Skip to main content Skip to main navigation menu Skip to site footer

The relationship between salivary cortisol levels with risk of behavioral-psychosocial-emotional disorders in adolescents aged 12-16 years


Introduction: Adolescents suffer from various forms of psychosocial, behavioral, mental and emotional problems. The relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents is still controversial. To analyze the relationship between salivary cortisol levels and the risk of behavioral-psychosocial-emotional disorders in adolescents aged 12-16 years using PSC-17.

Methods:  An observational analysis with a cross-sectional research design and simple random sampling was conducted from November 2022 - March 2023. Adolescents aged 12-16 years filled out biodata, characteristics and PSC-17 questionnaires. Salivary cortisol levels were measured by the Enzyme-linked immunosorbent assay method. Data analysis with univariate and multivariate tests.

Results: Of 170 adolescents, 53 (31.2%) were at risk of behavioral-psychosocial-emotional disorders with PSC-17 total score ≥15, consisting of risk of internalizing disorders at 73 (42.9%) adolescents, risk of externalizing disorders at 14 ( 8.2%), risk of attention disorder at 23 (13.5%) adolescents. The majority of adolescents who have normal salivary cortisol levels are 117 (68.8%) adolescents, and salivary cortisol levels are abnormal (high) in 53 (31.2%) adolescents. Salivary cortisol levels were associated with adolescents' risk of behavioral-psychosocial-emotional disorders (p<0.001).

Conclusion: Salivary cortisol levels are associated with the risk of behavioral-psychosocial-emotional disorders in adolescents. Likewise, salivary cortisol levels are related to the risk of internalizing disorders, the risk of externalizing disorders, and the risk of attention disorders in adolescents.


  1. Eijgerman DGM, Fang Y, Jansen DEMC, Bramer WM, Raat H, and Jansen W. Individual and contextual determinants of children’s and adolescent’s mental health use a systematic review. Children and Youth Service Review. 2021; 131:106288.
  2. Tammayan M, Jantaratnotai N, and Pachimsawat. Differential responses of salivary cortisol, amylase, and chromogranin A to academic stress. PLoS One. 2021; 16(8): e 0256172.
  3. Murphy JM, Bergmann P, Chiang C, Sturner R, Howard B, Abel MR and Jellinek MS. The PSC-17: subscale scores, reliability, and factor structure in a new national sample. Pediatrics 2016; 138 (3): 1-8.
  4. Hotting K, Schickert N, Kaiser J, Roder B and Schmidt-Kassow M. The Effects of Acute Physical Exercise on Memory , Peripheral BDNF , and Cortisol in Young Adults. Neural Plast. 2016: 6860573.
  5. Jones C and Gwenin C. Cortisol level dysregulation and its prevalence-Is it nature's alarm clock?. Physiol Rep.2020; 8 (4) :e14644.
  6. Chojnowska S, Sarosiek IP, Kepka A, Knas M, and Waszkiewicz N. