Longitudinal Trends in Stress-Related Endocrine Markers and Mental Health Outcomes Among Hospitalized Patients in Saudi Arabia Before, During, and After the COVID-19 Pandemic: A Retrospective Cohort Study

Background: The COVID-19 pandemic imposed unprecedented challenges to healthcare and patient well-being worldwide, including Saudi Arabia, yet its long-term impact on stress-related endocrine markers and mental health has not been systematically assessed. Objective: To determine the longitudinal changes in hair cortisol, DHEAS levels, and related mental health diagnoses before, during, and after the COVID-19 pandemic. Methods: We conducted a retrospective cohort study of adult patients admitted to King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from January 2019 to September 2024. We extracted demographic data, hair cortisol, DHEAS levels, cortisol/DHEAS ratios, and mental health diagnoses (anxiety, depression, and post-traumatic stress). Comparisons were made between pre-pandemic (2019), pandemic (2020–2021), and post-pandemic (2022–2024) periods using ANOVA, chi-square tests, and multivariable regression. Results: Of 4,562 patients included hair cortisol and cortisol/DHEAS ratios were significantly elevated during the pandemic phase, accompanied by higher rates of anxiety and depression diagnoses. By the post-pandemic period, there was partial normalization of endocrine and mental health parameters, although values remained higher than pre-pandemic levels. Conclusions: Our findings suggest that the pandemic triggered sustained alterations in stress biomarkers and mental health in this Saudi cohort. Continued efforts to support patients’ psychological and physiological recovery are warranted, underscoring the need for integrative post-pandemic healthcare interventions