Impact of loneliness on diurnal cortisol in youth
Abstract
Loneliness is associated with multiple forms of psychopathology in youth. However, we do not yet know how loneliness gets "under the skin" in ways that may impact the long-term health and development of early adolescents. In particular, loneliness may influence youths' patterns of diurnal cortisol, an index of hypothalamic-pituitary-adrenal (HPA) axis functioning and a central predictor of health across the lifespan. The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, or COVID-19) pandemic represents a salient period in which to study the consequences of loneliness, as recent work has provided evidence that the physical-distancing measures put in place to contain the virus have resulted in greater loneliness, particularly among youth. Thus, the current study aimed to examine the prospective association between loneliness during the COVID-19 pandemic and diurnal cortisol in early adolescents. We found that greater loneliness was associated with higher levels of cortisol at waking and a blunted cortisol awakening response (CAR). These results held even when controlling for covariates that can influence diurnal trajectories of cortisol. Critically, this pattern of HPA-axis functioning increases risk for adverse mental and physical health outcomes across adolescence and into adulthood. This study is the first to examine the prospective association between loneliness and diurnal cortisol in early adolescence, and the first to identify mechanisms that contribut…
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Loneliness affects youth's diurnal cortisol, potentially causing chronic increases in cortisol in young adulthood, leading to higher risks of depression, anxiety, inflammation, and other adverse health outcomes.
“Loneliness affects youth’s diurnal cortisol, a key stress hormone [83, 84], potentially causing chronic increases in cortisol in young adulthood, leading to higher risks of depression, anxiety, inflammation, and other adverse health outcomes [85–87].”
From The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study (2025) · cites this paper as [87]
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MethodInfluentialCortisol awakening response and psychosocial factors: a systematic review and meta-analysis
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“Indeed, a blunted CAR prospectively predicts worsened mental and physical health (e.g., increases in depressive symptoms and body mass index) across the adolescent period (Nederhof et al., 2015; Ruttle et al., 2013) and into adulthood (Chida and Steptoe, 2009).”
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“Loneliness has been implicated in multiple forms of psychopathology, and there is reason to believe that loneliness could get “under the skin” in ways that influence youth’s long-term health and development (Qualter et al., 2010).”
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Understanding adolescent stress during the COVID-19 pandemic
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“On the one hand, greater loneliness in young people during the first wave of the COVID-19 pandemic was associated with higher levels of salivary cortisol upon awakening (Jopling et al., 2021).”
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“Moreover, Jopling et al. (2021) found that loneliness due to COVID-19 lockdown was associated with higher levels of cortisol at waking in young subjects.”
BackgroundEmotion regulation and diurnal cortisol: A longitudinal study of early adolescents
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Self-citationHow does loneliness “get under the skin” to become biologically embedded?
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“However, in other samples, greater mean loneliness levels were associated with a smaller (Jopling et al. 2021; Lai et al. 2018; Schutter et al. 2017), or not significantly different (Doane et al. 2013; Drake, Sladek, and Doane 2016; Montoliu, Hidalgo, and Salvador 2019) awakening response.”
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“Consistent with previous studies (e.g., Fries et al., 2009; LeMoult et al., 2015; Jopling et al., 2021), participants were instructed to collect saliva on each of two consecutive weekdays at the following time points: at waking while still in bed (Sample 1 [S1]); 30 minutes after waking (S2);…”
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“Loneliness affects youth’s diurnal cortisol, a key stress hormone [83, 84], potentially causing chronic increases in cortisol in young adulthood, leading to higher risks of depression, anxiety, inflammation, and other adverse health outcomes [85–87].”
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“…short-term longitudinal study conducted in the first wave of the COVID-19 pandemic, it was reported that greater loneliness was associated with higher cortisol levels of waking and with a blunted cortisol awakening response (CAR) in young people even after controlling for potential covariates [97].”
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“Furthermore, loneliness is consistently identified as a significant predictor of PSU in youths (Jopling et al., 2021a; 2021b; Longo et al., 2023).”
Schneider, S., Holtforth, M. G., Wettstein, A., Jenni, G., Kühne, F., Tschacher, W., & Marca, R. L. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286475 · Cited by 8 · see citing works
“Although certain previous findings were not consistent with this [31, 69], social isolation has often been associated with an increased CAR as an indicator of HPA-axis activation [28, 30, 70, 71].”
