Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes

J Affect Disord. 2008 Mar;106(3):307-13. doi: 10.1016/j.jad.2007.07.025. Epub 2007 Aug 28.


Background: Cortisol secretion in elderly persons with anxiety disorders exposed to common stressful situations has not been evaluated.

Methods: Salivary-free cortisol levels were evaluated at 8, 15, and 22 h, in 201 elderly subjects during stressful and non-stressful days. Psychiatric symptomatology was assessed by a standardized psychiatric examination (MINI).

Results: Elderly subjects without psychiatric disorder showed a sustained increase in cortisol secretion several hours after the exposure to a stressful situation. In comparison, subjects with anxiety disorders showed a greater increase in cortisol secretion in the stressful situation, with lowered recuperation capacity. This effect was dose-dependent as a function of anxiety co-morbidity. Persons reporting lifetime major trauma with intrusions exhibited lowered continuous basal cortisol associated with efficient recuperation capacity. Independently of psychopathology, women appeared more reactive to stressful environmental conditions.

Limitations: Exclusion of institutionalized persons and benzodiazepine users may have led to sampling of less severe anxiety symptoms.

Conclusions: Dysregulation of the hypothalamic-pituitary-adrenal axis was observed in elderly persons with anxiety disorders experiencing environmental stress. A common pattern of up-regulated diurnal cortisol secretion was observed in anxious subjects with lifetime and current anxiety disorder irrespective of sub-type (generalized anxiety, phobias) suggesting a stable trait and a common "core" across disorders. Elderly persons who had experienced trauma with subsequent intrusions showed a distinct pattern with down-regulated activity.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Physiological / physiology
  • Aged
  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / physiopathology
  • Circadian Rhythm / physiology*
  • Comorbidity
  • Down-Regulation / physiology
  • Female
  • Geriatric Assessment
  • Humans
  • Hydrocortisone / analysis*
  • Hypothalamo-Hypophyseal System / physiopathology
  • Life Change Events*
  • Male
  • Phobic Disorders / diagnosis
  • Phobic Disorders / epidemiology
  • Phobic Disorders / physiopathology
  • Pituitary-Adrenal System / physiopathology
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Saliva / chemistry
  • Sex Factors
  • Stress, Psychological / diagnosis*
  • Stress, Psychological / epidemiology
  • Stress, Psychological / physiopathology


  • Hydrocortisone