Pre-trauma hair cortisol moderates adverse childhood experience and hypothalamic volume effects on stress symptoms after adult trauma

Adverse childhood experience (ACE) has been associated with impairments of the hypothalamic-pituitary-adrenal (HPA) axis including reduced hair cortisol concentrations (HCC) and hypothalamus volumes in adults from previous trauma studies, but how both impairments contribute to post-traumatic stress symptoms (PTSS) after new trauma remains unclear. It is possible that a combination of reduced pre-trauma baseline levels of cortisol and early post-trauma hypothalamic dysregulation contributes to inadequate stress reactions to acute trauma. To test this hypothesis, 73 adult trauma survivors completed a hair sample collection immediately after trauma for pre-trauma HCC measures. The PTSD Checklist (PCL), Childhood Trauma Questionnaire (CTQ), and an MRI scan for hypothalamic and subunit volume measures were obtained within 2 weeks post-trauma. PTSS was further assessed using PCL 3 months later. The results indicate that interactions of pre-trauma HCC and early post-trauma volumes of the hypothalamus or its posterior subunits significantly affect PTSS severity at 2 weeks post-trauma (bilateral t = 2.502 ~ 3.920, p = 0.016 ~ 0.001) and re-experiencing symptom severity at 3 months post-trauma (left side only, t = 2.196 ~ 2.529, p = 0.017 ~ 0.037). CTQ scores interact with pre-trauma HCC and with both HCC and left hypothalamus volume to significantly affect re-experiencing symptom severity at 3 months post-trauma (p = 0.017 ~ 0.031). These findings suggest that combinations of pre- and early post-trauma conditions of the HPA axis affect acute PTSS and moderate an association between ACE and re-experiencing symptoms in subsequent months after trauma.