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The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history

  • S. Vrshek-Schallhorn (a1), L. D. Doane (a2), S. Mineka (a1), R. E. Zinbarg (a1) (a3), M. G. Craske (a4) and E. K. Adam (a5) (a6)...

The cortisol awakening response (CAR) has been shown to predict major depressive episodes (MDEs) over a 1-year period. It is unknown whether this effect: (a) is stable over longer periods of time; (b) is independent of prospective stressful life events; and (c) differentially predicts first onsets or recurrences of MDEs.


A total of 270 older adolescents (mean age 17.06 years at cortisol measurement) from the larger prospective Northwestern-UCLA Youth Emotion Project completed baseline diagnostic and life stress interviews, questionnaires, and a 3-day cortisol sampling protocol measuring the CAR and diurnal rhythm, as well as up to four annual follow-up interviews of diagnoses and life stress.


Non-proportional person-month survival analyses revealed that higher levels of the baseline CAR significantly predict MDEs for 2.5 years following cortisol measurement. However, the strength of prediction of depressive episodes significantly decays over time, with the CAR no longer significantly predicting MDEs after 2.5 years. Elevations in the CAR did not significantly increase vulnerability to prospective major stressful life events. They did, however, predict MDE recurrences more strongly than first onsets.


These results suggest that a high CAR represents a time-limited risk factor for onsets of MDEs, which increases risk for depression independently of future major stressful life events. Possible explanations for the stronger effect of the CAR for predicting MDE recurrences than first onsets are discussed.

Corresponding author
*Address for correspondence: S. Vrshek-Schallhorn, Ph.D., Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, USA. (Email:
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Psychological Medicine
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