Hair cortisol concentrations in mental disorders: A systematic review
Abstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hair cortisol concentrations are related to PTSD, depression and anxiety disorders.
“Studies have found that HCC is related to PTSD, depression and anxiety disorders [40, 41] or with perceived job insecurity and work stress [42, 43].”
Cites
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., & the PRISMA-P Group (2015) · BMJ · doi:10.1136/bmj.g7647 · Cited by 13,120 · see citing works
Stress and disorders of the stress system
Chrousos, G. P. (2009) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2009.106 · Cited by 3,215 · see citing works
Self-citationDevelopment of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)
Downes, M. J., Brennan, M. L., Williams, H. C., & Dean, R. S. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011458 · Cited by 2,376 · see citing works
The HPA axis in major depression: classical theories and new developments
Pariante, C. M., & Lightman, S. L. (2008) · Trends in Neurosciences · doi:10.1016/j.tins.2008.06.006 · Cited by 2,009 · see citing works
Biomarkers: Potential uses and limitations
Mayeux, R. P. (2004) · NeuroRx · doi:10.1602/neurorx.1.2.182 · Cited by 925 · see citing works
Stress-related and basic determinants of hair cortisol in humans: a meta-analysis
Stalder, T., Steudte-Schmiedgen, S., Alexander, N., Klucken, T., Vater, A., Wichmann, S., Kirschbaum, C., & Miller, R. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.12.017 · Cited by 855 · see citing works
Analysis of cortisol in hair – State of the art and future directions
Stalder, T., & Kirschbaum, C. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.02.002 · Cited by 835 · see citing works
Major depressive disorder and hypothalamic-pituitary-adrenal axis activity
Vreeburg, S. A., Hoogendijk, W. J. G., van Pelt, J., DeRijk, R. H., Verhagen, J. C. M., van Dyck, R., Smit, J. H., Zitman, F. G., & Penninx, B. W. J. H. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.50 · Cited by 792 · see citing works
Hair cortisol, stress exposure, and mental health in humans: A systematic review
Staufenbiel, S. M., Penninx, B. W. J. H., Spijker, A. T., Elzinga, B. M., & van Rossum, E. F. C. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.11.015 · Cited by 736 · see citing works
Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008) · Psychological Medicine · doi:10.1017/s0033291707002012 · Cited by 493 · see citing works
Morris, M. C., Compas, B. E., & Garber, J. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.02.002 · Cited by 466 · see citing works
Brain development under stress: Hypotheses of glucocorticoid actions revisited
Oitzl, M. S., Champagne, D. L., van der Veen, R., & de Kloet, E. R. (2009) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2009.07.006 · Cited by 358 · see citing works
Charney, D. S., Woods, S. W., Goodman, W. K., & Heninger, G. R. (1987) · American Journal of Psychiatry · doi:10.1176/ajp.144.8.1030 · Cited by 301 · see citing works
Stress and neurodevelopmental processes in the emergence of psychosis
Holtzman, C. W., Trotman, H. D., Goulding, S. M., Ryan, A. T., MacDonald, A. N., Shapiro, D. I., Brasfield, J. L., & Walker, E. F. (2013) · Neuroscience · doi:10.1016/j.neuroscience.2012.12.017 · Cited by 242 · see citing works
Low cortisol, high DHEA, and high levels of stimulated TNF‐α, and IL‐6 in women with PTSD
Gill, J., Vythilingam, M., & Page, G. G. (2008) · Journal of Traumatic Stress · doi:10.1002/jts.20372 · Cited by 240 · see citing works
Short, S. J., Stalder, T., Marceau, K., Entringer, S., Moog, N. K., Shirtcliff, E. A., Wadhwa, P. D., & Buss, C. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.05.007 · Cited by 239 · see citing works
Roelofs, K., van Peer, J., Berretty, E., Jong, P. D., Spinhoven, P., & Elzinga, B. M. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.08.022 · Cited by 236 · see citing works
Mantella, R. C., Butters, M. A., Amico, J. A., Mazumdar, S., Rollman, B. L., Begley, A. E., Reynolds, C. F., & Lenze, E. J. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.03.002 · Cited by 222 · see citing works
Steudte, S., Kirschbaum, C., Gao, W., Alexander, N., Schönfeld, S., Hoyer, J., & Stalder, T. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.03.011 · Cited by 196 · see citing works
Dettenborn, L., Muhtz, C., Skoluda, N., Stalder, T., Steudte, S., Hinkelmann, K., Kirschbaum, C., & Otte, C. (2012) · Stress · doi:10.3109/10253890.2011.619239 · Cited by 181 · see citing works
Circadian secretion of cortisol in bipolar disorder.
