Anxiety disorders and salivary cortisol levels in older adults: a population-based study
Open accessAbstract
Context The hypothalamic-pituitary-adrenal (HPA) axis is one of the body's main systems that controls response to stress. It acts through the hormone cortisol. While the dysregulation of cortisol has been associated with anxiety disorders, the evidence is inconsistent. Moreover, only a few small studies have assessed this relationship in older adults.Objective To determine whether in adults aged 65 years and over there is a difference in daily cortisol pattern between those with and without an anxiety disorder.Methods The study population comprised 1788 older adults from a population-based cohort. The Munich version of the Composite International Diagnostic Interview was used to diagnose anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, agoraphobia and panic disorder). The cortisol awakening response and total cortisol secretion over the day were calculated from cortisol levels in four saliva samples taken over the course of one day (at awakening, 30min after awakening, at 1700h, at bedtime).Results Older adults with an anxiety disorder (n=145, median duration since first symptoms 41 years) had a lower cortisol awakening response (p=0.02) than those without such a disorder (n=1643). This association was most prominent in those with generalized anxiety disorder (p=0.008), but was not associated with the extent of chronicity of anxiety disorders.Conclusion Older adults from the general population with long-lasting anxiety disorders had a lower cortisol awakening response than those without. This is consistent with the notion that chronic anxiety may result in downregulation of HPA-axis activity. Longitudinal studies are needed to confirm this mechanism.
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Other reports have shown decreased cortisol levels or no differences in HPA axis function in those with GAD, PD, and phobia.
“Although these data suggest that increased HPA axis functioning and GR dysregulation is present in these fear-and anxiety-based disorders, other reports have shown decreased cortisol levels or no differences in HPA axis function in those with GAD, PD, and phobia (Hek et al, 2013;van Veen et al, 2008).”
From Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond (2017) · cites this paper as Hek et al, 2013
The Results and Table 2 report a lower cortisol awakening response in older adults with GAD, lower total cortisol secretion in those with specific phobia, and no significant differences on several other subtype measures. The paper says there were too few panic disorder cases to assess separately, so it does not establish the claimed pattern for PD. (LLM, conf=0.86)
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- Authors
- Hek, K., Direk, N., Newson, R. S., Hofman, A., Hoogendijk, W. J. G., Mulder, C. L., & Tiemeier, H.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Tiemeier, Henning
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 38
- Issue
- 2
- Pages
- 300-305
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2099827792
- Cited by
- 116
- References
- 18
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 4 · 2023: 7 · 2022: 9 · 2021: 11 · 2020: 12 · 2019: 6 · 2018: 5 · 2017: 12 · 2016: 15 · 2015: 7 · 2014: 13 · 2013: 4
- FWCI
- 3.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Funders
- Erasmus MC
- Erasmus University Rotterdam
- the Netherlands Organization for Scientific Research (NWO)
- the Netherlands Organization for Health Research and Development (ZonMw)
- the Research Institute for Diseases in the Elderly (RIDE)
- the Ministry of Education, Culture and Science
- the Ministry of Health, Welfare and Sports
- the European Commission (DG XII)
- Municipality of Rotterdam
- BavoEuropoort
- the Netherlands Consortium for Healthy Ageing
- Unilever R&D UK
- ZonMW (2009-017.106.370)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- anxiety disorders, salivary cortisol, cortisol awakening response, hypothalamic-pituitary-adrenal axis, older adults, generalized anxiety disorder, chronic anxiety, stress response
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Anxiety Disorders, Female, Humans, Hydrocortisone, Male, Psychiatric Status Rating Scales, Saliva, Wakefulness, Cohort Studies
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