Health anxiety moderates the daytime cortisol slope.

OBJECTIVES Edwards et al. argue that a steeper daytime cortisol slope indicates increased symptom awareness [Edwards S, Hucklebridge F, Clow A, Evans P. Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosom Med, 2003;65:320-7]. Theory suggests that health anxiety (HA) is associated with increased symptom awareness. Therefore, this study tests the hypothesis that higher levels of HA are associated with a steeper daytime cortisol slope and is the first to examine the daytime diurnal cortisol slope for HA. METHODS Forty-two healthy working adults completed measures of HA and neuroticism as well as indices to measure the severity and frequency of symptom reporting. Participants also provided eight consecutive days of salivary cortisol data. Two cortisol measures were taken each day -- once prior to lunch and once in the early evening -- the timing of these was synchronized to waking times. The data were analyzed using multilevel modeling. RESULTS The hypothesis was supported, with those scoring higher on HA showing a steeper daytime cortisol slope. There were no significant relationships between cortisol (average production and slope) and either neuroticism or symptom reporting (severity and frequency). CONCLUSIONS The results are interpreted as consistent with theories of HA that emphasis increased awareness of nonspecific symptoms.