Hydrocortisone for Prevention of Post-Traumatic Stress Disorder

Adult subjects will be screened in the Emergency Department (ED) by research associates. If they meet inclusion/exclusion criteria they will be offered enrollment. Subjects who choose to enroll will be randomized to receive either hydrocortisone 120mg PO, or placebo PO, one time in the Emergency Department. They will be given a packet of general information on traumatic stress and contact information for psychiatric assistance if they require it, but no further PTSD treatment will be given. Any further medical treatment will be at the discretion of the treating team. At 6 weeks after enrollment subjects will be contacted by phone, and a brief structured interview, based on the PCL-S (a well-validated screening instrument for PTSD), will be administered by phone. Participants who screen positive will be informed that they may be suffering from PTSD, and will be offered the opportunity to seek care with the Einstein Psychiatry Department's PTSD program. At 6 months after enrollment subjects will again be contacted and administered the PCL-C, as well as questions regarding other psychiatric comorbidities, substance use, and involvement in any further episodes of violence. In addition, review of subject medical records over the year since injury will be undertaken to determine if there is any difference in subsequent health-care utilization between those who received hydrocortisone vs placebo and between those who screen positive for PTSD vs those who don't.