Hair cortisol, stress exposure, and mental health in humans: A systematic review

Staufenbiel, Sabine M.; Penninx, Brenda W. J. H.; Spijker, Anne T.; Elzinga, Bernet M.; Rossum, Elisabeth F.C. van

doi:10.1016/j.psyneuen.2012.11.015

Cited by 616 publications

(562 citation statements)

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“…This accords with previous research that stress self-report measures are often inconsistent with behavioural and physiological measures (e.g., Weinberger et al, 1979). It also accords with the 2013 review of HCC studies, which discussed the 'often found ''lack of psychoendocrine covariance''' (Staufenbiel et al, 2013;p.1230); i.e., the dissonance between HCC and self-reported stress. Explanations proposed included divergence in time due to lag effects caused by different timing of stress responses (Schlotz et al, 2008), differences between the four-week recall period of the typically used PSS (Cohen et al, 1983) and hair samples reflecting 12-week cortisol secretion, and recall or social desirability biases associated with such measures (Staufenbiel et al, 2013).…”

Section: Discussionsupporting

confidence: 89%

“…Our data, in the context of the growing HCC literature, add to the evidence that the relationship between HCC and self-reported stress is inconsistent, in some cases, contradictory (Staufenbiel et al, 2013), and may vary across different population groups. Out of 15 studies, Staufenbiel noted positive associations in six, no association in seven, and inverse associations in two studies.…”

Section: Discussionsupporting

confidence: 61%

“…Staufenbiel et al (2013) noted the importance of considering the role of individual's cognitive stress appraisal in relation to HCC. Stress need not be perceived negatively by an individual and similar levels of selfreported stress can be associated with contrasting physiological responses, for example depending on whether the situation is perceived as a challenge or a threat (Seery et al, 2009;Turner et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…However, the association between HCC and subjectively measured stress remains unclear. A review of HCC with subjective stress-related psychological measures reported significant associations in less than half of studies (Staufenbiel et al, 2013). Reasons posited by the review authors included heterogeneity of study populations and diverse stress questionnaires (that cover different periods of time), and variable lengths of hair (which also cover different periods of time).…”

Section: Introductionmentioning

confidence: 99%

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Hair cortisol and self-reported stress in healthy, working adults

Gidlow

Randall²,

Gillman

et al. 2016

Psychoneuroendocrinology

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Chronic stress can be important in the pathology of chronic disease. Hair cortisol concentrations (HCC) are proposed to reflect long term cortisol secretion from exposure to stress. To date, inconsistencies in the relationship between HCC and self-reported stress have been attributed to variation and limitations of perceived stress measurement. We report data from employees of two large public sector worksites (n=132). Socio-demographic, health, lifestyle, Perceived Stress Scale (PSS), and work-related Effort Reward Imbalance (ERI) were collected at baseline. Participants were asked to respond to mobile text messages every two days, asking them to report current stress levels (Ecological Momentary Assessment, EMA), and mean stress was determined overall, during work hours, and out of work hours. At 12 weeks, the Appraisal of Stressful Life Events Scale (ALES) was completed and 3cm scalp hair samples were taken, from which HCC was determined (to reflect cortisol secretion over the past 12 weeks). Mean response rate to EMA was 81.9±14.9%. Associations between HCC and the various self-reported stress measures (adjusted for use of hair dye) were weak (all <.3). We observed significant associations with HCC for EMA measured stress responses received out of work hours (ρ=.196, p=.013) and ALES Loss subscale (ρ=.241, p=.003), and two individual items from ERI (relating to future work situation). In regression analysis adjusting for other possible confounders, only the HCC-ALES Loss association remained significant (p=.011). Overall, our study confirms that EMA provides a useful measurement tool that can gather perceived stress measures in real-time. But, there was no relationship between self-reported stress collected in this way, and HCC. The modest association between HCC and stress appraisal does however, provide some evidence for the role of cognitive processes in chronic stress.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hair cortisol and self-reported stress in healthy, working adults

Gidlow

Randall²,

Gillman

et al. 2016

Psychoneuroendocrinology

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“…Given inconsistent results related to cortisol release in GAD and MD, no specific hypotheses were formulated for the hormonal data. Previous work in GAD and MD alone, however, suggested abnormalities related to cortisol for each of these disorders (for reviews see Dedovic & Ngiam, 2015; Hilbert, Lueken, & Beesdo‐Baum, 2014; Staufenbiel, Penninx, Spijker, Elzinga, & van Rossum, 2013), therefore classification based on hormonal data was expected to perform above chance level for both classification problems. Brain imaging data were hypothesized to perform well for both classification problems and thus provide incremental value for the detection and classification of GAD.…”

Section: Introductionmentioning

confidence: 98%

Separating generalized anxiety disorder from major depression using clinical, hormonal, and structural MRI data: A multimodal machine learning study

et al. 2017

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BackgroundGeneralized anxiety disorder (GAD) is difficult to recognize and hard to separate from major depression (MD) in clinical settings. Biomarkers might support diagnostic decisions. This study used machine learning on multimodal biobehavioral data from a sample of GAD, MD and healthy subjects to differentiate subjects with a disorder from healthy subjects (case‐classification) and to differentiate GAD from MD (disorder‐classification).MethodsSubjects with GAD (n = 19), MD without GAD (n = 14), and healthy comparison subjects (n = 24) were included. The sample was matched regarding age, sex, handedness and education and free of psychopharmacological medication. Binary support vector machines were used within a nested leave‐one‐out cross‐validation framework. Clinical questionnaires, cortisol release, gray matter (GM), and white matter (WM) volumes were used as input data separately and in combination.ResultsQuestionnaire data were well‐suited for case‐classification but not disorder‐classification (accuracies: 96.40%, p < .001; 56.58%, p > .22). The opposite pattern was found for imaging data (case‐classification GM/WM: 58.71%, p = .09/43.18%, p > .66; disorder‐classification GM/WM: 68.05%, p = .034/58.27%, p > .15) and for cortisol data (38.02%, p = .84; 74.60%, p = .009). All data combined achieved 90.10% accuracy (p < .001) for case‐classification and 67.46% accuracy (p = .0268) for disorder‐classification.ConclusionsIn line with previous evidence, classification of GAD was difficult using clinical questionnaire data alone. Particularly cortisol and GM volume data were able to provide incremental value for the classification of GAD. Findings suggest that neurobiological biomarkers are a useful target for further research to delineate their potential contribution to diagnostic processes.

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The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care

DelFerro,

Whelihan,

Min

et al. 2024

JAMA Pediatr

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ImportanceLesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings.ObjectivesTo compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes.Design, Setting, and ParticipantsThis cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire–9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey.ExposuresThe primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates.Main Outcomes and MeasuresPHQ-9-M–derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt.ResultsThe sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P &lt; .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P &lt; .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P &lt; .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P &lt; .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth.Conclusions and RelevanceCompared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support–focused interventions to mitigate mental health inequities for LGBTQ+ youth.

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Hair cortisol, stress exposure, and mental health in humans: A systematic review

Cited by 616 publications

References 97 publications

Hair cortisol and self-reported stress in healthy, working adults

Hair cortisol and self-reported stress in healthy, working adults

Separating generalized anxiety disorder from major depression using clinical, hormonal, and structural MRI data: A multimodal machine learning study

The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care

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