Cervantes, P., Gelber, S., Kin, F. N. K. N. Y., Nair, V. N. P., & Schwartz, G. J. (2001) · PubMed Central · Cited by 163 · see citing works
Borges, S., Gayer-Anderson, C., & Mondelli, V. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.12.025 · Cited by 153 · see citing works
Petrowski, K., Herold, U., Joraschky, P., Wïttchen, H., & Kirschbaum, C. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.08.003 · Cited by 142 · see citing works
Nater, U. M., Hoppmann, C. A., & Scott, S. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.09.008 · Cited by 135 · see citing works
Steudte-Schmiedgen, S., Stalder, T., Schönfeld, S., Wittchen, H.-U., Trautmann, S., Alexander, N., Miller, R., & Kirschbaum, C. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.05.007 · Cited by 130 · see citing works
The relationship between cortisol, stress and psychiatric illness: New insights using hair analysis
Herane Vives, A., De Angel, V., Papadopoulos, A., Strawbridge, R., Wise, T., Young, A. H., Arnone, D., & Cleare, A. J. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.08.007 · Cited by 129 · see citing works
Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters
Melhem, N. M., Munroe, S., Marsland, A., Gray, K., Brent, D., Porta, G., Douaihy, A., Laudenslager, M. L., DePietro, F., Diler, R., et al. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.01.001 · Cited by 124 · see citing works
Increased nocturnal secretion of ACTH and cortisol in obsessive compulsive disorder
Kluge, M., SCHÜSSLER, P., Kunzel, H. E., Dresler, M., Yassouridis, A., & Steiger, A. (2006) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2006.08.005 · Cited by 120 · see citing works
Anxiety disorders and salivary cortisol levels in older adults: a population-based study
Hek, K., Direk, N., Newson, R. S., Hofman, A., Hoogendijk, W. J. G., Mulder, C. L., & Tiemeier, H. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.06.006 · Cited by 116 · see citing works
Gold, P. W., Gabry, K. E., Yasuda, M. R., & Chrousos, G. P. (2002) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(01)00022-6 · Cited by 114 · see citing works
Self-citationScott, L. V., & Dinan, T. G. (1998) · Journal of Affective Disorders · doi:10.1016/s0165-0327(97)00101-8 · Cited by 110 · see citing works
Aas, M., Pizzagalli, D. A., Laskemoen, J. F., Reponen, E. J., Ueland, T., Melle, I., Agartz, I., Steen, N. E., & Andreassen, O. A. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.01.011 · Cited by 102 · see citing works
Salivary Cortisol Response During Exposure Treatment in Driving Phobics
Alpers, G. W., Abelson, J. L., Wilhelm, F. H., & Roth, W. T. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000073872.85623.0c · Cited by 100 · see citing works
Epidemiological approaches to measure childhood stress.
