Whereas psychosocial risk factors increase the risk for disease, psychosocial resources reduce this risk. To examine a possible pathway for these effects, the relations between saliva cortisol levels and psychosocial factors were studied in a random sample of 257 men and women aged 30 to 64 years. Saliva samples were collected at home on waking, 30 min after waking, and in the evening. A flatter diurnal rhythm of cortisol, that is, lower deviations between awakening and evening cortisol levels, was related to high levels of psychosocial risk factors (cynicism, depression, and vital exhaustion), whereas a steeper diurnal rhythm was related to psychosocial resources (social support and coping), general health, and well-being (all p < .05). Our results support earlier suggestions that the capacity of the hypothalamic-pituitary-adrenal-axis to dynamically respond to stress is 1 pathway for observed effects of psychosocial factors regarding risk for disease development.

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Gender differences, found for a broad range of psychosocial factors, could not be explained by SES. However, associations between gender and psychosocial factors were more salient at lower levels of SES. Psychosocial factors, especially decision latitude and social integration, may help explain why women with low SES experience poorer health.

Thus, these results suggest that depressive symptoms and hopelessness are not independent predictors of IL-6 levels. Future research should explore the interplay of hopelessness and depressive symptoms on other risk factors of CVDs.

Purpose: Research has revealed a well-established relationship of depressive symptoms and hopelessness with a variety of physical illnesses that are associated with a dysfunction of the hypothalamic-pituitary-adrenal-axis. The purpose of this study was to test if depressive symptoms mediate the relationship between hopelessness and cortisol, a measure of the hypothalamic-pituitary-adrenal-axis. Methods: Hopelessness, depressive symptoms, and diurnal cortisol rhythm were measured in 257 adults (128 women and 129 men; age range: 20-74 years) in this cross-sectional study. To test the hypothesis, two linear regression analyses and asymmetrical confidence intervals around the regression weights were conducted. A second set of analyses was calculated to be able to exclude the possibility of hopelessness as a mediator between depressive symptoms and cortisol. Results: As predicted, after adjusting for age, gender, awakening time, medication use, more hopelessness predicted more depressive symptoms and more depressive symptoms predicted a flatter diurnal cortisol rhythm. The 95% confidence intervals revealed that the indirect relationship between hopelessness and diurnal cortisol rhythm was significant. The analyses with hopelessness as a potential mediator revealed that hopelessness does not mediate the association between depressive symptoms and cortisol. Conclusions:While the relationship between hopelessness and cortisol was mediated by depressive symptoms in this cross-sectional study, many other risk factors of depression have not been examined. Thus, future longitudinal studies should examine the relationships between those risk factors of depression and the hypothalamic-pituitary-adrenal-axis.Keywords: population-based; cross-sectional study; mediation model; hopelessness; depressive symptoms; diurnal cortisol rhythm Running head: Depressive Symptoms, Hopelessness, and Cortisol 3 Presently, psychosocial factors in general, and depressive symptoms in particular, are prospectively associated with incidents of both cancer and cardiovascular disease (CVD) [for meta-analyses see 1 and 2; 3; 4, respectively]. In the field of clinical psychology, two prominent models explaining the development of depressive symptoms based on cognitive risk factors have been well-supported by decades of research: Beck's cognitive theory [5] and the hopelessness model [6]. One crucial risk factor for the development and maintenance of depressive symptoms in both models is hopelessness. Hopelessness is a negative view of the future, or in other words, hopeless persons make long-range projections, anticipating that current difficulties or suffering will continue indefinitely [5,6]. Hopelessness is important for the purpose of this study, as empirical studies have also found it to be associated with cancer and CVD incidents. For example, a 6-year longitudinal study with middle aged men without a history of CVD or other serious illness at baseline revealed that hopelessness is associated with incidence rates of myocardial infarct...