Exposure to the Indian Ocean Tsunami shapes the HPA-axis resulting in HPA "burnout" 14 years later

We provide causal evidence on the long-term effects of traumatic exposures on HPA-axis function, using longitudinal data from survivors of the 2004 Indian Ocean tsunami in Indonesia. Fourteen years after the disaster, women who were exposed to the tsunami's direct impacts present with levels of hair cortisol 30% lower than counterparts not similarly exposed. We distinguish short-term from longer-term levels of elevated post-traumatic stress symptoms and show that effects are larger among individuals for whom post-traumatic symptoms remain elevated for 2 y after the tsunami which likely reflects "burnout" since low cortisol is also associated with contemporaneous indicators of poor general and psychosocial health. The impacts of large-scale traumatic events on women's physiology through the HPA-axis endure for many years.