal axis activation. However, although much research has focused on HPA axis activity, the TSST also affects the sympathetic-adrenal-medullary system, the immune system, cardiovascular outputs, gastric function and cognition. We critically assess the utility of different biological and psychological markers, with guidance for future research, and discuss factors which can moderate TSST effects. We outline the effects of the TSST in stress-related disorders, and if these responses can be abrogated by pharmacological and psychological treatments. Modified TSST protocols are discussed, and the TSST is compared to alternative methods of inducing acute stress. Our analysis suggests that multiple readouts are necessary to derive maximum information; this strategy will enhance our understanding of the psychobiology of stress and provide the means to assess novel therapeutic agents. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Cortisol and post-traumatic stress disorder in adults: systematic review and meta-analysis.

Marie-Louise Meewisse, Johannes Reitsma, Giel-Jan de Vries … (2007)

Post-traumatic stress disorder (PTSD) has inconsistently been associated with lower levels of cortisol. To compare basal cortisol levels in adults with current PTSD and in people without psychiatric disorder. Systematic review and meta-analysis. Standardised mean differences (SMD) in basal cortisol levels were calculated and random-effects models using inverse variance weighting were applied. Across 37 studies, 828 people with PTSD and 800 controls did not differ in cortisol levels (pooled SMD=-0.12, 95% CI=-0.32 to 0.080). Subgroup analyses revealed that studies assessing plasma or serum showed significantly lower levels in people with PTSD than in controls not exposed to trauma. Lower levels were also found in people with PTSD when females were included, in studies on physical or sexual abuse, and in afternoon samples. Low cortisol levels in PTSD are only found under certain conditions. Future research should elucidate whether low cortisol is related to gender or abuse and depends on the measurement methods used.

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Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis.

Matthew Morris, Bruce Compas, Judy Garber (2012)

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. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Aizhong Liu: lazroy@live.cn

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 5 October 2018

Publication date PMC-release: 5 October 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 324

Affiliations

[1 ]ISNI 0000 0001 0379 7164, GRID grid.216417.7, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, , Central South University, ; Changsha, China

[2 ]ISNI 0000 0001 2182 2255, GRID grid.28046.38, Department of Obstetrics and Gynaecology, , University of Ottawa, ; Ottawa, ON Canada

[3 ]ISNI 0000 0000 9606 5108, GRID grid.412687.e, Ottawa Hospital Research Institute, ; Ottawa, ON Canada

Article

Publisher ID: 1910

DOI: 10.1186/s12888-018-1910-9

PMC ID: 6173866

PubMed ID: 30290789

SO-VID: 77e4dba5-96e5-4d48-8e65-1517389a8ee4

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 9 January 2018

Date accepted : 25 September 2018

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: post-traumatic stress disorder,salivary cortisol,systematic review,meta-analysis

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: post-traumatic stress disorder, salivary cortisol, systematic review, meta-analysis

Salivary cortisol in post-traumatic stress disorder: a systematic review and meta-analysis

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Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 57

Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test.

Cortisol and post-traumatic stress disorder in adults: systematic review and meta-analysis.

Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis.

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