ResultPre-pandemic Psychobiological Features Predict Impact of COVID-19 Confinement on Loneliness
Baliyan, S., Cimadevilla, J. M., Pulopulos, M. M., Castillejo, L., Sandi, C., & Venero, C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.874232 · Cited by 6 · see citing works
“In contrast, other studies found either no relationship between loneliness and cortisol (Cacioppo et al., 2002), a flattening of the diurnal cortisol rhythm (Doane and Adam, 2010), or even a smaller cortisol awakening response (Jopling et al., 2021).”
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“Several reports have associated social isolation and loneliness with elevated levels of cortisol and a flattening of its diurnal rhythm, suggesting HPA perturbations (Doane and Adam, 2010; Jopling et al., 2021; Grant et al., 2009).”
Attention to social threat predicts diurnal cortisol dynamics during the high school transition
Jopling, E. N., Tracy, A., & LeMoult, J. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107226 · Cited by 4 · see citing works
“In support of this proposition, recent work has documented associations between attentional bias to social threat and cortisol hyperreactivity in response to a socio-evaluative laboratory stressor in youth (Jopling et al., 2021).”
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“…to the effects on later life outcomes (van den Bergh et al., 2020). in line with this, associations between hPa axis regulation and pandemic-related stressors have been shown in both children and adults (ahrens et al., 2022; haucke et al., 2022; Jopling et al., 2021; Perry et al., 2022).”
BackgroundResultPsychometric analysis of the three item loneliness scale in the Czech Republic
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Dziurkowska, E., Guz-Rzeniecka, G., & Dziurkowski, M. (2025) · Biomedicines · doi:10.3390/biomedicines13030697 · Cited by 1 · see citing works
“Previous studies indicated that cortisol levels increased during the pandemic, which was mainly due to perceived anxiety and loneliness [40,41].”
Li, M., He, F., Lan, Q., Zhang, C., Zang, Y.-Y., & Wang, L. (2024) · Infant and Child Development · doi:10.1002/icd.2541 · Cited by 1 · see citing works
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“Also, as mentioned above, both depression and loneliness have been associated with altered HPA axis (re)activity (Jopling et al., 2021; S. et al., 2017; Zajkowska et al., 2022).”
BackgroundLi, B., & Zhao, L. (2026) · Ageing Research Reviews · doi:10.1016/j.arr.2026.103396
Zhu, X., Liu, X., Zhai, B., Hou, X., Huo, L., & Li, J. (2026) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2026.100356
“For example, some studies report heightened cortisol awakening responses (CAR) among lonelier individuals [3], whereas others observe blunted CAR [4,5] or null associations [6].”
Saurabh, A., Baumer, Y., Mendelsohn, L. G., Peterson, E. M. A., Sandler, D., Leon, S. J. L. D., Dave, A., Baez, A. S., Ortiz-Whittingham, L. R., Pita, M. A., et al. (2026) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2026.107870
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
Nguyen, T., Zillich, L., Çetin, M., Hall, A. S. M., Foo, J., Sirignano, L., Frank, J., Send, T., Gilles, M., Rietschel, M., et al. (2022) · medRxiv · doi:10.1101/2022.02.03.22270311
“Pandemic related circumstances may influence diurnal cortisol patterns (Jopling et al., 2021).”
Background
- Authors
- Jopling, E., Rnic, K., Tracy, A., & LeMoult, J.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Jopling, Ellen
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 132
- Pages
- 105345
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W3173799733
- Cited by
- 32
- References
- 0
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 1
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (PJT-156053)
- Social Sciences and Humanities Research Council of Canada (430-2017-00408)
- Natural Sciences and Engineering Research Council of Canada (RGPIN-2018-04837)
- The University of British Columbia
- Michael Smith Foundation for Health Research (17713)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- loneliness, diurnal cortisol, cortisol awakening response, hypothalamic-pituitary-adrenal axis, early adolescence, youth, COVID-19 pandemic, social distancing, mental health
- MeSH terms
- COVID-19, SARS-CoV-2, Adolescent, Circadian Rhythm, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Loneliness, Male, Pituitary-Adrenal Function Tests, Pituitary-Adrenal System, Saliva
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