Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review.

This is a scoping review of research methods, not a study of patient outcomes or a test of clinical screening. The review did not assess the quality of the included studies. No formal review protocol was published. The search did not include every possible database, so relevant studies may have been missed. 106 articles were excluded for not including a non-biological chronic stress measure, which the authors say may have skewed the sample. The exact time of day for sample collection was not extracted, which matters for salivary cortisol. Most included studies were from North America and Europe (119), so the map may not represent all settings. Some counts are occurrences, not separate studies or patients, because indicators could be collected in multiple ways or from multiple participant types within one study.

The authors declared no conflicts of interest.

Do not conclude that salivary cortisol, hair cortisol or inflammatory markers can be used to screen patients for chronic stress. This review maps methods used in research studies, not tested clinical tools, and the authors explicitly do not recommend using biological indicators in clinical settings because they are difficult to interpret in one person.