The DOI matches its Crossref record; 153 of the 154 references it cites were found in a registry or an index.
Stress-related and basic determinants of hair cortisol in humans: A meta-analysis
Abstract
The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol levels, which is increasingly used in psychoneuroendocrinological research. Here, we conduct a first comprehensive meta-analysis of HCC research based on aggregated data from a total of 124 (sub)samples (66 independent studies; total N=10,289). We seek to answer two central questions: (i) Which covariates and basic features of HCC need to be considered in future research? (ii) What are the main determinants of HCC in terms of chronic stress exposure and mental health? Concerning basic characteristics, our findings identify several covariates to be considered (age, sex, hair washing frequency, hair treatment, oral contraceptive use), confirm a decline of HCC from the first to the second proximal 3cm hair segment, and show positive associations between HCC and short-term salivary cortisol measures. Regarding chronic stress, we show that stress-exposed groups on a whole exhibit 22% increased HCC. This long-term cortisol hypersecretion emerges particularly when stress is still ongoing at the time of study (+43% HCC) but is not present in conditions of past/absent stress (-9% HCC, n.s.). We also report evidence for 17%-reduced HCC in anxiety disorders, such as PTSD. Interestingly, no consistent associations with mood disorders and self-reports of perceived stress, depressiveness or social support are found. However, our findings reveal positive associations of HCC with stress-related anthropometric (body mass index, waist-to-hip ratio) and hemodynamic measures (systolic blood pressure). These meta-analytic results are discussed in the light of their practical implications and important areas for future inquiry are outlined.
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“Meta-analytic and descriptive reviews show that chronic stress is associated with elevated long-term cortisol secretion (Stalder et al., 2017; Staufenbiel et al., 2013), with stressor duration and recency since stressor onset being important factors in shaping basal cortisol levels (Miller et al., 2007).”
From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“Elevated hair cortisol levels in stressed populations have previously been found (reviewed in Stalder et al., 2017; Staufenbiel et al., 2013).”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“However, the first meta-analytic review, which included primarily cross-sectional studies, did not show consistent links with self-reported depressiveness (Stalder et al., 2017).”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“Cross-sectional studies have shown elevated hair cortisol in stressed populations (Stalder et al., 2017; Staufenbiel et al., 2013)”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“Our results are consistent with a recent meta-analysis that found no clear relationships between hair cortisol and self-reported depressiveness (Stalder et al., 2017).”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
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The effects of the chemical relaxer lye on hair cortisol concentrations
Burnett, C. L., Crandall, K., Osbourn, D. M., & Buchanan, T. W. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107750
Bias in hair cortisol measures for psychological stress: Self vs. professional collection
Gatny, H., Axinn, W. G., Ghimire, D. J., West, B. T., Hermosilla, S., Pradhan, S. M., Dixit, S., & Chaudary, I. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107775
Hou, X., Xie, M., Yi, S., Wei, G., Deng, H., & Lin, D. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107770
Ding, X., Hou, X., & Deng, H. (2026) · Journal of Mechanics in Medicine and Biology · doi:10.1142/s0219519426400233
Huc, M., Jouzizadeh, M., Bush, K., Lui, K., McQuaid, R. J., & Jaworska, N. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121473
Biology, conflict, and mental health: New Insights on a Critical and Growing Global Issue
Jankovic‐Rankovic, J., & Gettler, L. T. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107843
Miller, M. A., Brown, R. D., Krautkramer, C., Gogia, R., Fritz, H., Wylie, D., Kinney, K. L., & Champagne, F. A. (2026) · PLoS ONE · doi:10.1371/journal.pone.0346517
Recognition of adaptive stress response patterns in adolescents based on multiple hair biomarkers
Shen, S., Wang, W., Su, S., Liu, S., & Shen, H. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1720146
Stress responses and habituation across biological systems: The role of trait and state resilience
Barthel, M.-C., Muehlhan, M., Alexander, N., & Vogel, S. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107861
Self-citationHair Cortisol Concentrations in Children: A Longitudinal Analysis Across Childhood
Baos-González, M. Á., Echarri-Lorente, J. D., García‐León, M. Á., González-Pérez, R., & Peralta‐Ramírez, M. I. (2026) · Developmental Psychobiology · doi:10.1002/dev.70154
“The HCC method is thus gaining popularity because it is noninvasive, painless, easy to collect and store, and able to provide an index of long-term cortisol exposure (Li et al. 2023 ; Malisiova et al. 2021 ; Stalder et al. 2017 ).”
