Skip to main content Accessibility help

Psychosocial predictors of salivary cortisol among older adults with depression

  • Jason M. Holland (a1), Johanna Rengifo (a2), Joseph M. Currier (a3), Ruth O’Hara (a4), Keith Sudheimer (a4) and Dolores Gallagher-Thompson (a4)...



Previous studies have identified a number of psychosocial risk factors of dysregulated cortisol (frequently referred to as the “stress hormone”) among older adults with depression. However, these studies have typically only examined a handful of risk factors at a time and have sometimes yielded inconsistent results.


This study aims to address this gap in the literature by simultaneously examining a range of relevant psychosocial predictors of diurnal cortisol among 54 older adults with a depressive disorder. Salivary cortisol was assessed upon awakening, at 5 PM, and at 9 PM across two consecutive days. Participants also completed measures of global psychosocial stress, current psychiatric symptomatology, pervasive distress (e.g. history of past depression), and protective factors (e.g. social support, resiliency, extent to which one has “made sense” of a significant stressor).


High levels of current depressive symptoms, psychiatric comorbidities, past depressive episodes, trait anxiety, and poorer ability to make sense of one's stress were found to be associated with flatter (more abnormal) cortisol slopes. However, when all of these variables were entered simultaneously in a multiple regression analysis, only history of past depression and the degree of sense made of stress emerged as unique predictors of cortisol in the model.


These findings have important implications for identifying depressed elderly individuals with dysregulated cortisol patterns who may be most at risk for health complications. Treatments that aim to limit the chronicity of depression and help to increase the sense made of stress could potentially have a positive impact on health.


Corresponding author

Correspondence should be addressed to: Jason M. Holland, Department of Psychology, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Box 455030, Las Vegas, Nevada 89154-5030, USA. Phone: +702-895-3703; Fax: +702-895-0195. Email:


