Relationship of Salivary Cortisol Level With Severe Depression and Family History

The impact of psychological stress on salivary cortisol levels in periodontitis patients: a case-control study

BACKGROUND

Psychological stress is linked to elevated salivary cortisol levels, potentially worsening periodontitis by exacerbating inflammation. This study examines the impact of stress on cortisol levels in periodontitis patients, aiming to explore salivary cortisol as a biomarker for disease severity and its role in improving management strategies.

METHODS

This case-control study, conducted at Dow University of Health Sciences in Karachi from January to December 2022, involved 120 dental clinic patients aged 30-60. Participants were selected based on the presence (cases) or absence (controls) of periodontitis, excluding those with systemic diseases, taking hydrocortisone, immunosuppressives, antidepressants, systemic antibiotics, having oral ulcers and pregnancy or lactation. Periodontal parameters, stress levels (using the Perceived Stress Scale), and morning salivary cortisol (measured via ELISA) were assessed. Statistical analyses were performed using SPSS version 23, including descriptive statistics, independent t-tests, ANOVA, and odds ratio calculations with a 95% confidence interval at 0.05.

RESULTS

The study cohort comprised 120 subjects, equally divided between periodontitis patients and healthy controls. Predominantly male (63%) with a mean age of 41.75 years, participants were subjected to comprehensive evaluations. Oral health indices (Gingival index, Plaque index, Clinical attachment loss, Periodontal probing depth, Tooth mobility) and stress markers (Perceived Stress Score, Salivary cortisol levels [SCLs]) were significantly higher in cases compared to controls (p < 0.001). Majority of cases (58.3%) had stage II periodontitis. Notably, cases exhibited significantly higher stress levels (2.05 ± 0.59 vs. 1.38 ± 0.52; p < 0.001) and elevated salivary cortisol levels (6.67 ± 1.64 vs. 2.54 ± 0.88; p < 0.001) compared to controls. The odds ratio (OR) of 3.73 (95% CI [1.75, 7.93], p = 0.0006) indicated that periodontitis patients were over 3.5 times more likely to have elevated SCLs. Stress prevalence was 42.5% in periodontitis patients compared to 18.33% in controls.

CONCLUSIONS

This study highlights a potential link between stress, cortisol levels, and periodontitis, suggesting that salivary cortisol could be a valuable biomarker. Incorporating cortisol measurements into routine dental evaluations may enable personalized treatment plans, addressing both biological and psychological contributors to periodontitis. Further research is needed to explore the long-term effects of stress on cortisol levels and periodontal disease progression, as well as the role of stress management in managing periodontitis.

Recent developments in wearable & non-wearable point-of-care biosensors for cortisol detection

INTRODUCTION

Cortisol is one of the most prominent biomarkers used for the detection of psychological stress and related disorders. It plays an important role in many physiological processes including immunomodulation and fat metabolism. Thus, monitoring of cortisol levels can be used to indicate different pathological conditions including stress disorders. There has been a gradual rise in the development of point of care (PoC) biosensors for continuous cortisol monitoring.

AREAS COVERED

This review discusses recent breakthroughs toward the development of PoC sensors (wearable and non wearable) for cortisol monitoring. Challenges associated with them have also been summarized.

EXPERT OPINION

Electrochemical PoC devices have recently emerged as a powerful tools for continuous monitoring of cortisol that can be utilized for stress management and treatment of related disorders. However, there are many challenges that should be addressed before such devices can be deployed at mass level, such as inter-individual variability, changing the device calibration with the circadian rhythm, interference from other endocrine moieties, etc. [Figure: see text].

Stimulated Parotid Saliva Is a Better Method for Depression Prediction

BACKGROUND

Saliva cortisol is considered to be a biomarker of depression prediction. However, saliva collection methods can affect the saliva cortisol level.

OBJECTIVE

This study aims to determine the ideal saliva collection method and explore the application value of saliva cortisol in depression prediction.

METHODS

30 depressed patients and 30 healthy controls were instructed to collect saliva samples in the morning with six collection methods. Simultaneous venous blood was collected. Enzyme-linked immunosorbent assay was used to determine the cortisol level. The 24-observerrated Hamilton depression rating scale (HAMD-24) was used to assess the severity of depression.

RESULTS

The significant differences in saliva cortisol levels depend on the saliva collection methods. The level of unstimulated whole saliva cortisol was most correlated with blood (r = 0.91). The stimulated parotid saliva cortisol can better predict depression. The area under the curve was 0.89. In addition, the saliva cortisol level of the depression patients was significantly higher than the healthy controls. The correlation between the cortisol level and the HAMD-24 score was highly significant. The higher the saliva cortisol level, the higher the HAMD-24 score.

CONCLUSIONS

All the above findings point to an exciting opportunity for non-invasive monitoring of cortisol through saliva.