Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study

Eur Child Adolesc Psychiatry. 2017 May;26(5):511-519. doi: 10.1007/s00787-016-0933-3. Epub 2016 Dec 19.


In this exploratory case-control study, we investigated basal cortisol regulation in 5-16-year-old children, 3-6 months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times per day (immediately after waking, waking +30 min, and waking +12 h) over two consecutive weekdays. In addition, data on posttraumatic stress symptoms were ascertained from 33 PICU admitted children using the Impact of Events Scale-8 (IES-8). Primary analysis revealed no significant differences in basal cortisol concentrations between PICU discharged children and healthy controls (p > 0.05). Secondary analysis in the PICU group identified a significant positive association between posttraumatic stress symptoms and evening (waking +12 h) cortisol concentrations (p = 0.004). However, when subject to multivariate analysis, evening cortisol was a modest independent predictor of IES-8 scores, relative to the presence of septic illness and poor pre-morbid health. We conclude that paediatric critical illness does not appear to result in marked perturbations to basal cortisol at 3-6 month following discharge. There was evidence of a link between evening cortisol and symptoms of PTSD, but this was not a robust effect and requires further elucidation.

Keywords: Critical illness; Post-traumatic stress disorder; Psychological sequelae; Salivary cortisol.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Circadian Rhythm / physiology
  • Critical Illness / psychology
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Hydrocortisone / analysis
  • Hydrocortisone / metabolism*
  • Intensive Care Units, Pediatric*
  • London
  • Male
  • Multivariate Analysis
  • Psychiatric Status Rating Scales
  • Saliva / chemistry
  • Saliva / metabolism*
  • Stress Disorders, Post-Traumatic / diagnosis*
  • Stress Disorders, Post-Traumatic / metabolism
  • Stress Disorders, Post-Traumatic / psychology
  • Time Factors


  • Hydrocortisone