Salivary cortisol is widely recognized as a non-invasive, reliable biomarker for assessing psychological and acute stress. Its measurement reflects the activity of the hypothalamic-pituitary-adrenal (HPA) axis, which is central to the body’s stress response. Research has explored its utility across various populations and stress paradigms, highlighting both its strengths and limitations.
Mechanisms and Validity of Salivary Cortisol
Cortisol is secreted in response to stress via HPA axis activation, and its free (biologically active) form is readily detectable in saliva, closely mirroring blood levels during stress (Špiljak et al., 2022; Ahmed et al., 2024; Stojanović et al., 2021; Budala et al., 2025; Chojnowska et al., 2021). Salivary cortisol rises within about 20 minutes after acute stress exposure, making it a practical marker for both laboratory and real-life stressors (Stojanović et al., 2021; Fan et al., 2024; Chojnowska et al., 2021). However, results can vary due to individual differences, diurnal rhythms, and methodological factors (Kudielka et al., 2009; Smyth et al., 2013; Chojnowska et al., 2021).
Acute and Chronic Stress Responses
Acute psychological stressors—such as exams, public speaking, or mental arithmetic—consistently elevate salivary cortisol in healthy individuals (Špiljak et al., 2022; Ahmed et al., 2024; Stojanović et al., 2021; González-Cabrera et al., 2014; Qi et al., 2016; Fan et al., 2009; Fan et al., 2024). Chronic stress, such as prolonged exam preparation, also leads to sustained increases, though the cortisol awakening response may be more sensitive to acute anticipatory stress than to chronic stress (González-Cabrera et al., 2014). Both acute and chronic stress can be differentiated by cortisol’s temporal profile and association with other salivary biomarkers (Špiljak et al., 2022; Stojanović et al., 2021; Budala et al., 2025; Chojnowska et al., 2021).
Moderators and Individual Differences
Salivary cortisol responses are influenced by age, sex, personality traits, anxiety levels, and cognitive appraisal of stress (Kudielka et al., 2009; Takai et al., 2007; Bibbey et al., 2013; Gaab et al., 2005; Reschke-Hernández et al., 2017). For example, men often show stronger cortisol responses than women, and high trait anxiety in females may blunt the cortisol response (Takai et al., 2007; Reschke-Hernández et al., 2017). Personality traits like neuroticism and cognitive appraisal before stress exposure can also modulate the magnitude of the cortisol response (Bibbey et al., 2013; Gaab et al., 2005).
If You’re Looking For…
- Gender and Personality Effects: See (Takai et al., 2007; Bibbey et al., 2013; Gaab et al., 2005; Reschke-Hernández et al., 2017)- Acute vs. Chronic Stress: See (Špiljak et al., 2022; Stojanović et al., 2021; González-Cabrera et al., 2014; Budala et al., 2025; Chojnowska et al., 2021)- Salivary Cortisol in Disease Contexts (e.g., periodontitis): See (Hingorjo et al., 2025)- Methodological Reviews and Recommendations: See (Špiljak et al., 2022; Ahmed et al., 2024; Kudielka et al., 2009; Smyth et al., 2013; Batista et al., 2017)### Key Papers
| Paper | Study Focus | Key Insight | Year |
|---|---|---|---|
| (Špiljak et al., 2022) | Review of salivary biomarkers in student stress | Salivary cortisol reliably increases with academic stress | 2022 |
| (Kudielka et al., 2009) | Determinants of cortisol response | Age, sex, and psychological factors modulate response | 2009 |
| (Stojanović et al., 2021) | Lab-induced stress and salivary changes | Acute stress increases cortisol and decreases IgA | 2021 |
| (Fan et al., 2024) | Mindfulness and acute stress | Mindfulness can attenuate cortisol rise post-stress | 2024 |
| (Chojnowska et al., 2021) | Review of salivary biomarkers | Cortisol is the most validated marker for acute stress | 2021 |
Figure 1: Key studies on salivary cortisol and psychological stress.
Summary
Salivary cortisol is a robust, non-invasive biomarker for both acute and chronic psychological stress, though its response is shaped by individual and contextual factors. It is most effective when combined with other biomarkers and psychological assessments to provide a comprehensive picture of stress reactivity and health risk.
