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Current Neuropharmacology


ISSN (Print): 1570-159X
ISSN (Online): 1875-6190

Systematic Review Article

Hair Cortisol Research in Posttraumatic Stress Disorder - 10 Years of Insights and Open Questions. A Systematic Review

In Press, (this is not the final "Version of Record"). Available online 07 August, 2023
Author(s): Lena Schindler-Gmelch, Klara Capito, Susann Steudte-Schmiedgen*, Clemens Kirschbaum and Matthias Berking
Published on: 07 August, 2023

DOI: 10.2174/1570159X21666230807112425

Price: $95


Background: Cortisol is one of the most extensively studied biomarkers in the context of trauma/posttraumatic stress disorder (PTSD). For more than a decade, hair cortisol concentrations (HCC) have been measured in this context, leading to a two-staged dysregulation model. Specifically, an elevated secretion during/immediately after trauma exposure eventually reverts to hyposecretion with increasing time since trauma exposure has been postulated.

Objective: The aim of our systematic review was to re-evaluate the two-staged secretion model with regard to the accumulated diagnostic, prognostic, and intervention-related evidence of HCC in lifetime trauma exposure and PTSD. Further, we provide an overview of open questions, particularly with respect to reporting standards and quality criteria.

Method: A systematic literature search yielded 5,046 records, of which 31 studies were included.

Results: For recent/ongoing (traumatic) stress, the predictions of cortisol hypersecretion could be largely confirmed. However, for the assumed hyposecretion temporally more distal to trauma exposure, the results are more ambiguous. As most studies did not report holistic overviews of trauma history and confounding influences, this may largely be attributable to methodological limitations. Data on the prognostic and intervention-related benefits of HCC remain sparse.

Conclusion: Over the last decade, important insights could be gained about long-term cortisol secretion patterns following lifetime trauma exposure and PTSD. This systematic review integrates these insights into an updated secretion model for trauma/PTSD. We conclude with recommendations for improving HCC research in the context of trauma/PTSD in order to answer the remaining open questions.

Keywords: Posttraumatic stress disorder, trauma, hair cortisol, diagnostic, prognostic, intervention-related, biomarker.

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