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Cortisol levels and suicidal behavior: a meta-analysis

O’Connor, Daryl B.; Ferguson, Eamonn; Green, Jessica A.; O'Carroll, Ronan E.; O'Connor, Rory C.


Daryl B. O’Connor

Jessica A. Green

Ronan E. O'Carroll

Rory C. O'Connor


Suicide is a major cause of death worldwide, responsible for 1.5% of all mortality. The causes of suicidal behavior are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. This meta-analytic review aimed i) to estimate the strength and variability of the association between naturally fluctuating cortisol levels and suicidal behavior and ii) to identify moderators of this relationship. A systematic literature search identified 27 studies (N = 2226; 779 suicide attempters & 1447 non-attempters) that met the study eligibility criteria from a total of 417 unique records initially examined. Estimates of effect sizes (r) obtained from these studies were analysed using Comprehensive Meta-Analysis. In these analyses, we compared participants identified as having a past history of suicide attempt(s) to those with no such history. Study quality, mean age of sample and percentage of male participants were examined as potential moderators. Overall, there was no significant effect of suicide group on cortisol. However, significant associations between cortisol and suicide attempts were observed as a function of age. In studies where the mean age of the sample was below 40 years the association was positive (i.e., higher cortisol was associated with suicide attempts; r = .234, p < .001), and where the mean age was 40 or above the association was negative (i.e., lower cortisol was associated with suicide attempts; r = - .129, p < .001). These findings confirm that HPA axis activity, as indicated by age-dependent variations in cortisol levels, is associated with suicidal behavior. The challenge for theory and clinical practice is to explain the complete reversal of the association with age and to identify its clinical implications.


O’Connor, D. B., Ferguson, E., Green, J. A., O'Carroll, R. E., & O'Connor, R. C. (in press). Cortisol levels and suicidal behavior: a meta-analysis. Psychoneuroendocrinology, 63,

Journal Article Type Article
Acceptance Date Oct 16, 2015
Online Publication Date Oct 19, 2015
Deposit Date Nov 25, 2015
Publicly Available Date Nov 25, 2015
Journal Psychoneuroendocrinology
Print ISSN 0306-4530
Electronic ISSN 0306-4530
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 63
Keywords suicide, cortisol meta-analysis
Public URL
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address:


OConnor et al_PNEC_in press.pdf (586 Kb)

Copyright Statement
Copyright information regarding this work can be found at the following address:

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