Sex differences in cortisol levels in depression: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational and case-control studies
PubMed 38176541 · doi:10.1016/j.yfrne.2023.101118
What was done
A systematic review and meta-analysis of 50 original articles was conducted to assess sex differences in cortisol parameters in depression. Evaluated parameters included basal cortisol (general, morning, evening), hair cortisol, cortisol awakening response (CAR), and cortisol stress reactivity, examining both direct female-versus-male comparisons in depression and comparisons of each sex to sex-matched healthy controls.
What was found
Depressed females had significantly higher hair cortisol, higher CAR, and lower cortisol stress reactivity than depressed males. Compared with sex-matched healthy controls, depressed females showed significantly higher evening basal cortisol, higher CAR, and lower cortisol stress reactivity, whereas depressed males showed significantly higher general, morning, and evening basal cortisol. The abstract states these statistical significances qualitatively but provides no numerical effect sizes, sample sizes, or confidence intervals.
Why it matters
This review establishes that HPA-axis alterations in depression manifest differently in females and males. It emphasizes that biological sex is a necessary variable in clinical neuroendocrine profiling and biomarker research for depressive disorders.
Limits
The abstract reports no numerical effect sizes, variance estimates, or total patient counts. The included literature consists of observational and case-control studies subject to residual confounding, and the abstract provides no subgroup breakdowns for age, medication status, depression subtype, or menstrual phase.
Cited by
- supports Elevated end-of-day or late-day cortisol spikes are associated with depression and anxiety.