Perceived stress, depressive symptoms, and cortisol-to-cortisone ratio in spot urine in 6878 older adults

Chisato Shimanoe; Akiko Matsumoto; Megumi Hara; Chiho Akao; Yuichiro Nishida; Mikako Horita; Hinako Nanri; Yasuki Higaki; Keitaro Tanaka

doi:10.1016/j.psyneuen.2020.105125

Perceived stress, depressive symptoms, and cortisol-to-cortisone ratio in spot urine in 6878 older adults

Psychoneuroendocrinology. 2021 Mar:125:105125. doi: 10.1016/j.psyneuen.2020.105125. Epub 2020 Dec 30.

Authors

Chisato Shimanoe¹, Akiko Matsumoto², Megumi Hara², Chiho Akao², Yuichiro Nishida², Mikako Horita², Hinako Nanri³, Yasuki Higaki⁴, Keitaro Tanaka²

Affiliations

¹ Department of Pharmacy, Saga University Hospital, Saga, Japan; Department of Social Medicine, Faculty of Medicine, Saga University, Saga, Japan. Electronic address: chisatos@cc.saga-u.ac.jp.
² Department of Social Medicine, Faculty of Medicine, Saga University, Saga, Japan.
³ Section of Behavioral Physiology, Department of Physical Activity Research, National Institutes of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.
⁴ Laboratory of Exercise Physiology, Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan.

PMID: 33429220
DOI: 10.1016/j.psyneuen.2020.105125

Abstract

Background: Late life depression and perceived stress could influence disease pathways via reduced 11β-HSD2 activity, particularly given suggestions that reduced 11β-HSD2 activity, which is reflected in the cortisol-to-cortisone ratio, is a risk factor of disease. To date, however, examination of the relationship between the cortisol-to-cortisone ratio and perceived stress or depressive symptoms is insufficient.

Methods: We examined the cross-sectional association of the cortisol-to-cortisone ratio with perceived stress and depressive symptoms, and analyzed whether cortisol levels modify this association, in 6878 participants aged 45-74 years. Cortisol and cortisone in spot urine were measured using liquid chromatography-mass spectrometry. Perceived stress during the past year was measured using a self-reported questionnaire. Depressive symptoms were evaluated using the Zung Self-Rating Depression Scale. Analyses were performed with adjustment for age, sex, lifestyle factors (smoking habit, alcohol consumption, physical activity, and sleeping hours), and physical health factors (body mass index [kg/m²] and medical history [diabetes, hypertension, and medication for hyperlipidemia or corticosteroids]).

Results: Cortisol-to-cortisone ratio and cortisol were positively associated with perceived stress (% change: 2.33, P_trend = 0.003; and 4.74, P_trend = 0.001, respectively), but were not significantly associated with depressive symptoms. Further, the relationship between cortisol-to-cortisone ratio and perceived stress was modified by cortisol level and sex: the positive association between perceived stress and the cortisol-to-cortisone ratio was more evident in subjects with lower cortisol levels (P_interaction = 0.009) and in men (P_interaction = 0.026).

Conclusions: These findings suggest that the cortisol-to-cortisone ratio in spot urine may be a useful marker for non-acute perceived stress in daily life against a possible background of reduced 11β-HSD2 in older adults.

Keywords: 11β-HSD; Cortisol; Cortisone; Depressive symptoms; Perceived stress; Spot urine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

11-beta-Hydroxysteroid Dehydrogenase Type 2
Aged
Cortisone*
Cross-Sectional Studies
Depression
Humans
Hydrocortisone
Male
Stress, Psychological

Substances

11-beta-Hydroxysteroid Dehydrogenase Type 2
Cortisone
Hydrocortisone