title: Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy?
abstract: Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric disorders/symptoms measured with different instruments, and cortisol in a population with LBP. Participants (n=305) sick-listed 2-10 months due to non-specific LBP were included in the study. The screening instruments were the MINI-interview, HADS and HSCL-25. Saliva cortisol were measured on 2 consecutive days; at awakening, 30min later, at 15:00h and 22:00h. Results showed no associations between any of the main diagnostic categories from the MINI-interview, or anxiety/depression measured with HADS or HSCL-25 and cortisol. However, significant associations were found between low cortisol awakening response, low cortisol slope during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall asleep, headache). The results indicate that cortisol, may not be directly associated with psychopathology, such as anxiety and depression, but instead are associated with one dimension of the psychopathology, namely lack of energy. This could help explain the inconsistency in the literature, and it should be explored further.
authors.affiliation: Department of Health Promotion and Development, University of Bergen, Norway. Electronic address: anette.harris@uib.no.
authors.forename: Anette
authors.initials: A
authors.lastname: Harris
authors.affiliation: Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway; Uni Research Health, Bergen, Norway. Electronic address: silje.reme@uni.no.
authors.forename: Silje
authors.initials: S
authors.lastname: Endresen Reme
authors.affiliation: Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Norway. Electronic address: Tone.Tangen@k1.uib.no.
authors.forename: Tone
authors.initials: T
authors.lastname: Tangen
authors.affiliation: Department of Public Health, University of Copenhagen, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark. Electronic address: asemarie.hansen@sund.ku.dk.
authors.forename: Åse Marie
authors.initials: ÅM
authors.lastname: Hansen
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark. Electronic address: ahg@arbejdsmiljoforskning.dk.
authors.forename: Anne
authors.initials: A
authors.lastname: Helene Garde
authors.affiliation: Department of Health Promotion and Development, University of Bergen, Norway; Uni Research Health, Bergen, Norway. Electronic address: hege.eriksen@uni.no.
authors.forename: Hege Randi
authors.initials: HR
authors.lastname: Eriksen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D019540:Area Under Curve; D002940:Circadian Rhythm / Q000502:physiology; D003863:Depression / Q000175:diagnosis / Q000378:metabolism*; D004644:Emotions; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000503:physiopathology; D017116:Low Back Pain / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology; D012463:Saliva / Q000378:metabolism*; D012621:Seasons; D012944:Social Support; D014851:Wakefulness / Q000502:physiology
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; HADS; HPA-axis; HSCL-25; Low back pain; Somatization