Objective: Depressive symptoms are a common mental health problem among young adults, but the physiological mechanisms that mediate between stress and depressive symptoms remain unclear. Accordingly, this exploratory study (1) examined how hair cortisol concentrations were associated with self-perceived stress and depressive symptoms in a sample of young adults and (2) tested whether hair cortisol could explain variance in depressive symptoms beyond perceived stress before and after controlling for levels of vigorous physical activity (VPA). Methods: The sample consisted of 42 exercise and health science university students (20 males, 22 females; mean age = 21.2 years). Cortisol concentrations were extracted from hair strands close to the scalp. Participants completed self-rating questionnaires about depressive symptoms and perceived stress. Results: Students with elevated hair cortisol levels tended to report lower depressive symptoms and lower perceived stress. Increased perceived stress was associated with higher depressive symptoms, and both hair cortisol and perceived stress predicted depressive symptoms after controlling for VPA. Conclusions: The present data suggest that elevated hair cortisol levels do not necessarily constitute a health risk. Hair cortisol measurement can serve as a noninvasive and painless biomarker of chronic stress and mental disorders; however, additional research is needed.

Keywords:
Depressive symptoms, Hair cortisol, Hypocortisolism, Perceived stress, Physical activity, Young adults
1.
Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rossler W: Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 2008;31:473-480.
2.
Smith DJ, Harrison N, Muir W, Blackwood DH: The high prevalence of bipolar spectrum disorders in young adults with recurrent depression: toward an innovative diagnostic framework. J Affect Disord 2005;84:167-178.
3.
Aalto-Setala T, Marttunen M, Tuulio-Henriksson A, Poikolainen K, Lonnqvist J: One-month prevalence of depression and other DSM-IV disorders among young adults. Psychol Med 2001;31:791-801.
4.
Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ: The prevalence and impact of depression among medical students: a nationwide cross-sectional study in South Korea. Acad Med 2010;85:1384-1390.
5.
Tomoda A, Mori K, Kimura M, Takahashi T, Kitamura T: One-year prevalence and incidence of depression among first-year university students in Japan: a preliminary study. Psychiatry Clin Neurosci 2000;54:583-588.
6.
Vazquez FL, Blanco V: Prevalence of DSM-IV major depression among Spanish university students. J Am Coll Health 2008;57:165-171.
7.
Chang E, Eddins-Folensbee F, Coverdale J: Survey of the prevalence of burnout, stress, depression, and the use of supports by medical students at one school. Acad Psychiatry 2012;36:177-182.
8.
Mikolajczyk RT, Maxwell AE, El Ansari W, Naydenova V, Stock C, Ilieva S, Dudziak U, Nagyova I: Prevalence of depressive symptoms in university students from Germany, Denmark, Poland and Bulgaria. Soc Psychiatry Psychiatr Epidemiol 2008;43:105-112.
9.
Brand S, Gerber M, Pühse U, Holsboer-Trachsler E: Depression, hypomania and dysfunctional cognitions as mediators between stress and insomnia: the best advice is not always found on the pillow! Int J Stress Manag 2010;17:114-134.
10.
Sawatzky RG, Ratner PA, Richardson CG, Washburn C, Sudmant W, Mirwaldt P: Stress and depression in students: the mediating role of stress management self-efficacy. Nurs Res 2012;61:13-21.
11.
Dahlin M, Joneborg N, Runeson B: Stress and depression among medical students: a cross-sectional study. Med Educ 2005;39:594-604.
12.
Karlen J, Ludvidsson J, Frostell A, Theodorsson E, Faresjo T: Cortisol in hair measured in young adults - a biomarker of major life stressors? BMC Clin Pathol 2011;11:12.
13.
McEwen BS: Protective and damaging effects of stress mediators. N Engl J Med 1998;338:171-179.
14.
Miller G, Chen E, Zhou E: If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull 2007;133:25-45.
15.
Chrousos GP: Stress and disorders of the stress system. Nat Rev Endocrinol 2009;5:374-381.
16.
Tsigos C, Chrousos GP: Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 2002;53:865-871.
17.
Stalder T, Kirschbaum C: Analysis of cortisol in hair - state of the art and future directions. Brain Behav Immun 2012;26:1019-1029.
18.
Gow R, Thomson S, Rieder M, van Uum S, Koren G: An assessment of cortisol analysis in hair and its clinical applications. Forensic Sci Int 2010;196:32-37.
19.
Kirschbaum C, Tietze A, Skoluda N, Dettenborn L: Hair as a retrospective calendar of cortisol production - increased cortisol incorporation into hair in the third trimester of pregnancy. Psychoneuroendocrinology 2009;34:32-37.
