Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis

Abstract

Changes in levels of the stress-sensitive hormone cortisol from morning to evening are referred to as diurnal cortisol slopes. Flatter diurnal cortisol slopes have been proposed as a mediator between chronic psychosocial stress and poor mental and physical health outcomes in past theory and research. Surprisingly, neither a systematic nor a meta-analytic review of associations between diurnal cortisol slopes and health has been conducted to date, despite extensive literature on the topic. The current systematic review and meta-analysis examined associations between diurnal cortisol slopes and physical and mental health outcomes. Analyses were based on 179 associations from 80 studies for the time period up to January 31, 2015. Results indicated a significant association between flatter diurnal cortisol slopes and poorer health across all studies (average effect size, r = .147). Further, flatter diurnal cortisol slopes were associated with poorer health in 10 out of 12 subtypes of emotional and physical health outcomes examined. Among these subtypes, the effect size was largest for immune/inflammation outcomes (r = .288). Potential moderators of the associations between diurnal cortisol slopes and health outcomes were examined, including type of slope measure and study quality indices. The possible roles of flatter slopes as either a marker or a mechanism for disease etiology are discussed. We argue that flatter diurnal cortisol slopes may both reflect and contribute to stress-related dysregulation of central and peripheral circadian mechanisms, with corresponding downstream effects on multiple aspects of biology, behavior, and health.

Cultural neurobiology and the family: Evidence from the daily lives of Latino adolescents

“…This altered rhythm generally reflects a less adaptive pattern. For example, flatter cortisol slopes have been associated with poor mental and physical health (Adam et al, 2017), including depression in adolescence (Doane et al, 2013), and morbidity and mortality in adults (Kumari et al, 2011). …”

Associations of waking cortisol with DHEA and testosterone across the pubertal transition: Effects of threat-related early life stress

“…The hypothalamic-pituitary-adrenal (HPA) axis mediates physiological responses to stress (Gunnar and Quevedo, 2007), and functioning of the HPA axis has pervasive effects on mental and physical health (Koss and Gunnar, 2018). A burgeoning literature implicates atypical cortisol regulation, both diurnally and in response to stress, in the development of psychopathology (e.g., Adam et al, 2017;Colich, Kircanski, Foland-Ross, & Gotlib, 2015;Essex et al, 2011). Further, many studies have linked exposure to early life stress (ELS; with "early" defined as occurring during childhood) with subsequent cortisol dysregulation (e.g., Bernard, Frost, Bennett, & Lindhiem, 2017;Bunea, Szentágotai-Tătar, & Miu, 2017).…”

Mind, Body, Brain, and the Conditions of Meaning

“…Thus, to extend the example of chronic stress, such experience results in changes in the regulation of the hypothalamic pituitary adrenal axis and the stress hormones it controls (Adam et al. ). Patterns of hormonal response in turn affect the ways that individuals experience their environments and the meanings they make of their social and material worlds (Quinn, Grant, and Adam ; Seligman , ).…”