Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, UK.
BMC Psychiatry. 2021 Mar 31;21(1):174. doi: 10.1186/s12888-021-03170-w.
Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD.
We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants' clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance.
A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group.
These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms.
性侵犯与多种不良心理和身体健康结果有关，包括创伤后应激障碍（PTSD）和抑郁。神经生物学研究表明，与下丘脑-垂体-肾上腺（HPA）轴、免疫改变、代谢功能和大脑回路有关。尽管这些机制已经得到了广泛的研究，但在 PTSD 中结果却表现出不同的结果。
我们比较了 58 名性侵犯后发生 PTSD 的女性和 44 名无创伤史的女性对照的血浆促肾上腺皮质激素（ACTH）和唾液皮质醇水平。我们还评估了 PTSD 和抑郁的精神病诊断和症状严重程度。评估参与者的临床状况与其激素水平的关系，以确定症状严重程度是否与激素失衡有关。
大量性侵犯女性患有 PTSD 和共病性抑郁。与对照组相比，PTSD 组的 ACTH 水平更高，并且随着 PTSD 严重程度的增加而增加，考虑到贝克抑郁量表（BDI）（p<0.0001）测量的抑郁症状，以及临床医生管理的 PTSD 量表（CAPS-5）子量表 D（p=0.045）和 CAPS-5 总量表（p=0.026）测量的 PTSD 症状。与对照组相比，PTSD 组的 10 点皮质醇水平更高（p=0.045，p=0.037），并且 PTSD 组的皮质醇觉醒反应显示皮质醇水平升高。
这些结果表明 PTSD 患者的症状严重程度与 HPA 轴失衡之间存在相关性。伴发抑郁症状的患者的 ACTH 升高和皮质醇反应升高与仅患有 PTSD 的患者的预期反应相反。这种关联导致了这样的假设，即 PTSD 的神经生物学改变与所呈现的症状类型及其严重程度有关。这些表现可能会影响疾病的进程、预后和对治疗的反应。这些结果强调了需要讨论性侵犯后发生的 PTSD 患者的特定神经生物学改变，特别是那些伴有严重抑郁症状的患者。