20.
van Uum S, Sauvé B, Fraser LA, Morley-Forster P, Paul TL, Koren G: Elevated content of cortisol in hair of patients with severe chronic pain: a novel biomarker for stress. Stress 2008;11:483-488.
21.
Kristenson M, Garvin P, Lundberg U (eds): The Role of Saliva Cortisol Measurement in Health and Disease. Oak Park, Bentham Science Publishers, 2012.
22.
Dettenborn L, Tietze A, Bruckner F, Krischbaum C: Higher cortisol content in hair among long-term unemployed individuals compared to controls. Psychoneuroendocrinology 2010;35:1404-1409.
23.
Dettenborn L, Muhtz C, Skoluda N, Stalder T, Steudte S, Hinkelmann K, Kirschbaum C, Otte C: Introducing a novel method to assess cumulative steroid concentrations: increased hair cortisol concentrations over 6 months in medicated patients with depression. Stress 2012;15:348-353.
24.
D'Anna-Hernandez KL, Ross RG, Natvig CL, Laudenslager ML: Hair cortisol levels as a retrospective marker of hypothalamic-pituitary axis activity throughout pregnancy: comparison to salivary cortisol. Physiol Behav 2011;104:348-353.
25.
Dowlati Y, Herrmann N, Swardfager W, Thomson S, Oh PI, van Uum S, Koren G, Lactôt K: Relationship between hair cortisol concentrations and depressive symptoms in patients with coronary artery disease. Neuropsychiatr Dis Treat 2010;6:393-400.
26.
Steudte S, Stalder T, Dettenborn L, Klumbies E, Foley P, Beesdo-Baum K, Kirschbaum C: Decreased hair cortisol concentrations in generalised anxiety disorder. Psychiatry Res 2011;186:310-314.
27.
Stalder T, Steudte S, Miller R, Skoluda N, Dettenborn L, Krischbaum C: Intraindividual stability of hair cortisol concentrations. Psychoneuroendocrinology 2012;37:602-610.
28.
Manenschijn L, Koper JW, Lamberts SWJ, van Rossum EFC: Evaluation of a method to measure long term cortisol levels. Steroids 2011;76:1032-1036.
29.
Thomson S, Koren G, Fraser LA, Rieder M, Friedman TC, Van Uum SH: Hair analysis provides a historical record of cortisol levels in Cushing's syndrome. Exp Clin Endocrionol Diabetes 2010;118:133-138.
30.
Skoluda N, Dettenborn L, Stalder T, Kirschbaum C: Elevated hair cortisol concentrations in endurance athletes. Psychoneuroendocrinology 2012;37:611-617.
31.
Manenschijn L, van Kruysbergen RGPM, de Jong FH, Koper JW, van Rossum EFC: Shift work at young age is associated with elevated long-term cortisol levels and body mass index. J Clin Endocrinol Metab 2011;96:E1862-E1865.
32.
Stalder T, Kirschbaum C, Heinze K, Steudte S, Foley P, Tietze A, Dettenborn L: Use of hair cortisol analysis to detect hypercortisolism during active drinking phases in alcohol-dependent individuals. Biol Psychol 2010;85:357-360.
33.
Yamada J, Stevens B, de Silva N, Gibbins S, Beyene J, Taddio A, Newman C, Koren G: Hair cortisol as a potential biologic marker of chronic stress in hospitalized neonates. Neonatology 2007;92:42-49.
34.
Steudte S, Kolass I-T, Stalder T, Pfeiffer A, Kirschbaum C, Elbert T: Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD. Psychoneuroendocrinology 2011;36:1193-1200.
35.
Pereg D, Gow R, Mosseri M, Lishner M, Rieder M, van Uum S, Koren G: Hair cortisol and the risk for acute myocardial infarction in adult men. Stress 2011;14:73-81.
36.
Borer K: Exercise Endocrinology. Champaign, Human Kinetics, 2003.
37.
Gerber M, Brand S, Lindwall M, Elliot C, Kalak N, Herrmann C, Pühse U, Jonsdottir IH: Concerns regarding hair cortisol as a biomarker of chronic stress in exercise and sport science. J Sports Sci Med 2012;11:571-581.
38.
American Psychiatric Association: DSM-IV. Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 2000.
39.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571.
40.
Hautzinger M, Bailer M, Worall H, Keller F: Beck Depressions-Inventar. Bern, Huber, 1995.
41.
Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav 1983;24:385-396.
42.
Cohen S, Williamson GM: Perceived stress in a probability sample of the United States; in Spacapan S, Oskamp S (eds): The Social Psychology of Health. Newbury Park, Sage, 1988, pp 31-67.
43.
Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC: Using objective physical activity measures with youth: how many days of monitoring are needed? Med Sci Sports Exerc 2000;32:426-431.
44.
