Sex differences in impact of daily and chronic psychological stressors on diurnal cortisol level

Chronic stress contributes to multiple physical and mental disorders. The main goal of the present study was to investigate the effects of daily and chronic psychological stressors on hypothalamic-pituitary-adrenal (HPA) axis function measured by diurnal cortisol levels and rhythms using a community sample of adults experiencing different levels of stress. 78 individuals from the general population were recruited for this study. We measured recent daily stressors, chronic stress (Trier Inventory for Chronic Stress (TICS-E) English version) within the last three months, perceived stress level, mental health outcomes, and salivary cortisol (cortisol awakening response (CAR) and diurnal cortisol slope (DCS)). We found that increased morning cortisol output and CAR measures were associated with both more recent and chronic stress levels, while larger cortisol decreases in the afternoon, measured by DCS, were linked to chronic stress. The observed relationships among several TICS-E factors and mental health outcomes with both CAR and DCS differed between men and women. The associations between cortisol measures and TICS-E factors related to pressure to perform and social recognition were observed only in males, while associations with social overload and social tension factors were found in both sexes. In female participants higher HPA axis response was linked to increased levels of perceived stress, anxiety, and general distress. Our results demonstrated for the first time that the HPA axis response to chronic stressors might be context-specific in men and women and that changes in HPA axis function and related mental health outcomes are sex-specific.