title: Anxiety disorders and salivary cortisol levels in older adults: a population-based study.
abstract: BACKGROUND
  The hypothalamic-pituitary-adrenal (HPA) axis is one of the body's main systems that controls response to stress. It acts through the hormone cortisol. While the dysregulation of cortisol has been associated with anxiety disorders, the evidence is inconsistent. Moreover, only a few small studies have assessed this relationship in older adults.
  
  
  OBJECTIVE
  To determine whether in adults aged 65 years and over there is a difference in daily cortisol pattern between those with and without an anxiety disorder.
  
  
  METHODS
  The study population comprised 1788 older adults from a population-based cohort. The Munich version of the Composite International Diagnostic Interview was used to diagnose anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, agoraphobia and panic disorder). The cortisol awakening response and total cortisol secretion over the day were calculated from cortisol levels in four saliva samples taken over the course of one day (at awakening, 30min after awakening, at 1700h, at bedtime).
  
  
  RESULTS
  Older adults with an anxiety disorder (n=145, median duration since first symptoms 41 years) had a lower cortisol awakening response (p=0.02) than those without such a disorder (n=1643). This association was most prominent in those with generalized anxiety disorder (p=0.008), but was not associated with the extent of chronicity of anxiety disorders.
  
  
  CONCLUSIONS
  Older adults from the general population with long-lasting anxiety disorders had a lower cortisol awakening response than those without. This is consistent with the notion that chronic anxiety may result in downregulation of HPA-axis activity. Longitudinal studies are needed to confirm this mechanism.
authors: Research Center O3, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.
authors: Karin
authors: K
authors: Hek
authors: Nese
authors: N
authors: Direk
authors: Rachel S
authors: RS
authors: Newson
authors: Albert
authors: A
authors: Hofman
authors: Witte J G
authors: WJ
authors: Hoogendijk
authors: Cornelis L
authors: CL
authors: Mulder
authors: Henning
authors: H
authors: Tiemeier
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000378:metabolism; D014851:Wakefulness / Q000502:physiology
chemical_list: D006854:Hydrocortisone