Elsevier

Journal of Psychiatric Research

Volume 56, September 2014, Pages 36-42
Journal of Psychiatric Research

Cortisol response to an experimental stress paradigm prospectively predicts long-term distress and resilience trajectories in response to active police service

https://doi.org/10.1016/j.jpsychires.2014.04.020Get rights and content

Abstract

Heterogeneity in glucocorticoid response to experimental stress conditions has shown to differentiate individuals with healthy from maladaptive real-life stress responses in a number of distinct domains. However, it is not known if this heterogeneity influences the risk for developing stress related disorders or if it is a biological consequence of the stress response itself. Determining if glucocorticoid response to stress induction prospectively predicts psychological vulnerability to significant real life stressors can adjudicate this issue. To test this relationship, salivary cortisol as well as catecholamine responses to a laboratory stressor during academy training were examined as predictors of empirically identified distress trajectories through the subsequent 4 years of active duty among urban police officers routinely exposed to potentially traumatic events and routine life stressors (N = 234). During training, officers were exposed to a video vignette of police officers exposed to real-life trauma. Changes in salivary 3-methoxy-4-hydroxyphenylglycol (MHPG) and cortisol in response to this video challenge were examined as predictors of trajectory membership while controlling for age, gender, and baseline neuroendocrine levels. Officers who followed trajectories of resilience and recovery over 4 years mounted significant increases in cortisol in response to the experimental stressor, while those following a trajectory of chronic increasing distress had no significant cortisol change in response to the challenge. MHPG responses were not associated with distress trajectories. Cortisol response prospectively differentiated trajectories of distress response suggesting that a blunted cortisol response to a laboratory stressor is a risk factor for later vulnerability to distress following significant life stressors.

Section snippets

Objectives of the study and background

Biological response to a stressor is multifaceted, including processes that rapidly increase preparedness for harm as well as slower processes for regaining homeostasis to prevent adverse biological consequences of a prolonged physiological stress response (Conrad, 2011). Rapid responses to a stressor occur in the sympathetic adrenal medullary pathway (SAM), which activate physiological responses such as increased heart rate and blood pressure in service of defensive behavior such as fight or

Participants and procedures

Officer recruits from 4 urban police departments (New York City, San Francisco, Oakland, San Jose) were recruited into a large prospective study of bio-psycho-social predictors of stress responses to critical incident exposure. Trainees who had previously served in the military, law enforcement, or emergency services were excluded. Procedures were approved by the University of California, San Francisco Institutional Review Board and a Federal Certificate of Confidentiality was obtained.

Results

In the previous trajectory analysis, we compared solutions with linear parameters only and linear and quadratic parameters to assess which parameters best fit the data. Ultimately a four-class solution with linear and quadratic parameters best fit the data based on a significant reduction the information criteria, entropy, the BLRT, and conformity with theory and parsimony (see Fig. 2 for the classes and their proportions). Though reductions in the information criteria continued to be observed

Discussion

In the current investigation we tested the hypothesis that a blunted cortisol response would prospectively predict long-term stress response patterns. Secondarily, we examined whether catecholamine responses during the same time frame would predict these patterns. We tested this hypothesis by examining if trajectories were predicted by change scores in cortisol and catecholamine levels from immediately following a video stressor to 20 min later (capturing the cortisol response as well as a

Funding source

This work was supported by an NIMH R01 5R01MH056350-13 Prospective Study of Traumatic Stress in Police Officers, Charles Marmar P.I.

Contributors

Isaac R. Galatzer-Levy conceptualized the manuscript, conducted the analysis, interpreted the result, wrote the manuscript text, and revised the manuscript following review.

Maria M. Steenkamp aided in writing and reanalysis for review.

Meng Qian aided in post-hoc data analysis.

Sabra Inslicht designed the experimental paradigm.

Clare Henn-Haase aided in interpretation of behavioral data.

Christian Otte aided in the interpretation of neuroendocrine results.

Rachel Yehuda aided in the interpretation

Financial disclosure

Chistian Otte honoraria for scientific lectures from AstraZeneca, Lundbeck, and Servier. These honorary do not pose conflicts with the current work under. Thomas Neylan has received study medication from Actelion for a study funded by the Defense Department. I have also received study medication from Glaxo Smith Kline for a study funded by the Department of Veterans Affairs, Australian Government. These do not conflict with the current study. All other authors have no authors financial

Acknowledgments

This work was supported by an National Institute of Mental Health R01 5R01MH056350-13 Prospective Study of Traumatic Stress in Police Officers, Charles Marmar P.I.

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