Eileen Spoonster

Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims

BACKGROUND This study was designed to examine the relationship between urinary hormone levels collected upon admission to the trauma unit following a motor vehicle accident and posttraumatic stress disorder symptomatology 1 month later. METHODS Fifteen-hour urine samples were collected from 63 male and 36 female motor vehicle accident victims and were used to assess levels of catecholamines and cortisol reflecting peritraumatic and acute-phase posttraumatic levels. Presence of posttraumatic stress disorder symptomatology was assessed 1 month after the accident. RESULTS Motor vehicle accident victims subsequently diagnosed with acute posttraumatic stress disorder excreted significantly lower levels of cortisol in 15-hour urines collected upon admission to the hospital. In addition, urinary levels of cortisol predicted a significant percentage of the variance in intrusive and avoidant thoughts 1 month after the accident. CONCLUSIONS The results of our study suggest that initial cortisol levels in the immediate aftermath of a traumatic event contribute, in part, to subsequent symptoms of posttraumatic stress disorder.

Injury severity, prior trauma history, urinary cortisol levels, and acute PTSD in motor vehicle accident victims

This study examined the relationship between prior history of traumatic events, life threat, and injury severity experienced during a motor vehicle accident (MVA), and posttraumatic stress disorder (PTSD) assessed 1 month after the accident. In addition, initial urinary cortisol levels after the accident were examined as a possible mediator of this relationship. Fifteen-hour urinary cortisol samples were collected from MVA victims upon admission to the trauma unit. In the hospital, subjective life threat was measured and objective Injury Severity Scores (ISSs) were computed. One month after the accident, participants were assessed for prior history of traumatic experiences, presence of acute PTSD, and levels of intrusive and avoidant thoughts and behaviors. Victims, who met PTSD diagnostic criteria, reported more prior traumatic events, and significantly greater life threat despite receiving significantly lower ISSs than victims who did not develop PTSD. The relationships between ISSs and PTSD symptoms and prior trauma history and PTSD symptoms were mediated by cortisol levels. Results suggest that cortisol levels in the acute aftermath of a traumatic event may serve as a mechanism through which various factors may increase risk for PTSD.

Gender differences in PTSD symptoms: an exploration of peritraumatic mechanisms.

Females are at higher risk than males for developing posttraumatic stress disorder symptoms (PTSS) following exposure to trauma, which may stem from gender differences in initial physiological and psychological responses to trauma. The present study aimed to examine a number of peri- and initial posttraumatic reactions to motor vehicle accidents (MVAs) to determine the extent to which they contributed to gender differences in PTSS. 356 adult MVA survivors (211 males and 145 females) reported on peritraumatic dissociation, perception of life threat and initial PTSS. In addition, heart rate and urinary cortisol levels were collected in-hospital. 6 weeks and 6 months later, PTSS were assessed via clinical interviews. Results suggested that initial PTSS and peritraumatic dissociation were marginally significant mediators at 6-week follow-up and significant mediators at 6-month follow-up, providing partial support for the hypothesis that initial responses to trauma may account for observed gender differences in PTSS development.

Peritraumatic Dissociation Is Inversely Related to Catecholamine Levels in Initial Urine Samples of Motor Vehicle Accident Victims

ABSTRACT This study was designed to determine the relationship between self-reports of peritraumatic dissociation during a motor vehicle accident and measures of physiological arousal in the immediate aftermath of the accident. Upon admittance to the hospital, 15-hour urine samples were collected from participants to measure levels of urinary catecholamines and cortisol. Within two days of the accident, participants reported symptoms of peritraumatic dissociation, and one month after the accident, 59 (34 male and 25 female) participants completed an interview designed to assess symptoms of PTSD. Results revealed that patients who subsequently developed PTSD reported significantly higher levels of peritraumatic dissociation than victims who did not develop PTSD, and that dissociation was negatively associated with levels of urinary norepinephrine and epinephrine. Dissociation was not related to urinary cortisol or cardiovascular levels upon admission. These findings are consistent with previous research that has suggested that high dis-sociators may constitute a subgroup of trauma victims who are physiologically less reactive to trauma.