Vanaelst, B., de Vriendt, T., Huybrechts, I., Rinaldi, S., & de Henauw, S. (2012) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2012.01258.x · Cited by 96 · see citing works
Wells, S. L., Tremblay, P. F., Flynn, A. M., Russell, E., Kennedy, J., Rehm, J. T., Uum, S. H. M. V., Koren, G., & Graham, K. (2014) · Stress · doi:10.3109/10253890.2014.930432 · Cited by 93 · see citing works
Steudte‐Schmiedgen, S., Wichmann, S., Tobias Stalder, A., Hilbert, K., Muehlhan, M., Lueken, U., & Beesdo‐Baum, K. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.09.024 · Cited by 93 · see citing works
Salivary cortisol in early psychosis: New findings and meta-analysis
Chaumette, B., Kébir, O., Mam-Lam-Fook, C., Morvan, Y., Bourgin, J., Godsil, B. P., Plaze, M., Raphaël Gaillard, B., Jay, T. M., & Krebs, M. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.10.007 · Cited by 91 · see citing works
Yehuda, R., Bierer, L. M., Andrew, R., Schmeidler, J., & Seckl, J. R. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2008.12.003 · Cited by 90 · see citing works
Schalinski, I., Elbert, T., Steudte-Schmiedgen, S., & Kirschbaum, C. (2015) · PLOS ONE · doi:10.1371/journal.pone.0136921 · Cited by 88 · see citing works
Methodological Considerations for Hair Cortisol Measurements in Children
Slominski, R. M., Rovnaghi, C. R., & Anand, K. J. S. (2015) · Therapeutic Drug Monitoring · doi:10.1097/ftd.0000000000000209 · Cited by 80 · see citing works
Broocks, A., Bandelow, B., George, A., Jestrabeck, C., Opitz, M., Bartmann, U., Gleiter, C. H., Meineke, I., Roed, I. S., Rüther, E., et al. (2000) · International Clinical Psychopharmacology · doi:10.1097/00004850-200015030-00004 · Cited by 77 · see citing works
Pochigaeva, K., Druzhkova, T. A., Yakovlev, A. A., Onufriev, M. V., Гришкина, М. Н., Chepelev, A., Guekht, A. B., & Gulyaeva, N. V. (2017) · Metabolic Brain Disease · doi:10.1007/s11011-017-9952-0 · Cited by 77 · see citing works
Long-term cortisol in bipolar disorder: Associations with age of onset and psychiatric co-morbidity
Manenschijn, L., Spijker, A. T., Koper, J. W., Jetten, A. M., Giltay, E. J., Haffmans, J., Hoencamp, E., & van Rossum, E. F. C. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.04.010 · Cited by 76 · see citing works
Social anxiety disorder: a critical overview of neurocognitive research
Cremers, H. R., & Karin Roelofs, A. (2016) · Wiley Interdisciplinary Reviews Cognitive Science · doi:10.1002/wcs.1390 · Cited by 72 · see citing works
Wei, J., Sun, G., Zhao, L., Yang, X., Liu, X., Lin, D., Li, T., & Ma, X. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.023 · Cited by 70 · see citing works
Early-Life Stress: From Neuroendocrine Mechanisms to Stress-Related Disorders
Pervanidou, P., & Chrousos, G. P. (2018) · Hormone Research in Paediatrics · doi:10.1159/000488468 · Cited by 69 · see citing works
Self-citationKamali, M., Saunders, E. F. H., Prossin, A. R., Brucksch, C. B., Harrington, G. J., Langenecker, S. A., & McInnis, M. G. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.11.027 · Cited by 68 · see citing works
Mewes, R., Reich, H., Skoluda, N., Seele, F., & Nater, U. M. (2017) · Translational Psychiatry · doi:10.1038/tp.2017.14 · Cited by 62 · see citing works
Perceived stress and hair cortisol: Differences in bipolar disorder and schizophrenia
Streit, F., Memić, A., Hasandedic-Dapo, L., Rietschel, L., Frank, J., Lang, M., Witt, S. H., Forstner, A. J., Degenhardt, F., Wüst, S., et al. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.03.010 · Cited by 55 · see citing works
Tafet, G. E., Feder, D. J., Abulafia, D. P., & Roffman, S. S. (2005) · Cognitive, Affective, & Behavioral Neuroscience · doi:10.3758/cabn.5.1.37 · Cited by 53 · see citing works
Long-term glucocorticoid levels measured in hair in patients with depressive and anxiety disorders
Gerritsen, L., Staufenbiel, S. M., Penninx, B. W. J. H., van Hemert, A. M., Noppe, G., de Rijke, Y. B., & van Rossum, E. F. C. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.11.019 · Cited by 53 · see citing works
Prenatal and Postnatal Hair Steroid Levels Predict Post-Partum Depression 12 Weeks after Delivery
Jahangard, L., Mikoteit, T., Bahiraei, S., Zamanibonab, M., Haghighi, M., Bahmani, D. S., & Brand, S. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8091290 · Cited by 53 · see citing works
The next stage for diagnosis: validity through utility
McGorry, P. D. (2013) · World Psychiatry · doi:10.1002/wps.20080 · Cited by 51 · see citing works
Longer-term increased cortisol levels in young people with mental health problems
