Trauma exposure in relation to basal salivary cortisol and the hormone response to the dexamethasone/CRH test in male railway employees without lifetime psychopathology

Abstract

Background: Dysregulation of the hypothalamic-pituitary-adrenal (HPA)-axis is hypothesized to underlie stress-related psychiatric disorders such as post-traumatic stress disorder (PTSD). We aimed to explore whether trauma exposure is associated with alterations in HPA-axis functioning in the absence of lifetime psychiatric morbidity.

Method: We included 39 trauma-exposed healthy male subjects (mean age=47 years; SD=9.2) and 24 non-exposed healthy male controls (mean age=47.4 years; SD=14.5). All subjects were free of lifetime psychopathology. Basal salivary cortisol levels (on two consecutive days) as well as the cortisol and adrenocorticotropic hormone (ACTH) response to the combined dexamethasone/corticotropin releasing hormone (Dex/CRH) challenge test were analyzed using general linear models (GLM) adjusted for body mass index, age and smoking status.

Results: A blunted salivary cortisol awakening response was found in the exposed group compared to the non-exposed group (F(1,57)=5.46, p=.02). Consistent with these findings, salivary diurnal cortisol was lower in the trauma-exposed versus non-exposed group (F(1,57)=4.04, p=.05). No differences, however, were found between both groups for plasma cortisol or ACTH responses to the Dex/CRH test.

Conclusion: Low basal cortisol levels were found in trauma-exposed men, suggesting that HPA-axis alterations in men are associated with trauma exposure during adulthood, also in the absence of psychopathology.