Associations between DSM-IV diagnosis, psychiatric symptoms and morning cortisol levels in a community sample of adolescents

Soc Psychiatry Psychiatr Epidemiol. 2012 May;47(5):723-33. doi: 10.1007/s00127-011-0374-8. Epub 2011 Apr 8.


Purpose: Dysfunction of the hypothalamic-pituitary-adrenocortical axis (HPA-axis) is implicated in a variety of psychiatric and emotional disorders. In this study, we explore the association between HPA-axis functioning, as measured by morning cortisol, and common psychiatric disorders and symptoms among a community sample of adolescents.

Method: Data from a cross-sectional school-based survey of 501 school pupils, aged 15, were used to establish the strength of association between salivary morning cortisol and both diagnosis of psychiatric disorders and a number of psychiatric symptoms, as measured via a computerised psychiatric interview. Analysis, conducted separately by gender, used multiple regressions, adjusting for relevant confounders.

Results: With one exception (a positive association between conduct disorder symptoms and cortisol among females) there was no association between morning cortisol and psychiatric diagnosis or symptoms. However, there was a significant two-way interaction between gender and conduct symptoms, with females showing a positive and males a negative association between cortisol and conduct symptoms. A further three-way interaction showed that while the association between cortisol and conduct symptoms was negative among males with a few mood disorder symptoms, among females with many mood symptoms it was positive.

Conclusions: Except in relation to conduct symptoms, dysregulation of morning cortisol levels seems unrelated to any psychiatric disorder or symptoms. However, the relationship between cortisol and conduct symptoms is moderated by both gender and mood symptoms. Findings are compatible with the recent work suggesting research should concentrate on the moderated associations between gender, internalising and externalising symptoms and cortisol, rather than any simple relationship.

Publication types

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

MeSH terms

  • Adolescent
  • Conduct Disorder / diagnosis*
  • Conduct Disorder / epidemiology
  • Confounding Factors, Epidemiologic
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / physiopathology
  • Depressive Disorder / psychology
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Female
  • Humans
  • Hydrocortisone / metabolism*
  • Hypothalamo-Hypophyseal System / metabolism
  • Interview, Psychological
  • Male
  • Mood Disorders / diagnosis*
  • Mood Disorders / epidemiology
  • Pituitary-Adrenal System / physiopathology
  • Psychology, Adolescent
  • Saliva / metabolism
  • Schizophrenic Psychology
  • Schools*
  • Scotland / epidemiology
  • Sex Distribution
  • Stress, Psychological / psychology*
  • Students / psychology*
  • Students / statistics & numerical data


  • Hydrocortisone