Hair cortisol concentrations in mental disorders: A systematic review

Physiol Behav. 2021 Feb 1:229:113244. doi: 10.1016/j.physbeh.2020.113244. Epub 2020 Nov 10.


Objective: Research on HPA axis dysregulation has been associated with vulnerability to, or perseverence of, several mental disorders. Hoever, measurements of cortisol levels in blood, saliva and/or urine have yielded variable results. Nevertheless, cortisol analysis in scalp hair appears to be a consistent tool for measurement of long-term exposure to stress. This article provides a systematic review of studies exploring hair cortisol concentrations in patients with mental disorders in comparison with healthy controls.

Methods: This review was conducted according to PRISMA guidelines. The electronic databases of PubMed/Medline, Web of Science and Scopus were searched for relevant articles, using a specific syntax.

Results: A total of 582 articles were identified, of which 22 were finally included. Patients with depression show a general trend for higher hair cortisol concentrations (HCC) than controls, whereas patients with PTSD tend to demonstrate lower HCC. Very little is known about other mental disorders, including suicidality and drug abuse. The divergence of samples included and the timing of cortisol sampling, seem to play a key role in the discrepancies of the results. Correlations of HCC with self-reported measures of stress were found, at best, inconclusive.

Conclusions: Further research should attempt to describe specific cortisol profiles for each psychiatric disorder and HCC could contribute in evaluating therapy outcomes and predicting relapses. Obtaining information on HCC in different stages of psychiatric disorders in association with pertinent clinical variables, might help in forging a neuroendocrine model for clinical staging of mental disorders.

Keywords: Hair cortisol concentrations; Hpa axis; Long-term cortisol; Mental disorders.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Hair
  • Humans
  • Hydrocortisone*
  • Hypothalamo-Hypophyseal System
  • Mental Disorders*
  • Pituitary-Adrenal System
  • Stress, Psychological


  • Hydrocortisone