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Associations of perceived stress with the present and subsequent cortisol levels in fingernails among medical students: a prospective pilot study

Authors Wu H, Zhou K, Xu P, Xue J, Xu X, Liu L

Received 31 July 2018

Accepted for publication 30 August 2018

Published 9 October 2018 Volume 2018:11 Pages 439—445

DOI https://doi.org/10.2147/PRBM.S181541

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Professor Igor Elman


Hui Wu,1 Kexin Zhou,1 Peiyao Xu,1 Jiayu Xue,1 Xin Xu,2 Li Liu1

1Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China; 2Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

Purpose: Cortisol in fingernails could retrospectively reflect cumulative stress over a long period. However, the association between fingernail cortisol and perceived stress needs to be validated. This exploratory study aimed to investigate the associations of perceived stress with the present and subsequent cortisol levels in fingernails of the subjective stress measurement among medical students.
Methods: Students were recruited from a medical university in Shenyang, China. The final sample consisted of 51 students (16 men, 35 women). On the Day 30 of our data and fingernail collection procedure, the 10-item Perceived Stress Scale was used to measure perceived stress. Fingernail samples were collected twice, on Days 15 (denoted as FD15) and 45 (denoted as FD45) of the procedure, and participants were asked to grow fingernails for 15 days in each collection. Cortisol was determined by an enzyme immunoassay method using the ELISA kit. Multiple linear regression was performed to examine the association between perceived stress and cortisol level. The Bonferroni correction was made for multiple comparisons.
Results: The level of cortisol was 5.65 pg/mg (SD =1.88) for FD15 and 5.41 pg/mg (SD =1.63) for FD45. Perceived stress was not associated with the cortisol level of FD15 (β=−0.014, P=0.924), but it was significantly and positively associated with the cortisol level of FD45 (β=0.436, P=0.003), which remained significant after Bonferroni correction. The associations between fingernail cortisol and demographic variables (gender, age, BMI, and physical activity) were not significant.
Conclusion: This study was the first to investigate fingernail cortisol in China. Perceived stress was positively associated with the subsequent cortisol levels in fingernails, but not the present. The findings suggested that fingernail cortisol could indicate stress exposure in the past. Furthermore, a simple and easy self-reported measure could reflect cumulative stress as measured by fingernail cortisol.

Keywords: cortisol, fingernail, perceived stress, chronic stress, China

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