Yi, S., Hou, X., Xu, G., Zhai, T., Zhong, X., Gao, W., & Deng, H. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107871
Pregnancy cortisol and postpartum depression: The moderating role of optimism
Giles, L., Perrot, T. S., Tulipan, T., Allen, V. M., Campbell-Yeo, M. L., & Khoury, J. E. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107874
Oculometric Function More Strongly Predicts Working Memory than Stress in Military Officers
McGuire, M., Bahrani, N., Kennedy, Q., & Liston, D. B. (2026) · Journal of Eye Movement Research · doi:10.3390/jemr19030046
“These findings suggest that chronic stress may alter baseline executive capacity rather than merely perturb performance during acute episodes [13,15].”
Schommer, S., Drost, L., Finke, J., & Schulz, A. (2026) · Biological Psychology · doi:10.1016/j.biopsycho.2026.109283 · Cited by 1
Hollandt, M., Richter, J., & Wirkner, J. (2026) · Journal of Experimental Psychopathology · doi:10.1177/20438087261443727
“In addition, there is evidence that hair growth rates differ, for example, between sex or race identities, and that stress per se might affect hair growth rate, making it difficult to precisely trace back time intervals (Greff et al., 2019; Stalder et al., 2017; but see Dettmer et al., 2023).”
InfluentialChanges in hair cortisol among Brazilian adolescents before and during the COVID-19 pandemic
Luciana, T.-R., Carpena, M. X., Maruyama, J. M., González, A., Bar, A. J., Santos, I. S., Oliveira, I. O., Tormen, A., Schuch, J. B., Matijasevich, A., et al. (2026) · Scientific Reports · doi:10.21203/rs.3.rs-9436198/v1
Hutloff, E. J., Jaramillo, I., Bergunde, L., Garthus‐Niegel, S., & Steudte‐Schmiedgen, S. (2026) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2026.100354
“Here, the assessment of steroids in hair, pioneered by Prof. Clemens Kirschbaum and his lab among the early investigators in this field [13,14], allows for a retrospective assessment of cumulated steroids up to several months [5].”
Self-citationYang, J., Xiao, Z., Hu, W., Rekemubieke, B., & Li, Y.-H. (2026) · Nutrition Journal · doi:10.1186/s12937-026-01339-1
“Third, maternal choline intake may attenuate the activation of hypothalamic-pituitary-adrenal axis [49], leading to the reduction of cortisol level and further promoting fetal growth [50, 51].”
Welsh, A. M., Smith, J., Lehrer, H. M., Montero‐Zamora, P., Dubois, S. K., Harrison, L., Tanaka, H., & Steinhardt, M. A. (2026) · Contemporary Clinical Trials · doi:10.1016/j.cct.2026.108366
Jankovic‐Rankovic, J., Oka, R., Meyer, J. S., & Gettler, L. T. (2026) · American Journal of Human Biology · doi:10.1002/ajhb.70284
“…are composed primarily of keratin, through similar mechanisms as in hair, which is a more commonly used medium to measure the body's longer-term production of cortisol (e.g., over the previous month; de Berker et al. 2007; Russell et al. 2012; Stalder and Kirschbaum 2012; Stalder et al. 2017).”
Daley, C., Pathmaraj, M., Haodong, T., Verner, M.-A., & Caron-Beaudoin, É. (2026) · Hygiene and Environmental Health Advances · doi:10.1016/j.heha.2026.100187
Ethnic and Racial Discrimination and Biological and Physiological Processes among Adolescents
Xie, M., Lu, X., Liang, C., Yang, Y., & Jiang, Y. (2026) · Cambridge University Press eBooks · doi:10.1017/9781009351478.013
Hair cortisol as psychotherapy process parameter – an inpatient pediatric psychosomatic study
Botschek, T., Röhlich, A., & Brosig, B. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1867478
Katab, A., Kolehmainen, N., Cheetham, T. D., Arnott, B., & Craw, O. A. (2026) · Research Square · doi:10.21203/rs.3.rs-9791429/v1
Gao, M., Yin, H., GAO, C., & Wang, H. (2026) · Medicine · doi:10.1097/md.0000000000049804
“[58] Finally, the speculative interpretations regarding the nonlinear vital capacity findings are not directly testable with our cross-sectional data and should be interpreted with caution.”