Rowlands AV: Accelerometer assessment of physical activity in children: an update. Pediatr Exerc Sci 2007;19:252-266.
45.
Freedson PS, Melanson E, Sirard J: Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc 1998;30:777-781.
46.
Leenders NY, Nelson TE, Sherman WM: Ability of different physical activity monitors to detect movement during treadmill walking. Int J Sports Med 2003;24:43-50.
47.
Silva P, Mota J, Esliger D, Welk G: Technical reliability assessment of the Actigraph GT1M accelerometer. Meas Phys Educ Exerc Sci 2010;14:79-91.
48.
Rothney MP, Apker GA, Song Y, Chen KY: Comparing the performance of three generations of ActiGraph accelerometers. J Appl Physiol 2008;105:1091-1097.
49.
Cohen J: Statistical Power Analysis for the Behavioral Sciences. Mahwah, Erlbaum, 1988.
50.
Byrne BM: Structural Equation Modeling with AMOS. Basic Concepts, Applications, and Programming. New York, Taylor and Francis, 2010.
51.
Blunch N: Introduction to Structural Equation Modeling using IBM SPSS Statistics and AMOS. London, Sage, 2013.
52.
McDonald RP, Ho RM: Principles and practice in reporting structural equation analyses. Psychol Methods 2002;7:65-69.
53.
Jonsdottir IH, Halford C, Eek F: Mental health and salivary cortisol; in Kristenson M, Garvin P, Lundberg U (eds): The Role of Saliva Cortisol Measurement in Health and Disease. Oak Park, Bentham Science Publishers, 2012, pp 129-166.
54.
Majumdar SK, Shaw GK, Bridges PK: Relationship between plasma cortisol concentrations and depression in chronic alcoholic patients. Drug Alcohol Depend 1984;14:45-49.
55.
Cohen MR, Pickar D, Extein I, Gold MS, Sweeney DR: Plasma cortisol and beta-endorphin immunoreactivity in nonmajor and major depression. Am J Psychiatry 1984;141:628-632.
56.
Chodzko-Zajko WJ, O'Connor PJ: Plasma cortisol, the dexamethasone suppression test and depression in normal adult males. J Psychosom Res 1986;30:313-320.
57.
Deuschle M, Weber B, Colla M, Depner M, Heuser I: Effects of major depression, aging and gender upon calculated diurnal free plasma cortisol concentrations: a re-evaluation study. Stress 1998;2:281-287.
58.
Morris MC, Compas BE, Garber J: Relations among posttraumatic stress disorder, comorbid major depression, and HPA function: a systematic review and meta-analysis. Clin Psychol Rev 2012;32:301-315.
59.
Piwowarska J, Chimiak A, Matsumoto H, Dziklinska A, Radziwon-Zaleska M, Szelenberger W, Pachecka J: Serum cortisol concentration in patients with major depression after treatment with fluoxetine. Psychiatry Res 2012;198:407-411.
60.
Holsboer F, Barden N: Antidepressants and hypothalamic-pituitary-andrenocortical regulation. Endocr Rev 1996;17:187-205.
61.
Xie Q, Gao W, Li J, Qiao T, Jin J, Deng H, Lu Z: Correlation of cortisol in 1-cm hair segment with salivary cortisol in human: hair cortisol as an endogenous biomarker. Clin Chem Lab Med 2011;49:1-6.
62.
Daley A: Exercise and depression: a review of reviews. J Clin Psychol Med Settings 2008;15:140-147.
63.
De Moor MHM, Beem AL, Stubbe JH, Boomsma DI, De Geus EJC: Regular exercise, anxiety, depression and personality: a population-based study. Prev Med 2006;42:273-279.
64.
Mota-Pereira J, Silverio J, Carvalho S, Ribeiro JC, Fonte D, Ramos J: Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder. J Psychiatr Res 2011;45:1005-1011.
65.
Blumenthal JA, Michael A, Babjak A: Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med 2007;69:587-596.
66.
Hatzinger M, Brand S, Perren S, Von Wyl A, Von Klitzing K, Holsboer-Trachsler E: Hypothalamic-pituitary-adrenocortical (HPA) activity in kindergarten children: importance of gender and associations with behavioral/emotional difficulties. J Psychiatr Res 2007;41:861-870.
67.
Kalra S, Einarson A, Karaskov T, Van Uum S, Koren G: The relationship between stress and hair cortisol in healthy pregnant women. Clin Invest Med 2007;30:E103-E107.
68.
Schlotz W, Kumsta R, Layes I, Entringer S, Jones A, Wust S: Covariance between psychological and endocrine responses to pharmacological challenge and psychosocial stress: a question of timing. Psychosom Med 2008;70:787-796.
69.
