The British Journal of Psychiatry (2007) 191: 387-392. doi: 10.1192/bjp.bp.106.024877
© 2007 The Royal College of Psychiatrists
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REVIEW ARTICLES

Cortisol and post-traumatic stress disorder in adults

Systematic review and meta-analysis*

MARIE-LOUISE MEEWISSE, MSc

Center for Psychological Trauma, Department of Psychiatry and Academic Medical Center de Meren, University of Amsterdam

JOHANNES B. REITSMA, PhD

Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam

GIEL-JAN DE VRIES, MSc, BERTHOLD P. R. GERSONS, MD, PhD and MIRANDA OLFF, PhD

Center for Psychological Trauma, Department of Psychiatry and Academic Medical Center de Meren, University of Amsterdam, The Netherlands

Correspondence: Marie-Louise Meewisse, Center for Psychological Trauma, Academic Medical Center de Meren, Department of Psychiatry, University of Amsterdam, Meibergdreef 5,1105 AZ Amsterdam, The Netherlands. Email: M.L.Meewisse{at}amc.uva.nl

Declaration of interest None.

* This paper was presented at the International Society for Traumatic Stress Studies conference, Hollywood 4–7 November, 2006, and at the European Conference on Traumatic Stress, Opatija, 5–9 June, 2007.

Background Post-traumatic stress disorder (PTSD) has inconsistently been associated with lower levels of cortisol.

Aims To compare basal cortisol levels in adults with current PTSD and in people without psychiatric disorder.

Method 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.

Results 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.

Conclusions 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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