Acute endocrine trauma response and posttraumatic stress disorder: A pilot study on sex differences

Sex differences have been described in the sympathetic-adrenal-medullary (SAM) system and in the hypothalamic-pituitary-adrenal (HPA) axis response to acute stressors, as well as in the risk and severity of posttraumatic stress disorder (PTSD). However, sex is generally overlooked as a potential moderator of associations between the acute stress response and subsequent PTSD. The present pilot prospective cohort study examined sex as a potential moderator of SAM system and HPA axis activity and PTSD symptoms (PTSSs) in a small sample of accident victims admitted to a Level 2 trauma center. Blood drawn upon arrival and blood and saliva samples collected on the following morning were used to measure cortisol, corticosteroid-binding globulin, cortisone, epinephrine, norepinephrine, and dopamine. Of 77 included participants (31 women and 46 men), 34 provided questionnaire data on International Statistical Classification of Diseases and Related Health Problems, 11th edition, and Diagnostic and Statistical Manual of Mental Disorders, fifth edition, PTSSs at baseline, 3 months, and/or 6 months. Sex emerged as a moderator of several associations between the acute endocrine stress response and subsequent PTSS. Epinephrine was moderately positively correlated with PTSS in men, but correlations in women were strong and negative. Similar, but weaker and less consistent sex differences were found for associations between PTSS and cortisol. Findings indicate important sex differences in the acute SAM system and HPA axis response to stress and symptom development. Though results must be considered preliminary due to low statistical power, they highlight the importance of future research considering sex as a potential moderator in the role of the acute stress response in PTSS and PTSD