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Your Questions — 6 minutes

Can a person’s exposure to stress be measured?


Stress is defined as any situation (real or perceived) that can trigger an overproduction of catecholamines and cortisol. One would think that a simple measurement of these hormones would be enough to determine whether a person is experiencing harmful stress. However, while it’s true that stress alters cortisol and catecholamine levels, it’s difficult to use these assays to measure stress levels. According to the scientific literature, two methods can be used to measure stress [1]:

  • Psychological questionnaires
  • Physiological examinations including laboratory tests

Read more: How stress influences your gastrointestinal health

Psychological questionnaires

Because each person perceives stressful situations differently and laboratory tests are rarely conclusive, it’s important to evaluate the perception of stress. There are dozens of questionnaires available to try to determine the nature of stressful situations in an individual. The Centre for studies on human stress has one called the N.U.T.S. questionnaire.

Laboratory tests

There are two types of laboratory tests: those designed to measure certain effects of stress hormones on the body and those that measure hormone levels directly.

Measuring the effects on the body

Stress hormones increase blood pressure and heart rate. Therefore, a blood pressure measurement at rest or in a stressful situation can easily be used. A common example of the effect of stress on blood pressure is white coat syndrome.[2] This phenomenon occurs in many people whose blood pressure is significantly higher in the doctor’s office than it is in everyday life. One way to distinguish this syndrome from actual hypertension is to measure the blood pressure at home.

Direct measurement of stress hormones

Catecholamine and cortisol levels can be measured in the blood and urine. Cortisol can also be detected in saliva and hair. However, it’s difficult to distinguish the impact of stress versus other causes of elevated hormone levels (e.g., variations with the time of day, illnesses of all kinds, use of medications, etc.). In addition, an assay alone cannot determine an individual’s stress level.

Catecholamines and metabolites

Catecholamines can be measured in the blood, but this method has its flaws. Many people get apprehensive at the sight of the needle used to take the sample. This apprehension is enough to cause their catecholamine levels to skyrocket. To eliminate this stress, an ideal solution would be to install a system with a catheter several minutes before the collection and obtain the sample without the patient’s knowledge! For these reasons, an assay of catecholamines and their derivatives is mainly used for the diagnosis of pheochromocytomas and paragangliomas, two very rare types of tumours.

Blood and urinary cortisol

Cortisol is easier to measure in the blood, but because its level varies greatly depending on the time of day, the time of collection is critical. Since we don’t all have the same diurnal and nocturnal cycle, the reference intervals are wide and make it difficult to interpret the results. A cortisol assay is mainly used to assess adrenal gland dysfunction.

Salivary cortisol

The salivary rate remains the most widely used technique for measuring cortisol. Easy to obtain, even at home, samples can be repeated during the day. However, variations due to stress are difficult to differentiate from “normal” values, except in marked cases such as Cushing’s syndrome. This makes it difficult to determine whether an individual is under intense stress. However, two groups of subjects can be compared, with one group being exposed to a stressful situation and the other serving as a control group.

Hair cortisol

Technological advances are paving the way for a promising new test: the measurement of hair cortisol levels. Hair grows at a rate of one centimetre per month. The level of hair cortisol is a reflection of cortisol levels in the body and therefore the stress experienced during this period. Usually performed on three centimetres of hair (three months of growth), this assay is already commonly used to detect illicit drugs and exposure to heavy metals.[3]

Prevention is better than a cure

Despite their obvious usefulness, laboratory tests don’t yet allow us to establish a person’s stress level. However, they can be used to diagnose health problems indirectly related to stress. Nothing beats stress prevention: sleep well, eat well and, above all, live well!

Read more: The manifestations of stress on the body (infographic)

For professional support, we’re here.

We provide services that can help your doctor diagnose stress-related disorders and determine whether a medication may be ineffective or cause adverse effects. Please note that these tests are not used to measure stress levels.

Do you have a doctor's prescription on hand for one of these tests? Book an appointment online or contact Biron Health Group’s customer service at 1 833 590-2712.

  1. Source consulted October 21, 2020.
  2. (in French). Source consulted October 21, 2020.
  3. (in French). Source consulted October 21, 2020.