The role of peripheral cortisol levels in suicide behavior: a systematic review and meta-analysis of 30 studies
Abstract
Cortisol can be considered as one biomarker for diagnosis of suicide; nevertheless, several studies have shown conflicting results. This study aimed to evaluate the levels of cortisol in individuals with suicide behavior and controls (healthy or with other psychiatric disorders). Published articles were searched on online databases (PubMed, Scopus and EBSCO). Standardized mean differences (SMD), heterogeneity, publication bias and sensitivity were assessed using the Comprehensive Meta-Analysis (CMA) statistical software. The meta-analysis comprised 30 studies that provided 1775 cases, and 2162 controls (696 healthy individuals and 1465 individuals with other psychiatric diagnoses). The pooled results revealed that cortisol levels were higher in individuals with suicide behavior (SMD = 0.92, 95%CI = 0.26; 1.57, P = 0.006; I 2 = 88%, Q < 0.001) than healthy controls. However, individuals with suicide behavior showed decreased levels of cortisol in the morning. Additionally, individuals with suicide behavior showed lower levels of cortisol than psychiatric controls (SMD = -1.79, 95%CI = -3.01; -0.58, P = 0.004, I 2 = 89%, Q < 0.001). Morning cortisol levels in individuals with suicide behavior were higher than morning cortisol levels in psychiatric controls. Our updated meta-analysis suggests that peripheral levels of cortisol have a role in suicide behavior.
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When suicidal individuals were compared to psychiatric controls rather than healthy individuals, cortisol levels were significantly lower.
“Additionally, when suicidal individuals were compared to psychiatric controls rather than healthy individuals, cortisol levels were significantly lower.”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [89]
When morning cortisol was examined specifically, levels were lower in suicidal individuals relative to healthy controls.
“However, when morning cortisol was examined specifically, levels were paradoxically lower in suicidal individuals relative to healthy controls, highlighting the importance of circadian timing in hormonal assessment.”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [89]
A large meta-analysis including 30 studies with over 1,700 individuals with suicidal behavior and 2,000 controls reported that individuals with suicidal ideation or attempts had higher overall cortisol levels than healthy controls.
“A large meta-analysis including 30 studies with over 1,700 individuals with suicidal behavior and 2,000 controls reported that individuals with suicidal ideation or attempts had higher overall cortisol levels than healthy controls (89).”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [89]
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Salehi, M., Saeidi, M., Amanat, M., Barias, T., Anyeji, U., Alzein, O., & Gunturu, S. (2026) · Frontiers in Pediatrics · doi:10.3389/fped.2026.1738009
“A large meta-analysis including 30 studies with over 1,700 individuals with suicidal behavior and 2,000 controls reported that individuals with suicidal ideation or attempts had higher overall cortisol levels than healthy controls (89).”
- Authors
- Hernández-Díaz, Y., González-Castro, T. B., Tovilla-Zárate, C. A., Juárez-Rojop, I. E., López-Narváez, M. L., Pérez-Hernández, N., Rodríguez-Pérez, J. M., Genis-Mendoza, A. D., & Nicolini, H.
- Affiliations
- National Institute of Genomic Medicine (MX)
- ORCID
- Nicolini, Humberto
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 293
- Pages
- 113448
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W3088247078
- Cited by
- 25
- References
- 61
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 2
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- cortisol, suicidal behavior, diurnal cortisol rhythm, morning cortisol, mental illness, suicide risk
- MeSH terms
- Mental Disorders, Humans, Hydrocortisone, Suicide, Suicide, Attempted, Biomarkers, Case-Control Studies, Suicidal Ideation
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