Article Text

Download PDFPDF

Diurnal cortisol and mental well-being in middle and older age: evidence from four cohort studies
  1. Mai Stafford1,
  2. Yoav Ben-Shlomo2,
  3. Cyrus Cooper3,
  4. Catharine Gale3,4,
  5. Michael P Gardner5,
  6. Marie-Claude Geoffroy6,7,
  7. Chris Power8,
  8. Diana Kuh1,
  9. Rachel Cooper1
  1. 1 MRC Unit for Lifelong Health and Ageing, University College London, London, UK
  2. 2 School of Social and Community Medicine, University of Bristol, Bristol, UK
  3. 3 MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  4. 4 Department of Psychology, University of Edinburgh, Edinburgh, UK
  5. 5 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  6. 6 McGill Group for Suicide Studies at Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
  7. 7 Department of Psychiatry, McGill University, Montreal, Quebec, Canada
  8. 8 Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
  1. Correspondence to Dr Mai Stafford; m.stafford{at}


Objectives We conducted an individual participant meta-analysis to test the hypothesis that cortisol patterns indicative of dysregulated hypothalamic–pituitary–adrenal axis functioning would be prospectively associated with poorer well-being at follow-up.

Setting Four large UK-based cohort studies.

Participants Those providing valid salivary or serum cortisol samples (n=7515 for morning cortisol; n=1612 for cortisol awakening response) at baseline (age 44–82) and well-being data on the Warwick Edinburgh Mental Wellbeing Scale at follow-up (0–8 years) were included.

Results Well-being was not associated with morning cortisol, diurnal slope or awakening response though a borderline association with evening cortisol was found. Adjusting for sex and follow-up time, each 1 SD increase in evening cortisol was associated with a −0.47 (95% CI −1.00 to 0.05) point lower well-being. This was attenuated by adjustment for body mass index, smoking and socioeconomic position. Between-study heterogeneity was low.

Conclusions This study does not support the hypothesis that diurnal cortisol is prospectively associated with well-being up to 8 years later. However, replication in prospective studies with cortisol samples over multiple days is required.

  • meta-analysis
  • individual participant data
  • positive psychology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors YBS, CC, CG, CP and DK conceptualised the study. MS, YBS, MG, MCG and RC identified the variables, cleaned the data and undertook data analysis. All authors contributed to reviewing and interpreting the results, commenting on the manuscript and approved the final version.

  • Funding MS, RC and DK are supported by the UK Medical Research Council (Programme codes MRC_MC_UU_12019/1; MRC_MC_UU_12019/4;MRC_MC_UU_12019/5). The MRC National Survey of Health and Development is funded by the UK Medical Research Council. HALCyon was funded by the New Dynamics of Ageing (RES-353-25-0001) and MG was supported by this grant. Data collection of cortisol in NCDS at 45 years was funded by the United Kingdom Medical Research Council, grant G0000934. This research was supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The funders had no role in the study design,data collection, data analysis, data interpretation,writing of the report or the decision to submit the article for publication.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of the Division of Medicine of the former South Glamorgan Area Health Authority (CaPS); Central Manchester Local Research Ethics Committee (NSHD); London MREC (NCDS and BCS).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement MRC National Survey of Health and Development data used in this publication are available to bona fide researchers upon request to the NSHD Data Sharing Committee via a standard application procedure. Further details can be found at doi: 10.5522/NSHD/Q101;doi:10.5522/NSHD/Q102. All requests for collaboration on the Caerphilly Prospective Study are reviewed by an independent steering committee ( National Child Development Study data are available via registration with the UK Data Service. The Hertfordshire Cohort Study has governance and access arrangements that comply with MRC data sharing policy. The survey data are accessible to bonafide researchers by contacting Professor Cyrus Cooper, Director of the MRC Lifecourse Epidemiology Unit at the University of Southampton, who can forward a collaborators’ agreement.