Associations between symptoms of depression and anxiety and cortisol responses to and recovery from acute stress

Background: Anxiety disorders and major depressive disorder (MDD) have been associated with increased and blunted HPA axis reactivity to social stress. However, research focusing on associations between HPA axis responses to stress and symptoms of anxiety and depression among individuals without a diagnosis remains an understudied area of research. Methods: One hundred forty-three adults (52% female) completed the Trier Social Stress Test (TSST). Symptoms of depression and anxiety were assessed prior to the TSST using the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS). HPA axis responses were assessed by measuring salivary cortisol at baseline and following the TSST. Reactivity to and recovery from stress were assessed using multilevel growth modeling controlling for age, BMI, and sex among the full sample and a subset of cortisol responders (n=72). Results: Anxiety symptoms were positively associated with flatter recovery slopes among the full sample (t (122.3)=2.082, p=.039). Among cortisol responders, depression symptoms were associated with steeper reactivity (t(63.32)=2.53, p=.026) and recovery (t(58.75)=2.20, p=.03). Anxiety symptoms were associated with marginally flatter reactivity (t(64.00)=1.97, p=.053) and significantly flatter recovery (t (59.22)=2.29, p=.025). Conclusion: Symptoms of anxiety and depression among individuals without a psychiatric diagnosis are associated with blunted and exaggerated cortisol responses to and recovery from stress. Such patterns could indicate increased risk for unhealthy HPA axis dysregulation, allostatic load, and disease.