Cortisol and post-traumatic stress disorder in adults: Systematic review and meta-analysis
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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% C1= −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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Some studies have suggested that women's monthly hormonal fluctuations sensitize the HPA-axis.
“Some studies have suggested that women's monthly hormonal fluctuations sensitize the HPA-axis (73, 74).”
From Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness (2022) · cites this paper as [74]
The Gender section says women appear to have a more sensitised HPA axis than men. It does not attribute that difference to monthly hormonal fluctuations; the Study characteristics section mentions menstrual cycle only as a factor for which few studies matched participants. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredStudies have found increased or no differences in basal glucocorticoid levels in individuals with PTSD.
“However, studies have also found increased or no differences in basal glucocorticoid levels (Meewisse et al, 2007) and diurnal cortisol rhythms in individuals with PTSD (Freidenberg et al, 2010;Maes et al, 1998)”
From Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond (2017) · cites this paper as Meewisse et al, 2007
The Results section (page unavailable) reports no overall difference in basal cortisol between adults with PTSD and controls across 37 studies. It does not establish increased basal levels; the subgroup findings reported in Main findings are lower levels in some comparisons. The paper measures cortisol specifically, rather than basal glucocorticoids generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredHypocortisolemia has been widely reported in PTSD, but findings are mixed.
“Hypocortisolemia has also been reported widely in PTSD; however, here too the findings have been mixed5.”
From Neurobiology of resilience (2012) · cites this paper as [5]
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- Authors
- Meewisse, M.-L., Reitsma, J. B., De Vries, G.-J., Gersons, B. P. R., & Olff, M.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Meewisse, Marie-Louise
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2007-11
- Volume
- 191
- Issue
- 5
- Pages
- 387-392
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W1990652217
- Cited by
- 661
- References
- 53
- Citations by year
- 2026: 13 · 2025: 25 · 2024: 21 · 2023: 35 · 2022: 38 · 2021: 41 · 2020: 36 · 2019: 37 · 2018: 51 · 2017: 40 · 2016: 37 · 2015: 36 · 2014: 43 · 2013: 46 · 2012: 35
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- post-traumatic stress disorder, cortisol, hypothalamic-pituitary-adrenal axis, trauma exposure, physical abuse, sexual abuse, sex differences, plasma cortisol, serum cortisol, diurnal cortisol rhythm
- MeSH terms
- Adult, Child, Child Abuse, Circadian Rhythm, Depression, Female, Humans, Hydrocortisone, Male, Sex Factors, Stress Disorders, Post-Traumatic, Time Factors, Biomarkers
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