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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

Posttraumatic stress disorder (PTSD) and depression severity in sexually assaulted women: hypothalamic-pituitary-adrenal (HPA) axis alterations

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Author(s):
D'Elia, Ana Teresa D. [1] ; Juruena, Mario F. [2, 1] ; Coimbra, Bruno M. [1] ; Mello, Marcelo F. [1] ; Mello, Andrea F. [1]
Total Authors: 5
Affiliation:
[1] Fed Univ Sao Paulo UNIFESP, Dept Psychiat, Rua Major Maragliano 241, BR-04017030 Sao Paulo, SP - Brazil
[2] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol Med, London - England
Total Affiliations: 2
Document type: Journal article
Source: BMC Psychiatry; v. 21, n. 1 MAR 31 2021.
Web of Science Citations: 0
Abstract

Background Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD. Methods We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants' clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance. Results A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group. Conclusions These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms. (AU)

FAPESP's process: 14/12559-5 - Posttraumatic stress disorder and neuroprogression: new approaches to understand the effects of violence on mental functioning
Grantee:Marcelo Feijó de Mello
Support Opportunities: Research Projects - Thematic Grants