Kramer MS, Lydon J, Séguin L, Goulet L, Kahn SR, McNamara H, Genest J, Dassa C, Chen MF, Sharma S, Meaney JJ, Thomson S, van Uum S, Koren G, Dahhou M, Lamoureux J, Platt RW: Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. Am J Epidemiol 2009;169:1319-1326.
70.
Giacobbi PR, Hausenblas HA, Frye N: A naturalistic assessment of the relationship between personality, daily life events, leisure-time exercise, and mood. Psychol Sport Exerc 2005;6:67-81.
71.
Twisk JW, Snel J, Kemper HC, van Mechelen W: Changes in daily hassles and life events and the relationship with coronary heart disease risk factors: a 2-year longitudinal study in 27-29-year-old males and females. J Psychosom Res 1999;46:229-240.
72.
Lazarus RS, Folkman S: Stress, Appraisal, and Coping. New York, Springer, 1984.
73.
Hobfoll SE: Stress, Culture, and Community. The Psychology and Philosophy of Stress. New York, Plenum Press, 1998.
74.
Eller NH, Kristiansen J, Hansen AM: Long-term effects of psychosocial factors of home and work on biomarkers of stress. Int J Psychophysiol 2011;79:195-202.
75.
Persson R, Orbaek P, Kecklund G, Akerstedt T: Impact of an 84-hour workweek on biomarkers for stress, metabolic processes and diurnal rhythm. Scand J Work Environ Health 2006;32:349-358.
76.
Chida Y, Steptoe A: Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol 2009;80:265-278.
77.
Tak LM, Cleare AJ, Ormel J, Manoharan A, Kok IC, Wessely S, Rosmalen JG: Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol 2011;87:183-194.
78.
Edwards LD, Heyman AH, Swidan S: Hypocortisolism: an evidence-based review. Int Med 2011;10:26-33.
79.
Fries E, Hesse J, Hellhammer J, Hellhammer DH: A new view on hypocortisolism. Psychoneuroendocrinology 2005;30:1010-1016.
80.
Heim C, Ehlert U, Hellhammer DH: The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 2000;25:1-35.
81.
Raison CL, Miller AH: When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry 2003;160:1554-1565.
82.
Yehuda R: Sensitization of the hypothalamic-pituitary-adrenal axis in posttraumatic stress disorder. Ann NY Acad Sci 1997;821:57-75.
83.
Ruehlman LS, Karoly P, Pugliese J: Psychosocial correlates of chronic pain and depression in young adults: further evidence of the utility of the Profile of Chronic Pain: Screen (PCP: S) and the Profile of Chronic Pain: Extended Assessment (PCP: EA) battery. Pain Med 2010;11:1546-1553.
84.
Ahola K, Honkonen T, Isometsä E, Kalimo R, Nykyri E, Aromaa A, Lönnqvist J: The relationship between job-related burnout and depressive disorders - results from the Finnish Health 2000 Study. J Affect Disord 2005;88:55-62.
85.
Murck H: Atypical depression spectrum disorder - neurobiology and treatment. Acta Neuropsychiatr 2003;15:227-241.
86.
Kudielka BM, Wüst S: Human models in acute and chronic stress: assessing determinants of individual hypothalamus-pituitary-adrenal axis activity and reactivity. Stress 2010;13:1-14.
87.
MacCallum RC, Zhang S, Preacher KJ, Rucker DD: On the practice of dichotomization of quantitative variables. Psychol Methods 2002;7:19-40.
88.
Boomsma A: Robustness of LISREL against small sample sizes in factor analysis models; in Jöreskog GK, Wold H (eds): Systems under Indirect Observations, Causality, Structure, Prediction: Part 1. Amsterdam, North Holland, 1982, pp 149-173.
89.
Bentler PM, Chou CP: Practical issues in structural modeling. Sociol Methods Res 1987;16:78-117.
90.
Westland JC: Lower bounds on sample size in structural equation modeling. Electron Commer Res Appl 2010;9:476-487.
91.
Iacobucci D: Structural equation modeling: fit indices, sample size, and advanced topics. J Consum Psychol 2010;20:90-98.
92.
Little TD, Cunningham WA, Shahar G, Widaman KF: To parcel or not to parcel: exploring the question, weighing the merits. Struct Equ Modeling 2002;9:151-173.
93.
MacCallum RC, Austin JT: Applications of structural equation modeling in psychological research. Ann Rev Psychol 2000;51:201-226.
94.
Sarrazin P, Vallerand R, Guillet E, Pelletier L, Cury F: Motivation and dropout in female handballers: a 21-month prospective study. Eur J Sport Psychol 2002;32:395-418.
95.
Comrey AL, Lee HB: A First Course in Factor Analysis. Hillsdale, Erlbaum, 1992.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.