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Stress. 2017 Jul;20(4):350-354. doi: 10.1080/10253890.2017.1340450. Epub 2017 Jun 29.

Psychobiology of cumulative trauma: hair cortisol as a risk marker for stress exposure in women.

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a Department of Family and Community Medicine , Meharry Medical College , Nashville , TN, USA.
b Center for Molecular and Behavioral Neuroscience , Meharry Medical College , Nashville , TN, USA.
c Department of Psychology , Vanderbilt University , Nashville , TN, USA.
d Department of Psychiatry , University of Michigan , Ann Arbor , MI, USA.
e Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN, USA.
f Vanderbilt Kennedy Center , Vanderbilt University Medical Center , Nashville , TN, USA.
g Center for Behavioral Health Research , University of Tennessee , Knoxville , TN, USA.


Childhood trauma (CT) is associated with long-lasting alterations of the hypothalamic-pituitary-adrenal (HPA) axis and elevated risk for stress exposure in adulthood. Although HPA alterations are present in the early aftermath of trauma, it remains unclear how initial HPA activity is associated with subsequent stress exposure and whether CT exposure influences the strength and direction of this association. The present study examined prospective associations between hair cortisol content (HCC) and stress exposure from baseline to 3-month follow-up in young adult women with recent (i.e. past 3 months) exposure to interpersonal violence (IPV; i.e. physical or sexual assault) and non-traumatized controls. History of significant CT abuse or neglect was determined based on clinical cutoffs for a self-report CT measure: 12 women had abuse or neglect and recent IPV exposure (CT + IPV); 7 women had abuse or neglect but no IPV exposure (CT); 15 women had no history of trauma (NTC). HCC was computed for 3 cm sections reflecting cortisol secretion during the 3 months preceding the baseline assessment. The interaction of cumulative trauma and HCC predicted stress exposure over 3-month follow-up, controlling for baseline stress exposure and depressive symptoms. Simple slopes analyses revealed that lower baseline HCC predicted greater stress exposure in the CT + IPV group compared to the CT group; HCC was not associated with stress exposure in the NTC group. The present findings highlight the potential utility of HCC as a predictor of stress exposure for women with a history of childhood abuse or neglect, particularly in the context of recent IPV. Lay summary Adults with a history of CT show long-lasting alterations in major stress response systems, including the HPA axis. They are also more likely to experience stressful life events in adulthood. However, it is not clear how altered HPA activity influences risk for stress exposure and whether CT affects their relationship. The results from this study show that lower HPA activity (measured with hair cortisol) predicted greater stress exposure in women with CT - particularly for women who also experienced recent incidents involving physical or sexual assault.


Interpersonal violence; abuse; childhood trauma; hair cortisol; neglect; stress

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