Who still suffers? Effects of COVID-19 stressful experiences on somatic symptoms and anxious mood moderated by diurnal cortisol: A daily diary study

Appl Psychol Health Well Being. 2025 Feb;17(1):e12638. doi: 10.1111/aphw.12638.

Abstract

This daily diary study drew on the allostatic load model to examine the predictive effect of COVID-19 stressful experiences (CSE) on somatic symptoms and anxious mood, as well as applying the biological sensitivity to context model to explore whether diurnal cortisol moderated the above associations. A total of 101 Chinese college students retrospectively reported CSE in October 2020, followed by 5-day diary reports on somatic symptoms and anxious mood in November 2020, with salivary cortisol collected on Days 2 to 4 to measure cortisol awakening response (CAR), diurnal cortisol slope (DCS), and daily cortisol output (area under the curve with respect to ground, AUCg). Results of multilevel models showed that greater CSE predicted more somatic symptoms but not anxious mood, which was only observed at flatter CAR, flatter DCS, or low AUCg. Furthermore, three-way interactions of CSE, CAR, and AUCg significantly predicted both somatic symptoms and anxious mood. Specifically, greater CSE predicted more somatic symptoms at flatter CAR with low AUCg, while predicting higher anxious mood at flatter CAR with high AUCg. Our findings demonstrate the long-term consequences following the prior pandemic, especially highlighting the biological vulnerability related to the synergetic effects of diurnal cortisol rhythms and daily cortisol output.

Keywords: COVID‐19; anxious mood; cortisol; daily diary; somatic symptoms.

MeSH terms

  • Adolescent
  • Adult
  • Affect / physiology
  • Allostasis / physiology
  • Anxiety* / metabolism
  • Anxiety* / psychology
  • COVID-19* / psychology
  • China
  • Circadian Rhythm* / physiology
  • Female
  • Humans
  • Hydrocortisone* / metabolism
  • Male
  • Medically Unexplained Symptoms*
  • Retrospective Studies
  • Saliva* / chemistry
  • Saliva* / metabolism
  • Stress, Psychological* / metabolism
  • Stress, Psychological* / psychology
  • Students / psychology
  • Young Adult

Substances

  • Hydrocortisone