Liu, Y., Tam, B. T., Chan, S.-Y., Wang, Y.-Y., Wan, K., Chung, W.-L., Taddese, A. A., & Chan, K. Y. (2026) · World Journal of Pediatrics · doi:10.1007/s12519-026-01064-z
“Hair cortisol levels will be used as an indicator of chronic physiological stress and as a psychological marker [48, 49].”
Pokushalov, E., Terebenin, E., Ponomarenko, A., Sinyuk, Y., Samoilov, A., Gigovskaya, T., Bubnovskaya, M., Kudlay, D. A., Trubicina, E., Garcia, C., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0352095
Self-citationPoudel‐Tandukar, K., Laws, H., Martell, C. R., Rai, S., Ramdam, R., Meyer, J. S., Bertone‐Johnson, E. R., Jacelon, C. S., & Hollon, S. D. (2026) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796026100742
“First,taken together,previouslypublishedstudieshavefoundnoconsistent relationshipbetweenhaircortisolandperceivedstress(Gerber et al. , 2012; Stalder et al. , 2017; Prado-Gascó et al. , 2019).”
Huthsteiner, K., Finke, J. B., Klucken, T., & Tobias Stalder, A. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107985
Self-citationFlorentino, S. A., Kaszluga, C. J., Bui, V., Hirpara, A., Warren, J., Narendran, N., Berk, A. N., Good, L., & Belding, J. (2026) · Neurochirurgie · doi:10.1016/j.neuchi.2026.101866
Qin, P., & Steptoe, A. (2026) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2026.100377
“Compared with traditional approaches, quantification of cortisol and cortisone levels in hair have the advantage of reflecting integrated systemic glucocorticoid secretion over the preceding months due to the approximate growth rate of 1 cm/month for scalp hair [9].”
Jancic, P., Kovac, I., Demirtas, H. E., Knežević, N. N., & Lubinsky, G. T. (2026) · Biomolecules · doi:10.3390/biom16081183
“Hair cortisol concentration is influenced by BMI, hair characteristics, and oral contraceptive use, and a comprehensive meta-analysis found no consistent association between HCC and self-reported perceived stress or depressive symptoms [74].”
Guo, Y., Liu, J., Peng, Y., & Li, X. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1922174
“However, different biological matrices capture distinct temporal windows and biological dimensions of glucocorticoid exposure and should not be considered interchangeable (24, 26).”
InfluentialAbbasi‐Asl, R., Keces, N., Lerner, R. M., Mackin, M., Zhang, R., Dowling, E. M., Tirrell, J. M., Hasse, A., Olander, K., Larkan, A., et al. (2026) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.70212
Liblub, S., McLaughlin, K., Pringle, K. G., & Cummins, A. M. (2026) · European Journal of Midwifery · doi:10.18332/ejm/226733
“Cortisol is a well-established and accessible indicator of physiological stress because it reflects activation of the hypothalamic–pituitary–adrenal (HPA) axis 10,11 .”
Fitzke, R. E., Raudales, A. M., Ferguson, J. J., Egan, A., Mahoney, C. T., Günsoy, C., & Weiss, N. H. (2026) · Substance Use & Misuse · doi:10.1080/10826084.2026.2727142
Mikkelsen, S., Forman, J. L., Andersen, J. H., Flachs, E. M., Grynderup, M. B., Hansen, Å. M., Kærlev, L., Kolstad, H. A., Rugulies, R., Skaaby, S., et al. (2026) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-026-02209-3
“A systematic review with meta-analyses of associations between HCC and chronic stress-exposure showed a positive association with ongoing but not with past chronic exposure, and not with perceived stress (Stalder et al. 2017).”
Sharif, H. A., Mohammed, I. N., Hossain, M. I., Heilbronner, U., Schulze, T. G., Kizilhan, J. I., & Hautzinger, M. (2026) · BJPsych Open · doi:10.1192/bjo.2026.12096
Liedtke, C., Schaefer, M., & Enge, S. (2026) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.70217
“In the realm of physiological stress research, the analysis of hair cortisol concentrations (HCC) is an innovative and non-invasive method to retrospectively assess cumulative cortisol levels (Stalder et al., 2017).”
InfluentialCibulcova, V., Elavsky, S., Cipryan, L., Jackowska, M., Dostal, T., Jiřík, V., Jandačka, D., & Jandackova, V. K. (2026) · Stress · doi:10.1080/10253890.2026.2721526
Khuzaiyah, S., Kristiyanti, R., Anindyajati, G., & Caparrós-González, R. A. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1796186
“These characteristics make hair cortisol particularly suitable for population studies conducted in resource-constrained environments (46).”
