A meta-analysis and systematic review of the association between cortisol and the beginning of depression symptoms in adolescents and young adults.

Abstract

Introduction: The incidence of major depressive disorder (MDD) in adults has been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated secretion of cortisol. However, limited research has been done globally on how the dysregulated HPA axis and changed cortisol levels relate to depression in adolescents and young adults. The objective of this research was to conduct a systematic review and meta-analysis of the association between cortisol level, a marker of HPA axis activity, and depression in adolescents and young adults.

Material and methods: A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals written in English. The odds ratio (OR) and standard mean difference (SMD) were calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane c2 and I2 statistics and the appropriate P-value. The analysis used RevMan 5.3.

Results: The current meta-analysis included 10 cross-sectional studies with a total of 1301 adolescents and young adults across various age cohorts, with 629 depressed and 672 non-depressed individuals. It was found that the likelihood of depression is higher among the included adolescents and young adults, with an OR of 1.62 (95% CI: 0.44-5.92), and depressed individuals have significantly higher cortisol levels (SMD of 0.87 (95% CI 0.43-1.31) and cortisol stress response SMD of 0.68 (95% CI 0.31-1.05)). Furthermore, there was a strong positive linear association ( r = 0.82) between morning and afternoon cortisol levels in adolescents and young adults and depression scores.

Conclusions: The results of our study indicate that an increase in both morning and afternoon cortisol levels is associated with the development of depression in adolescence and young adults. Research has indicated that an increased level of cortisol is considered a risk factor for depression during adolescence and a linear correlation exists between cortisol levels and depression scores.