Weill Cornell Medical College, New York Presbyterian Hospital, White Plains, NY 10605, USA.
Int J Psychiatry Med. 2009;39(3):215-26. doi: 10.2190/PM.39.3.a.
This prospective study aimed to describe the nature and time course of HPA axis dysregulation and psychopathology among terror-bereaved spouses.
Twenty-three spouses bereaved from September 11, 2001 terror attacks and 22 nonbereaved spouses were compared using a psychiatric diagnostic interview (SCID), 3 days of salivary cortisol collection, and a dexamethasone suppression test. Most subjects had repeated assessments at 6 month intervals during the 2 year study.
After September 11, 2001, bereaved compared to nonbereaved had significantly higher rates ofposttraumatic stress disorder (PTSD; 68.1% versus 0%) and major depressive disorder (MDD; 45.5% versus 9.5%). Bereaved had significantly higher morning basal cortisol and less afternoon postdexamethasone cortisol suppression than nonbereaved. Among bereaved, those with PTSD without comorbid MDD had significantly greater afternoon postdexamethasone cortisol suppression than those without psychiatric disorders.
Terror-related spouse death is a severe stressor associated with persistent HPA axis activation, PTSD, and MDD. However, bereaved spouses who developed PTSD and were not depressed had enhanced postdexamethasone cortisol suppression, evidence of heightened glucocorticoid receptor sensitivity.
本前瞻性研究旨在描述创伤后应激障碍（PTSD）丧亲配偶的 HPA 轴失调和精神病理学的性质和时间进程。
对 23 名 2001 年 9 月 11 日恐怖袭击事件中丧偶的配偶和 22 名未丧偶的配偶进行比较，使用精神科诊断访谈（SCID）、3 天唾液皮质醇采集和地塞米松抑制试验。大多数受试者在 2 年研究期间每隔 6 个月重复评估。
2001 年 9 月 11 日之后，丧偶者 PTSD（68.1%对 0%）和重度抑郁症（MDD；45.5%对 9.5%）的发生率明显高于未丧偶者。丧偶者的清晨基础皮质醇明显升高，地塞米松抑制后下午皮质醇的抑制明显减少。在丧偶者中，患有 PTSD 但无共病 MDD 的患者与无精神障碍的患者相比，地塞米松抑制后下午的皮质醇抑制明显更高。
与创伤相关的配偶死亡是一种严重的应激源，与持续的 HPA 轴激活、PTSD 和 MDD 有关。然而，患有 PTSD 但未抑郁的丧偶者地塞米松抑制后下午的皮质醇抑制增强，这表明糖皮质激素受体敏感性增强。