Alcohol Use Disorder History Moderates the Relationship Between Avoidance Coping and Posttraumatic Stress Symptoms

Avoidance coping (AVC) is common in individuals with posttraumatic stress disorder (PTSD) and in individuals with alcohol use disorder (AUD). Given that PTSD and AUD commonly co-occur, AVC may represent a risk factor for the development of comorbid posttraumatic stress and alcohol use. In this study, the relationship between AVC and PTSD symptoms (PTSS) was examined in individuals with versus without AUDs. Motor vehicle accident (MVA) victims were assessed 6 weeks postaccident for AUD history (i.e. diagnoses of current or past alcohol abuse or dependence) and AVC. PTSS were assessed 6 weeks and 6 months post-MVA. All analyses were conducted on the full sample of MVA victims as well as on the subset of participants who were legally intoxicated (blood alcohol concentration ≥ 0.08) during the accident. It was hypothesized that the relationship between AVC and PTSS would be stronger in those individuals with an AUD history and especially strong in the subset of individuals who were legally intoxicated during the MVA. Results were largely supportive of this hypothesis, even after controlling for in-hospital PTSS, gender, and current major depression. Early assessment of AUD history and avoidance coping may aid in detecting those at elevated risk for PTSD, and intervening to reduce AVC soon after trauma may help buffer the development of PTSD + AUD comorbidity.

Effects of early nightmares on the development of sleep disturbances in motor vehicle accident victims.

The present study prospectively examined the extent to which trauma-related nightmares affected the subsequent development of insomnia symptoms in 314 motor vehicle accident (MVA) victims. Participants were assessed in-hospital and at 2 weeks, 6 weeks, 3 months, and 1 year post-MVA. Hierarchical linear regression analyses showed that 6-week PTSD symptoms (PTSS) and 3-month nightmares, but not 2-week nightmares were positively associated with sleep onset and maintenance problems reported at 3-month post-MVA. Nightmares reported at 3-months post-MVA were positively associated with 1-year sleep maintenance problems. These findings highlight the dynamic relationship between PTSS and sleep problems as well as the potential importance of early intervention for trauma-related nightmares as a means to prevent sleep problems after a traumatic experience.

Trauma history characteristics and subsequent PTSD symptoms in motor vehicle accident victims

The present study examined the relationship between trauma history characteristics (number and type of traumas, age at first trauma, and subjective responses to prior traumas) and the development of posttraumatic stress disorder (PTSD) symptoms following a motor vehicle accident (MVA). One hundred eighty-eight adult MVA victims provided information about prior traumatization and were evaluated for PTSD symptoms 6 weeks and one year following the MVA. Results indicated that after controlling for demographics and depression, prior trauma history characteristics accounted for a small, but significant amount of the variance in PTSD symptoms. Distress from prior trauma and number of types of prior traumas were the most meaningful trauma history predictors. Results encourage further evaluation of trauma history as a multifaceted construct.

Avoidant coping as a mediator between peritraumatic dissociation and posttraumatic stress disorder symptoms

Peritraumatic dissociation consistently predicts posttraumatic stress disorder (PTSD). Avoidant coping may serve as a mechanism through which peritraumatic dissociation contributes to PTSD symptoms. Path analysis was used to examine whether avoidant coping assessed 6 weeks following a motor vehicle accident mediated the relationship between in-hospital peritraumatic dissociation and 6-month (n = 193) and 12-month (n = 167) chronic PTSD symptoms. Results revealed that, after controlling for age, gender, depression, and 6-week PTSD symptoms, avoidant coping remained a partial mediator between peritraumatic dissociation and chronic PTSD symptoms 6- and 12-months postaccident. Post-hoc multigroup analyses suggested that at 6-months posttrauma, the mediation was significant in women, but not in men. Gender-specific results were not significant at 12-months posttrauma. Interventions targeted at reducing avoidant coping in high dissociators may aid in reducing PTSD symptoms.

Amnesia, neuroendocrine levels and PTSD in motor vehicle accident victims

Primary objective : To examine the initial neuroendocrine responses and subsequent PTSD symptomatology among amnesic and non-amnesic victims of motor vehicle accidents. It was hypothesized that amnesic patients would be less likely to meet PTSD criteria at 1 month follow-up and would display lower catechalomine levels and higher basal cortisol than non-amnesics. Methods and procedure : Fifteen-hour urinary hormone samples were collected from 70 MVA victims upon hospital admission. Participants were assessed for PTSD symptomatology 1 month later. Main outcomes and results : Amnesic patients displayed lower NE/cortisol ratios than non-amnesics, were less likely than non-amnesics to develop PTSD, and displayed fewer PTSD symptoms than non-amnesics. Conclusions : Amnesics may physiologically experience a motor vehicle accident differently from non-amnesics and have lower subsequent PTSD incidence. These results provide partial support for the hypothesis that amnesia for a traumatic event can serve as a buffering function in the development of subsequent PTSD among MVA victims.

Effects of early albuterol (salbutamol) administration on the development of posttraumatic stress symptoms

The present study examined whether the use of albuterol within hours of a motor vehicle accident (MVA) impacted subsequent posttraumatic stress symptoms (PTSS). Participants receiving albuterol had less severe overall PTSS and hyperarousal symptoms at 6 weeks and less severe reexperiencing symptoms at 1 year post-MVA than those who did not receive albuterol.