AD03 DASS-21 stress severity is associated with altered diurnal salivary cortisol ratio in Greek endocrinology patients: a pilot study
Psychological stress is common in clinical practice; however, its association with biological stress markers remains incompletely characterized. The Depression Anxiety Stress Scales-21 (DASS-21) questionnaire assesses depression, anxiety, and stress, while salivary cortisol is an established marker of hypothalamic–pituitary–adrenal axis activity. This pilot study evaluated whether DASS-21 Stress scale severity is associated with alterations in the diurnal salivary cortisol rhythm in endocrinology patients. To investigate the association between DASS-21 Stress scale severity and the diurnal salivary cortisol profile in adult endocrinology patients. This pilot study included 33 Greek endocrinology patients aged 18–65 years with paired salivary cortisol measurements. Participants completed the DASS-21 questionnaire and provided saliva samples at 08:00 and 20:00. Morning cortisol, evening cortisol, and the morning-to-evening cortisol ratio were assessed. Patients were categorized according to DASS-21 Stress severity and compared using the Mann–Whitney U test. DASS-21 Stress scale severity was significantly associated with the diurnal cortisol ratio. Patients with moderate-to-extremely severe stress had a lower morning-to-evening cortisol ratio than those with normal-to-mild stress (median 1.40, interquartile range [IQR] 0.74–2.83 vs. median 4.14, IQR 2.46–6.29; Mann–Whitney U = 64.0, P = 0.016), suggesting a flatter diurnal cortisol rhythm in patients with higher perceived stress severity. In this pilot cohort of Greek endocrinology patients, higher DASS-21 Stress scale severity was associated with a flatter diurnal cortisol rhythm. These preliminary findings suggest that perceived stress severity may correspond to biological alterations in cortisol regulation. Larger studies are warranted to confirm these observations and to explore the clinical utility of combining psychometric stress assessment with salivary cortisol measurements in endocrine populations.