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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Association for the Advancement of Automotive Medicine (1990): The Abbreviated Injury Scale. Des Plaines, IL: AAAM.

        • Baum A
        • Gatchel R.J
        • Schaeffer M.A
        Emotional, behavioral, and physiological effects of chronic stress at Three Mile Island.
        J Consult Clin Psychol. 1983; 51: 565-572
      2. Baum A, Grunberg N (1995): Measurement of stress hormones. In: Cohen S, Kessler RC, Gordon LU, editors. Measuring Stress. New York: Oxford University Press, 175–191.

        • Blanchard E.B
        • Hickling E.J
        • Taylor A.E
        The psychophysiology of motor vehicle accident related post-traumatic stress disorder.
        Biofeedback Self Regul. 1991; 16: 449-458
      3. Charney DS, Southwick SM, Krystal JH, Deutch AY, Murburg MM, Davis M (1994): Neurobiological mechanisms of PTSD. In: Murburg MM, editor. Catecholamine Function in Posttraumatic Stress Disorder: Emerging Concepts. Washington, DC: American Psychiatric Press, 131–158.

        • Dziedzic L
        • Brady W.J
        • Lindsay R
        • Huff J.S
        The use of the Mini-Mental Status Examination in the ED evaluation of the elderly.
        Am J Emerg Med. 1998; 16: 686-689
      4. First MB, Gibbon M, Spitzer RL, Williams JBW (1996): User’s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders—Research Version, Version 2.0, February 1996 FINAL Version. Washington, DC: American Psychiatric Press.

        • Folstein M.F
        • Folstein S.E
        • McHugh P.R
        “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Friedman M.J
        Biological aproaches to the diagnosis and treatment of post-traumatic stress disorder.
        J Trauma Stress. 1991; 4: 67-89
        • Halbreich U
        • Olympia J
        • Carson S
        • Glogowski J
        • Yeh C
        • Axelrod S
        • Desu M.M
        Hypothalamo-pituitary-adrenal activity in endogenously depressed post-traumatic stress disorder patients.
        Psychoneuroendocrinology. 1989; 14: 365-370
        • Holzer J.C
        • Gansler D.A
        • Moczynski N.P
        • Folstein M.F
        Cognitive function in the informed consent evaluation process.
        J Am Acad Psychiatry Law. 1997; 25: 531-540
        • Horowitz M
        • Wilner N
        • Alvarez W
        Impact of events scale.
        Psychosom Med. 1979; 41: 209-218
        • Kosten T.R
        • Mason J.W
        • Giller E.L
        • Ostroff R.B
        • Harkness L
        Sustained urinary norepinephrine and epinephrine elevation in post-traumatic stress disorder.
        Psychoneuroendocrinology. 1987; 12: 13-20
        • Lemieux A.M
        • Coe C.L
        Abuse related posttraumatic stress disorder.
        Psychosom Med. 1995; 57: 105-115
        • Mason J.W
        • Giller E.L
        • Kosten T.R
        • Ostroff R
        • Harkness L
        Urinary free cortisol levels in post traumatic stress disorder patients.
        J Nerv Ment Dis. 1986; 174: 145-149
        • McFall M.E
        • Murburg M
        • Ko G.N
        • Veith R.C
        Autonomic responses to stress in Vietnam combat veterans with posttraumatic stress disorder.
        Biol Psychiatry. 1990; 27: 1165-1175
        • McFarlane A.C
        • Atchison M
        • Yehuda R
        The acute stress response following motor vehicle accidents and its relation to PTSD.
        Ann N Y Acad Sci. 1997; 821: 437-441
        • McKinnon W
        • Weisse C.S
        • Reynolds C.P
        • Bowles C.A
        • Baum A
        Chronic stress, leukocyte subpopulations, and humoral response to latent viruses.
        Health Psychol. 1989; 8: 389-402
        • Pitman R.K
        Biol Psychiatry. 1989; 26: 221-223
        • Pitman R.K
        • Orr S.P
        Twenty-four hour urinary cortisol and catecholamine excretion in combat-related posttraumatic stress disorder.
        Biol Psychiatry. 1990; 27: 245-247
        • Pitman R.K
        • Orr S.P
        • Lowenhagen M.J
        • Macklin M.L
        • Altman B
        Pre-Vietnam contents of posttraumatic stress disorder veterans’service medical and personnel records.
        Compr Psychiatry. 1991; 32: 416-422
        • Resnick H.S
        • Yehuda R
        • Pitman R.K
        • Foy D.W
        Effect of previous trauma on acute plasma cortisol level following rape.
        Am J Psychiatry. 1995; 152: 1675-1677
        • Schaeffer M.A
        • Baum A
        Adrenal cortical response to stress at Three Mile Island.
        Psychosom Med. 1984; 46: 227-237
        • Southwick S.M
        • Bremner D
        • Krystal J.H
        • Charney D.S
        Psychobiologic research in post-traumatic stress disorder.
        Psychiatr Clin North Am. 1994; 17: 251-264
        • Ursano R.J
        • Fullerton C.S
        • Epstein R.S
        • Crowley B
        • Kao T
        • Vance K
        • et al.
        Acute and chronic posttraumatic stress disorder in motor vehicle accident victims.
        Am J Psychiatry. 1999; 156: 589-595
      5. van der Kolk BA (1996): Trauma and memory. In: van der Kolk BA, McFarlane AC, Weisaeth L, editors. Traumatic Stress. New York: Guilford, 279–302.

