Self-reported depressive symptoms and stress levels in healthy young men: associations with the cortisol response to awakening

Psychosom Med. Jan-Feb 2003;65(1):92-9. doi: 10.1097/01.psy.0000040950.22044.10.


Objective: There is evidence that clinical depression and negative mood are associated with elevated basal cortisol levels. Recently, measuring the cortisol response during the first hour in the morning with strict reference to the time of awakening was established as a reliable marker of individual adrenocortical activity. In studies using this marker, a relationship with self-reported stress levels and psychosomatic symptoms has been found. The goal of the present study was to investigate the association of self-reported depressive symptomatology with early morning free cortisol levels and their relationship to measures of stress.

Methods: We assessed the severity of depressive symptoms using the Hamilton Depression Inventory and chronic and acute stress perception in 40 healthy young men. Once a week, for 4 consecutive weeks, subjects provided saliva samples collected at 0, 30, and 60 minutes after awakening.

Results: Higher levels of depressive symptomatology were associated with a greater cortisol response after awakening. This association seemed to be stronger when only subjects in the nonclinical range of depression were included. Furthermore, cortisol levels and depressive symptomatology were significantly positively correlated with measures of chronic and acute stress perception.

Conclusions: The present study extends earlier findings of hypothalamus-pituitary-adrenal axis hyperactivity in clinical depression to healthy young men with mild levels of depressive symptomatology. Measuring the cortisol response to awakening is proposed as an economical alternative to traditional approaches for determining basal hypothalamus-pituitary-adrenal axis activity. Associations between depressive symptomatology and chronic stress, as well as implications for future studies, are discussed.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Chronic Disease
  • Circadian Rhythm*
  • Depression / physiopathology*
  • Humans
  • Hydrocortisone / metabolism*
  • Hypothalamo-Hypophyseal System / physiopathology
  • Male
  • Pituitary-Adrenal System / physiopathology
  • Saliva / chemistry
  • Severity of Illness Index
  • Stress, Psychological / physiopathology*
  • Time Factors
  • Wakefulness / physiology*


  • Hydrocortisone