Original Articles| Volume 46, ISSUE 6, P850-855, September 15, 1999

Salivary cortisol and serum prolactin in relation to stress rating scales in a group of rescue workers

  • Elisabeth Aardal-Eriksson
    Address reprint requests to Elisabeth Aardal-Eriksson, Department of Biomedicine and Surgery, Division of Clinical Chemistry, Faculty of Health Sciences, Linköping University, S-581 85 Linköping, Sweden
    Department of Biomedicine and Surgery, Division of Clinical Chemistry, Faculty of Health Sciences, Linköping University, Linköping (EA-E, A-CH), Sweden
    Search for articles by this author
  • Thomas Erik Eriksson
    Department of Neuroscience and Locomotion, Division of Psychiatry, Faculty of Health Sciences, Linköping University, Linköping (TEE), Sweden
    Search for articles by this author
  • Ann-Charlotte Holm
    Department of Biomedicine and Surgery, Division of Clinical Chemistry, Faculty of Health Sciences, Linköping University, Linköping (EA-E, A-CH), Sweden
    Search for articles by this author
  • Tom Lundin
    Department of Psychiatry, Uppsala Academic Hospital, Uppsala University, Uppsala (TL), Sweden
    Search for articles by this author


      Background: Rescue service personnel are often exposed to traumatic events as part of their occupation, and higher prevalence rates of psychiatric illness have been found among this group.
      Methods: In 65 rescue workers, salivary cortisol at 8 am and 10 pm and serum prolactin at 8 am were related to the psychiatric self-rating scale General Health Questionnaire (GHQ-28) measuring psychiatric health, and the Impact of Events Scale (IES) and Post Traumatic Symptom Scale (PTSS) measuring posttraumatic symptoms.
      Results: Seventeen percent of the study population scored above the GHQ-28 cut-off limit but none scored beyond the cut-off limit in the IES and PTSS questionnaires. Salivary cortisol concentration at 10 pm correlated with statistical significance to anxiety (p < .005) and depressive symptoms (p < .01) measured with GHQ-28, as well as to posttraumatic symptoms, with avoidance behavior measured with IES (p < .01) and PTSS (p < .005). Two of the rescue workers were followed over time with the same sampling procedure after a major rescue commission.
      Conclusions: The correlation between evening salivary cortisol and anxiety, depressiveness, and posttraumatic avoidance symptoms indicates that these parameters can be used in screening and follow-up after traumatic stress events.


      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


        • Aardal E
        • Holm A.-C
        Cortisol in saliva-reference ranges and relation to cortisol in serum.
        Eur J Clin Chem Clin Biochem. 1995; 33: 927-932
        • Andersen H.S
        • Christensen A.K
        • Odden Petersen G
        Posttraumatic stress reactions amongst rescue workers after a major rail accident.
        Anxiety Res. 1991; 4: 245-251
        • Chrousos G.P
        Regulation and dysregulation of the hypothalamic-pituitary adrenal axis.
        Endocrinol Metab. 1992; 21: 833-858
        • Dallman M.F
        Stress update.
        TEM. 1993; 4: 62-69
        • Deahl M.P
        • Gillham A.B
        • Thomas J
        • Searle M.M
        • Srinivasan M
        Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing.
        Br J. 1994; 165: 60-65
        • Farmer R
        • Tranah T
        • O’Donnell I
        • Catalan J
        Railway suicide.
        Psychol Med. 1992; 22: 407-414
        • Fullerton C.S
        • McCarroll J.E
        • Ursano R.J
        • et al.
        Psychological responses of rescue workers.
        Am J Orthopsychiatry. 1992; 62: 371
        • Goldberg D.P
        • Hillier V.F
        A scaled version of the General Health Questionnaire.
        Psychol Med. 1979; 9: 139-145
        • Halbreich U
        • Olympia J
        • Carson S
        Hypothalamo-pituitary-adrenal activity in endogenously depressed posttraumatic stress disorder patients.
        Psychoneuroendocrinology. 1989; 14: 365-370
        • Henry J.P
        • Stephens P.M
        • Ely D.L
        Editional review. Psychosocial hypertension and the defence and defeat reactions.
        J Hypertens. 1986; 4: 687-697
        • Holen A
        • Sund A
        • Weisaeth L
        The Alexander Kielland disaster, March 27th 1980. Psychological reactions among the survivors. Division of Disaster Psychiatry, University of Oslo, Oslo1983
        • Horowitz M
        • Wilner N
        • Alvarez W
        Impact of Event Scale.
        Psychosom Med. 1979; 41: 209-217
        • Janet P
        L’Automatisme Psychologique. Alcan, Paris1889
        • Malt U.F
        • Weisaeth L
        Disaster psychiatry and traumatic stress studies in Norway. History, current status and future.
        Acta Psychiatr Scand Suppl. 1989; 355: 7-12
        • Mason J.W
        • Giller E.L
        • Kosten T.R
        Urinary free cortisol levels in posttraumatic stress disorder patients.
        J Nerv Ment Dis. 1986; 174: 145-149
        • McCranie E.W
        • Hyer L.A
        • Boudewyns P.A
        • et al.
        Negative parenting behavior, combat exposure and PTSD symptom severity.
        J Nerv Ment Dis. 1992; 180: 431-438
        • McFarlane A.C
        The aetiology of posttraumatic stress disorders following a natural disaster.
        Br J Psychiatry. 1988; 152: 116
        • Molitch M.E
        Pathologic hyperprolactinemia.
        Endocrinol Metab. 1992; 21: 877-897
        • Raphael B
        • Lundin T
        • Weisaeth L
        A research method for the study of psychological and psychiatric aspects of disaster.
        Acta Psychiatr Scand Suppl. 1989; 353: 1-75
        • Sacher E.J
        • Roffwarg H.P
        • Gruen P.H
        Neuroendocrine studies of depressive illness.
        Pharmacopsychiatry. 1976; 9: 11-17
        • Schedlowski M
        • Weichert D
        • Wagner T.O.F
        Acute psychological stress increases plasma levels of cortisol, prolactin and TSH.
        Life Sci. 1992; 50: 1201-1205
        • Snedecor G
        • Cochran W
        Statistical Methods. Iowa State University Press, Ames, Iowa1980
        • Theorell T
        Prolactin—A hormone that mirrors passiveness in crisis situations.
        Integr Physiol Behav Sci. 1992; 27: 32-38
        • Thompson J
        • Solomon M
        Body recovery team at disasters.
        Anxiety Res. 1991; 4: 235-244
        • Ward W
        Psychiatric morbidity in Australian veterans of the United Nations Peacekeeping Force in Somalia.
        Aust N Z J Psychiatry. 1997; 31: 184-193
        • 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
        • Resnick H
        • Kahana B
        • Giller E.L
        Long-lasting hormonal alterations to extreme stress in humans.
        Psychosom Med. 1993; 55: 287-297
        • Yehuda R
        • Southwick S.M
        • Nussbaum S.M
        Low urinary cortisol excretion in patients with posttraumatic stress disorder.
        J Nerv Ment Dis. 1990; 178: 366-369