        • Yanovski J.A
        • Yanovski S.Z
        • Cutler J.B
        • Chrousos G.P
        • Filmer K.M
        Differences in the hypothalamic-pituitary-adrenal axis of black girls and white girls.
        J Pediatr. 1996; 129: 130-135
        • Yanovski J.A
        • Yanovski S.Z
        • Friedman T.C
        • Loh Y.P
        • Jayasvasti V
        • Cutler G.B
        • Chrousos G.P
        Etiology of the differences in corticotropin-releasing hormone-induced adrenocorticotropin secretion of black and white women.
        J Clin Endocrinol Metab. 1996; 81: 3307-3311
        • Yehuda R
        • Boisoneau D
        • Lowy M.T
        • Giller E.L
        Dose-response changes in plasma cortisol and lymphocyte glucocorticoid receptors following dexamethasone administration in combat veterans with and without posttraumatic stress disorder.
        Arch Gen Psychiatry. 1995; 52: 583-593
        • Yehuda R
        • Boisoneau D
        • Mason J.W
        • Giller E.L
        Glucocorticoid receptor number and cortisol excretion in mood, anxiety, and psychotic disorders.
        Biol Psychiatry. 1993; 34: 18-25
      6. Yehuda R, Harvey P (1997): Relevance of neuroendocrine alterations in PTSD to memory-related impairments of trauma survivors. In: Read DJ, Lindsay SD, editors. Recollections of Trauma. New York: Plenum Press, 221–252.

        • Yehuda R
        • Kahana B
        • Binder-Brynes K
        • Southwick S.M
        • Mason J.W
        • Giller E.L
        Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder.
        Am J Psychiatry. 1995; 152: 982-986
        • Yehuda R
        • Levengood R.A
        • Schmeidler J
        • Wilson S
        • Guo L.S
        • Gerber D
        Increased pituitary activation following metyrapone administration in posttraumatic stress disorder.
        Psychoneuroendocrinology. 1996; 21: 1-16
        • Yehuda R
        • Lowy M.T
        • Southwick S.M
        • Shaffer D
        • Giller E.L
        Lymphocyte clucocorticoid receptor number in posttraumatic stress disorder.
        Am J Psychiatry. 1991; 148: 499-504
        • Yehuda R
        • McFarlane A.C
        • Shalev A.Y
        Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event.
        Biol Psychiatry. 1998; 44: 1305-1313
        • Yehuda R
        • Southwick S
        • Giller E.L
        • Ma X
        • Mason J.W
        Urinary catecholamine excretion and severity of PTSD symptons in Vietnam combat veterans.
        J Nerv Ment Dis. 1992; 180: 321-325
        • Yehuda R
        • Southwick S.M
        • Nussbaum G
        • Wahby V
        • Giller E.L
        • Mason J.W
        Low urinary cortisol excretion in patients with posttraumatic stress disorder.
        J Nerv Ment Dis. 1990; 178: 366-369