Hide All
Aldwin, C. M. (1990). The Elders Life Stress Inventory: egocentric and nonegocentric stress. In Stephens, A. M. P., Crowther, J. H., Hobfoll, S. E. and Tennenbaum, D. L. (eds.), Stress and Coping in Late Life Families (pp. 4969). New York, NY: Hemisphere.
Beluche, I. et al. (2009). Persistence of abnormal cortisol levels in elderly persons after recovery from major depression. Journal of Psychiatric Research, 43, 777783. doi: 10.1016/j.jpsychires.2008.10.011.
Brown, E. S. and Chandler, P. A. (2001). Mood and cognitive changes during systemic corticosteroid therapy. The Primary Care Companion to the Journal of Clinical Psychiatry, 3, 1721. doi: 10.4088/PCC.v03n0104.
Brown, E. S., Varghese, F. P. and McEwen, B. S. (2004). Association of depression with medical illness: does cortisol play a role? Biological Psychiatry, 55, 19. doi: 10.1016/S0006-3223(03)00473-6.
Chapman, D. P. and Perry, G. S. (2008). Depression and a major component of public health for older adults. Preventing Chronic Disease, 5, A22.
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385396. doi: 10.2307/2136404.
Dickerson, S. and Kemeny, M. E. (2004). Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355391. doi: 10.1037/0033-2909.130.3.355 .
Greden, J. F. et al. (1980). Normalization of dexamethasone suppression test: a laboratory index of recovery from endogenous depression. Biological Psychiatry, 15, 449458.
Greden, J. F., Gardner, R., King, D., Grunhaus, L., Carroll, B. J. and Kronfol, Z. (1983). Dexamethasone suppression tests in antidepressant treatment of melancholia. The process of normalization and test-retest reproducibility. Archives of General Psychiatry, 40, 493500. doi: 10.1097/00004714-198310000-00025.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5661. doi: 10.1136/jnnp.23.1.56.
Hjortskov, N., Garde, A. H., Ørbæk, P. and Hansen, A. M. (2004). Evaluation of salivary cortisol as a biomarker of self-reported mental stress in field studies. Stress and Health, 20, 9198.
Holland, J. M., Currier, J. M., Coleman, R. A. and Neimeyer, R. A. (2010). The Integration of Stressful Life Experiences Scale (ISLES): development and initial validation of a new measure. International Journal of Stress Management, 17, 325352. doi:10.1037/a0020892.
Holland, J. M. et al. (2011). Cortisol outcomes among Caucasian and Latina/Hispanic women caring for a family member with dementia: a preliminary examination of psychosocial predictors and the effect of a psychoeducational intervention. Stress and Health, 27, 334346. doi: 10.1002/smi.1375.
Holsboer, F. (2000). The corticosteroid receptor hypothesis of depression. Neuropsychopharmacology, 23, 477501. doi: 10.1016/S0893-133X(00)00159-7.
Hooper, L. M., Stockton, P., Krupnick, J. L. and Green, B. L. (2011). Development, use, and psychometric properties of the trauma history questionnaire. Journal of Loss and Trauma, 16, 258283. doi: 10.1080/15325024.2011.572035.
Ice, G. H. (2005). Factors influencing cortisol level and slope among community dwelling older adults in Minnesota. Journal of Cross-Cultural Gerontology, 20, 91108. doi: 10.1007/s10823-005-9085-5.
John, O. P., Naumann, L. P. and Soto, C. J. (2008). Paradigm shift to the integrative big five trait taxonomy: history, measurement, and conceptual issues. In John, O. P., Robins, R. W. and Pervin, L. A. (eds.), Handbook of Personality: Theory and Research (pp. 114158). New York, NY: Guilford Press.
Koenig, H. G., Westlund, R. E., George, L. K., Hughes, D. C., Blazer, D. G. and Hybels, C. (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics, 34, 6169. doi: 10.1016/S0033-3182(93)71928-3 .
Kumari, M., Shipley, M., Stafford, M. and Kivimaki, M. (2011). Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. Journal of Clinical Endocrinology and Metabolism, 96, 14781485. doi: 10.1210/jc.2010-2137.
Ling, M. H., Perry, P. J. and Tsuang, M. T. (1981). Side effects of corticosteroid therapy. Psychiatric aspects. Archives of General Psychiatry, 38, 471477. doi: 10.1001/archpsyc.1981.01780290105011 .
Liotti, M., Mayberg, H. S., McGinnis, S., Brannan, S. L. and Jerabek, P. (2002): Unmasking disease-specific cerebral blood flow abnormalities: mood challenge in patients with remitted unipolar depression. American Journal of Psychiatry, 159, 18301840. doi: 10.1176/appi.ajp.159.11.1830.
Miller, G., Chen, E. and Zhou, E. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133, 2545. doi: 10.1037/0033-2909.133.1.25 .
Moskowitz, J. T. and Epel, E. S. (2006). Benefit finding and diurnal cortisol slope in maternal caregivers: a moderating role for positive emotion. The Journal of Positive Psychology, 1, 8391. doi: 10.1080/17439760500510510 .
Muthén, L. K. and Muthén, B. O. (1998–2010). Mplus User's Guide, 6th edn. Los Angeles, CA: Muthén & Muthén.
Neimeyer, R. A. (2009). Constructivist Psychotherapy: Distinctive Features. New York, NY: Routledge.
Ong, A. D., Bergeman, C. S. and Boker, S. M. (2009). Resilience comes of age: defining features in later adulthood. Personality, 77, 17771804. doi: 10.1111/j.1467-6494.2009.00600.x.
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the Geriatric Anxiety Inventory. International Psychogeriatrics, 19, 103114. doi: 10.1017/S1041610206003504.
Park, C. L. (2010). Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136, 257301. doi:10.1037/a0018301.
Polk, D. E., Cohen, S., Doyle, W. J., Skoner, D. P. and Kirschbaum, C. (2005). State and trait affect as predictors of salivary cortisol in healthy adults. Psychoneuroendocrinology, 30, 261272. doi: 10.1016/j.psyneuen.2004.08.004 .
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401. doi: 10.1177/014662167700100306.
Rosal, M. C., King, J., Ma, Y. and Reed, G. (2004). Stress, social support, and cortisol: inverse associations? Behavioral Medicine, 30, 1121. doi: 10.3200/BMED.30.1.11-22 .
Sapolsky, R. M., Krey, L. C. and McEwen, B. S. (1986). The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocrine Reviews, 7, 284301. doi: 10.1210/edrv-7-3-284 .
Sheehan, D. V. et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 2233.
Simpson, E. A., McConville, G. R., O’Conner, J. M., Stewart-Knox, B. J., Coudray, C. and Strain, J. J. (2008). Salivary cortisol, stress and mood in healthy older adults: the Zenith study. Biological Psychology, 78, 19. doi: 10.1016/j.biopsycho.2007.12.001.
Stetler, C. and Miller, G. E. (2011). Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research. Psychosomatic Medicine, 73, 114126. doi: 10.1097/PSY.0b013e31820ad12b.
Thoresen, S., Tambs, K., Hussain, A., Heir, T., Johansen, V. A. and Bisson, J. I. (2010). Brief measure of posttraumatic stress reactions: impact of Event Scale-6. Social Psychiatry and Psychiatric Epidemiology, 45 (3), 405412. doi: 10.1007/s00127-009-0073-x.
Vaishnavi, S., Connor, K. and Davidson, J. R. T. (2007). An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials. Psychiatry Research, 152, 293297. doi: 10.1016/j.psychres.2007.01.006.
van Eck, M. M., Nicolson, N. A., Berkof, H. and Sulon, J. (1996). Individual differences in cortisol responses to a laboratory speech task and their relationship to responses to stressful daily events. Biological Psychology, 43, 6984. doi: 10.1016/0301-0511(95)05159-7.
Zobel, A. W., Nickel, T., Sonntag, A., Uhr, M., Holsboer, F. and Ising, M. (2001). Cortisol response in the combined dexamethasone/CRH test as predictor of relapse in patients with remitted depression: A prospective study. Journal of Psychiatric Research, 35, 8394. doi: 10.1016/S0022-3956(01)00013-9.


Related content

Powered by UNSILO

Psychosocial predictors of salivary cortisol among older adults with depression

  • Jason M. Holland (a1), Johanna Rengifo (a2), Joseph M. Currier (a3), Ruth O’Hara (a4), Keith Sudheimer (a4) and Dolores Gallagher-Thompson (a4)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.