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References
Špiljak, B., Vilibić, M., Glavina, A., Crnković, M., Šešerko, A., & Lugović-Mihić, L. (2022). A Review of Psychological Stress among Students and Its Assessment Using Salivary Biomarkers. Behavioral Sciences, 12. https://doi.org/10.3390/bs12100400
Ahmed, T., Powner, M., Qassem, M., & Kyriacou, P. (2024). Rapid optical determination of salivary cortisol responses in individuals undergoing physiological and psychological stress. Scientific Reports, 14. https://doi.org/10.1038/s41598-024-69466-5
Kudielka, B., Kudielka, B., Hellhammer, D., & Wüst, S. (2009). Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology, 34, 2-18. https://doi.org/10.1016/j.psyneuen.2008.10.004
Takai, N., Yamaguchi, M., Aragaki, T., Eto, K., Uchihashi, K., & Nishikawa, Y. (2007). Gender‐Specific Differences in Salivary Biomarker Responses to Acute Psychological Stress. Annals of the New York Academy of Sciences, 1098. https://doi.org/10.1196/annals.1384.014
Hingorjo, M., Owais, M., Siddiqui, S., Nazar, S., & Ali, Y. (2025). The impact of psychological stress on salivary cortisol levels in periodontitis patients: a case-control study. BMC Oral Health, 25. https://doi.org/10.1186/s12903-024-05017-8
Bibbey, A., Carroll, D., Roseboom, T., Phillips, A., & De Rooij, S. (2013). Personality and physiological reactions to acute psychological stress.. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 90 1, 28-36. https://doi.org/10.1016/j.ijpsycho.2012.10.018
Gaab, J., Rohleder, N., Nater, U., & Ehlert, U. (2005). Psychological determinants of the cortisol stress response: the role of anticipatory cognitive appraisal. Psychoneuroendocrinology, 30, 599-610. https://doi.org/10.1016/j.psyneuen.2005.02.001
Stojanović, N., Randjelović, P., Pavlović, D., Stojiljković, N., Jovanovic, I., Sokolović, D., & Radulović, N. (2021). An Impact of Psychological Stress on the Interplay between Salivary Oxidative Stress and the Classic Psychological Stress-Related Parameters. Oxidative Medicine and Cellular Longevity, 2021. https://doi.org/10.1155/2021/6635310
González-Cabrera, J., Fernández-Prada, M., Iribar-Ibabe, C., & Peinado, J. (2014). Acute and chronic stress increase salivary cortisol: a study in the real-life setting of a national examination undertaken by medical graduates. Stress, 17, 149 – 156. https://doi.org/10.3109/10253890.2013.876405
Reschke-Hernández, A., Okerstrom, K., Edwards, A., & Tranel, D. (2017). Sex and stress: Men and women show different cortisol responses to psychological stress induced by the Trier social stress test and the Iowa singing social stress test. Journal of Neuroscience Research, 95. https://doi.org/10.1002/jnr.23851
Qi, M., Gao, H., Guan, L., Liu, G., & Yang, J. (2016). Subjective Stress, Salivary Cortisol, and Electrophysiological Responses to Psychological Stress. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00229
Fan, Y., Tang, Y., Lu, Q., Feng, S., Yu, Q., Sui, D., Zhao, Q., , Y., & Li, S. (2009). Dynamic changes in salivary cortisol and secretory immunoglobulin A response to acute stress. Stress and Health, 25, 189-194. https://doi.org/10.1002/smi.1239
Smyth, N., Hucklebridge, F., Thorn, L., Evans, P., & Clow, A. (2013). Salivary Cortisol as a Biomarker in Social Science Research. Social and Personality Psychology Compass, 7, 605-625. https://doi.org/10.1111/spc3.12057
Budala, D., Luchian, I., Virvescu, D., Tudorici, T., Constantin, V., Surlari, Z., Butnaru, O., Bosînceanu, D., Bida, C., & Hancianu, M. (2025). Salivary Biomarkers as a Predictive Factor in Anxiety, Depression, and Stress. Current Issues in Molecular Biology, 47. https://doi.org/10.3390/cimb47070488
Fan, Y., Cui, Y., Tang, R., Sarkar, A., Mehta, P., & Tang, Y. (2024). Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males. Stress, 27. https://doi.org/10.1080/10253890.2024.2316041
Chojnowska, S., Ptaszyńska-Sarosiek, I., Kępka, A., Knaś, M., & Waszkiewicz, N. (2021). Salivary Biomarkers of Stress, Anxiety and Depression. Journal of Clinical Medicine, 10. https://doi.org/10.3390/jcm10030517
Batista, P., Pereira, A., & Vaz, A. (2017). Salivary Biomarkers in Psychological Stress Diagnosis. **, 3, 9-18. https://doi.org/10.20431/2455-1538.0302002
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