Litzenberger, N., Jenni, G., & Wettstein, A. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1880670
Fortuna, F., Ocagli, H., Lima, L. S., Suraci, F., González, D., Jamardo, J., Jacobsen, D., Fritzler, A., Ibar, C., Gomez, M. E., et al. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.108029
Schindler‐Gmelch, L., Fuhrmann, L. M., Steudte‐Schmiedgen, S., & Berking, M. (2026) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2026.100380
“…laboratories of Dirk Hellhammer and Clemens Kirschbaum, who established salivary cortisol analyses for psychobiological research [e.g., 1], the Trier Social Stress Test as the state-of-the-art laboratory stress protocol [2], and hair analyses for studying long-term endocrine processes (e.g.,[3,4]).”
InfluentialSelf-citationZlatkova, K., Kerson, C. R., Sherman, R., & Bendinskas, K. G. (2026) · NeuroRegulation · doi:10.15540/nr.13.3.220
Bu, L., & Wang, Z. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2730909
“Hair cortisol reflects integrated HPA-axis activity over a recent window and is affected by multiple biological and psychosocial determinants (Stalder et al., 2017; Stalder & Kirschbaum, 2012).”
Long-term cortisol exposure and echocardiographic measures of cardiac structure and function
Söderholm, S., Faresjö, Å., Kylhammar, D., Östgren, C. J., Cantù, C., & Iredahl, F. (2026) · Heart · doi:10.1136/heartjnl-2026-328566
Bruun, C. F., Long, C., Krogh, H. B., Zarp, J., Coello, K., Frikke‐Schmidt, R., Ostrowski, S. R., Nielsen, F., Giraldi, A. G. E., Vinberg, M., et al. (2026) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2026.111964
Cordero, G. A., Хайтович, М. В., Удовицький, В. В., Rogozin, V. V., & Усенко, В. О. (2026) · Clinical and Preventive Medicine · doi:10.31612/2616-4868.7.2026.20
Törnhage, C., Robertz, A.-C., Kantzer, A., & Nilsson, S. (2026) · International Journal of Pediatrics · doi:10.1155/ijpe/5891199
Frost, A., Shartle, K., Gallis, J. A., Carías, M. E., Lin, W.-C., Collins, A. J., Aikat, D., Hagaman, A. K., Bhalotra, S. R., Baranov, V., et al. (2026) · Stress and Health · doi:10.1002/smi.70239
“Prior research indicates that stress exposure is associated with increased HPA axis activity, often indexed by elevated cortisol and cortisone levels in hair (Li et al. 2023; Stalder et al. 2017; Vanaelst et al. 2013).”
Ahmad, M., Sechi, C., Fadda, R., Congiu, S., Lucarelli, L., & Vismara, L. (2026) · Infant Behavior and Development · doi:10.1016/j.infbeh.2026.102269
Biomarkers of stress across biological systems: conceptual and measurement perspectives
Weiss, S. J., El-Refaay, S. M. M., Keeton, V. F., Longoria, K., Adynski, H., & Leung, C. Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1895140
Metadata
- Authors
- Stalder, T., Steudte-Schmiedgen, S., Alexander, N., Klucken, T., Vater, A., Wichmann, S., Kirschbaum, C., & Miller, R.
- Affiliations
- Universität Hamburg (DE)
- University of Siegen (DE)
- Technische Universität Dresden (DE)
- MSB Medical School Berlin (DE)
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 77
- Pages
- 261-274
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2512922965
- Semantic Scholar
- 78b482bd463a2e29e2aae66b9cf8e24a66b06fe6
- Cited by
- 855
- References
- 154
- Citations by year
- 2026: 83 · 2025: 100 · 2024: 123 · 2023: 101 · 2022: 88 · 2021: 111 · 2020: 95 · 2019: 74 · 2018: 56 · 2017: 23
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- German Research Foundation (1213/5-1, 940/2)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Animal Behavior and Welfare Studies
- Keywords
- hair cortisol, chronic stress, cortisol hypersecretion, salivary cortisol, anxiety disorders, post-traumatic stress disorder, mood disorders, perceived stress, body mass index, waist-to-hip ratio, systolic blood pressure, hair treatment, oral contraceptive use
- MeSH terms
- Hair, Hemodynamics, Humans, Hydrocortisone, Stress, Psychological
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