Individuals with post-traumatic stress disorder (PTSD) evidence increased rates of metabolic syndrome (MetS), and both PTSD and MetS are associated with alterations in hypothalamic–pituitary–adrenal (HPA) axis function. Few investigations have examined the possible role of HPA-axis dysfunction in the co-occurrence of PTSD and MetS. In a case-control study, we aimed to determine whether hair cortisol concentrations (HCC) were associated with (i) PTSD caseness and severity and (ii) PTSD and MetS co-occurrence. We used the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) to determine PTSD diagnoses and severity scores in 216 females of mixed ancestry aged between 20 and 79 years (M = 43.8, SD =13.3). Hair samples, representing a three-month retrospective window of cortisol levels, were obtained and analyzed utilizing liquid chromatography-tandem mass spectrometry. We constructed multivariate linear regression models to evaluate whether PTSD diagnosis, PTSD severity, and MetS comorbidity were associated with HCC, controlling for potential confounders. HCC were significantly higher (adj β = 0.154, p = .033; Cohen’s d = 0.44) in PTSD patients (n = 110) than trauma-exposed controls (n = 106) and CAPS severity scores (adj β = 0.207, p = .005) were significantly associated with HCC. MetS was not associated with HCC and there were no significant interactions between PTSD and MetS on HCC. This study provides evidence of a chronically dysregulated neuroendocrine mediated stress response in PTSD, with a clear dose-response relationship. HCC do not, however, appear to have specificity for the comorbidity of PTSD and MetS in this sample.

• LAY SUMMARY

• We found that levels of the stress hormone, cortisol, measured in hair samples were significantly higher in South African women with post-traumatic stress disorder (PTSD) than in women who had also experienced trauma but did not have PTSD. Hair cortisol levels were, however, not associated with metabolic syndrome, a cluster of risk factors for heart disease, in the women studied. We thus show that South African women with PTSD have elevated long-term stress hormone levels and that this effect is related to PTSD and not solely due to trauma exposure.

患有创伤后应激障碍（PTSD）的人证明了代谢综合征（MetS）的发生率增加，并且PTSD和MetS均与下丘脑-垂体-肾上腺（HPA）轴功能的改变有关。很少有研究检查过HPA轴功能障碍在PTSD和MetS并发中的可能作用。在病例对照研究中，我们旨在确定毛发皮质醇浓度（HCC）是否与（i）PTSD的病情和严重程度以及（ii）PTSD和MetS的同时出现有关。我们使用临床医师管理的DSM-5 PTSD量表（CAPS-5）确定了216名年龄在20至79岁之间的混合血统女性的PTSD诊断和严重程度评分（M = 43.8，SD = 13.3）。获得了代表皮质醇水平三个月回顾性窗口的头发样本，并使用液相色谱-串联质谱法进行了分析。我们构建了多元线性回归模型，以评估PTSD诊断，PTSD严重程度和MetS合并症是否与HCC相关联，从而控制潜在的混杂因素。HCC均显著更高（ADJ β  = 0.154，p  = 0.033; Cohen的d  = 0.44）在PTSD患者（Ñ  = 110）比创伤暴露对照（Ñ  = 106）和CAPS严重程度评分（ADJ β  = 0.207，p = .005）与HCC显着相关。MetS与HCC无关，PTSD与MetS在HCC上没有显着的相互作用。这项研究提供了在PTSD中慢性失调的神经内分泌介导的应激反应的证据，并具有明确的剂量反应关系。但是，在该样本中，HCC对于PTSD和MetS的合并症似乎没有特异性。

• 图层摘要

• 我们发现，在患有创伤后应激障碍（PTSD）的南非女性中，头发样本中测量的应激激素，皮质醇水平显着高于也遭受创伤但未患有PTSD的女性。然而，在所研究的妇女中，头发的皮质醇水平与代谢综合症（心脏病的一系列危险因素）无关。因此，我们表明南非患有PTSD的妇女长期应激激素水平升高，并且这种影响与PTSD有关，而不仅仅是由于创伤暴露。