Heinze, K., Lin, A. P., Reniers, R. L. E. P., & Wood, S. J. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.12.025 · Cited by 50 · see citing works
Herane-Vives, A., de Angel, V., Papadopoulos, A. S., Wise, T., Chua, K., Strawbridge, R., Castillo, D., Arnone, D., Young, A. H., & Cleare, A. J. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12852 · Cited by 41 · see citing works
Urinary free cortisol levels in obsessive-compulsive disorder
Gehris, T. L., Kathol, R. G., Black, D. W., et al. (1990) · Psychiatry Research · doi:10.1016/0165-1781(90)90081-f · Cited by 39 · see citing works
Dissociation between ACTH and cortisol response in DEX–CRH test in patients with panic disorder
Petrowski, K., Wintermann, G., Kirschbaum, C., & Bornstein, S. R. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.12.013 · Cited by 35 · see citing works
Hypersensitivity of 5-HT2 receptors in OCD patients
de Leeuw, A. S., & Westenberg, H. G. M. (2008) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.09.001 · Cited by 30 · see citing works
Hair cortisol in newly diagnosed bipolar disorder and unaffected first-degree relatives
Coello, K., Munkholm, K., Nielsen, F., Vinberg, M., & Kessing, L. V. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.09.020 · Cited by 28 · see citing works
Dunčko, R., Fischer, S., Hatch, S., Frissa, S., Goodwin, L., Papadopoulos, A., Cleare, A., & Hotopf, M. (2019) · Neuropsychobiology · doi:10.1159/000498920 · Cited by 27 · see citing works
van Zuiden, M., Savas, M., Koch, S. B. J., Nawijn, L., Staufenbiel, S. M., Frijling, J. L., Veltman, D. J., van Rossum, E. F. C., & Olff, M. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22395 · Cited by 26 · see citing works
Hair cortisol in drug-naïve first-episode individuals with psychosis
Andrade, E. H. S., Rizzo, L. B., Noto, C. D. S., Ota, V., Gadelha, A., Daruy-Filho, L., Tasso, B. D. C., Mansur, R. B., Cordeiro, Q., Belangero, S. I., et al. (2016) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2014-1634 · Cited by 23 · see citing works
Yang, J., Li, J., Xu, G., Zhang, J., Chen, Z., Lu, Z., & Deng, H. (2016) · PLoS ONE · doi:10.1371/journal.pone.0150729 · Cited by 22 · see citing works
Mayer, S. E., Snodgrass, M. D., Liberzon, I., Briggs, H., Curtis, G. C., & Abelson, J. L. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.02.001 · Cited by 21 · see citing works
Brand, S., Annen, H., Holsboer‐Trachsler, E., & Blaser, A. B. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.04.010 · Cited by 17 · see citing works
Brambilla, F., Bellodi, L., Perna, G., et al. (1997) · Psychiatry Research · doi:10.1016/s0165-1781(96)03009-0 · Cited by 16 · see citing works
Decoding the impact of adverse childhood experiences on the progression of schizophrenia
Hirt, V., Schalinski, I., & Rockstroh, B. S. (2019) · Mental Health & Prevention · doi:10.1016/j.mhp.2019.01.002 · Cited by 11 · see citing works
Associations of plasma testosterone with clinical manifestations in acute panic disorder
Masdrakis, V. G., Papageorgiou, C., & Markianos, M. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.11.017 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Mentis, A.-F. A., Lee, D., & Roussos, P. (2024) · Molecular Psychiatry · doi:10.1038/s41380-023-02047-6 · Cited by 75 · see citing works
Roos, R., Witteveen, A. B., Ayuso-Mateos, J. L., Barbui, C., Bryant, R. A., Felez-Nobrega, M., Figueiredo, N., Kalisch, R., Haro, J. M., McDaid, D., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05288-5 · Cited by 5 · see citing works
“Studies have found that HCC is related to PTSD, depression and anxiety disorders [40, 41] or with perceived job insecurity and work stress [42, 43].”
Background
- Authors
- Koumantarou Malisiova, E., Mourikis, I., Darviri, C., Nicolaides, N. C., Zervas, I. M., Papageorgiou, C., & Chrousos, G. P.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Venue
- Physiology & Behavior
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 229
- Pages
- 113244
- ISSN
- 0031-9384 (ISSN-L)
- OpenAlex
- W3103217176
- Cited by
- 99
- References
- 68
- Citations by year
- 2026: 15 · 2025: 15 · 2024: 23 · 2023: 27 · 2022: 8 · 2021: 11
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physiology & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- hair cortisol, HPA axis dysregulation, mental illness, depression, post-traumatic stress disorder, chronic stress, recurrence prediction, suicidality, drug abuse, self-reported stress
- MeSH terms
- Mental Disorders, Hair, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Stress, Psychological
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
