Symptom-specific associations between low cortisol responses and functional somatic symptoms: The TRAILS study
Open accessAbstract
Background Functional somatic symptoms (FSS), like chronic pain and overtiredness, are often assumed to be stress-related. Altered levels of the stress hormone cortisol could explain the association between stress and somatic complaints. We hypothesized that low cortisol levels after awakening and low cortisol levels during stress are differentially associated with specific FSS.Methods This study is performed in a subsample of TRAILS (Tracking Adolescents' Individual Lives Survey) consisting of 715 adolescents (mean age: 16.1 years, SD=0.6, 51.3% girls). Adolescents' cortisol levels after awakening and during a social stress task were assessed. The area under the curve with respect to the ground (AUCg) and the area under the curve above the baseline (AUCab) were calculated for these cortisol levels. FSS were measured using the Youth Self-Report and pain questions. Based upon a factor analysis, FSS were divided into two clusters, one consisting of headache and gastrointestinal symptoms and the other consisting of overtiredness, dizziness and musculoskeletal pain.Results Regression analyses revealed that the cluster of headache and gastrointestinal symptoms was associated with a low AUCg of cortisol levels during stress (β=-.09, p=.03) and the cluster of overtiredness, dizziness and musculoskeletal pain with a low AUCg of cortisol levels after awakening (β=-.15, p=.008). All these analyses were adjusted for the potential confounders smoking, physical activity level, depression, corticosteroid use, oral contraceptive use, gender, body mass index and, if applicable, awakening time.Conclusion Two clusters of FSS are differentially associated with the stress hormone cortisol.
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Recent studies suggest a potential correlation between physiological stress and FSS, with physical inactivity as a potential covariate.
“Recent studies suggest a potential correlation between physiological stress and FSS, with physical inactivity as a potential covariate.13–16”
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- Authors
- Janssens, K. A. M., Oldehinkel, A. J., Verhulst, F. C., Hunfeld, J. A. M., Ormel, J., & Rosmalen, J. G. M.
- Affiliations
- University Medical Center Groningen (NL)
- Erasmus MC - Sophia Children’s Hospital (NL)
- Erasmus MC (NL)
- Corresponding author
- Janssens, Karin A.M.
- ORCID
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 37
- Issue
- 3
- Pages
- 332-340
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2026806581
- Cited by
- 56
- References
- 39
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 2 · 2020: 7 · 2019: 6 · 2018: 6 · 2017: 2 · 2016: 5 · 2015: 8 · 2014: 1 · 2013: 2 · 2012: 2
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- European Science Foundation (FP-006)
- Rijksuniversiteit Groningen
- ZonMw (GB-MW 940-38-011, 100 – 001-004, 261-98-710, 175.010.2003.005, 60-60600-98-018, 60‐60600‐97‐118, 60600)
- Fondation pour la Recherche Médicale
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (GB-MW 940-38-011, GB‐MaGW 452‐06‐004, GB‐MaGW 480‐01‐006, 261-98-710, GB-MaGW 457-03-018, 60-60600-97-118, 452‐06‐004, GB‐MaGW 480‐07‐001, 480‐07‐001, 100‐001‐004, 940-38-011, 175.010.2003.005, 60-60600-98-018, 60600, GB-MaGW 452-04-314, 452‐04‐314, 480-01-006)
- Wetenschappelijk Onderzoek- en Documentatiecentrum
- Medical Research Council (GB-MW 940-38-011)
- Erasmus Universitair Medisch Centrum Rotterdam
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- functional somatic symptoms, cortisol, stress, adolescents, headache, gastrointestinal symptoms, dizziness, musculoskeletal pain, stress hormones
- MeSH terms
- Adolescent, Female, Humans, Hydrocortisone, Male, Pituitary-Adrenal Function Tests, Psychomotor Performance, Saliva, Somatoform Disorders, Stress, Psychological, Wakefulness, Biomarkers
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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.
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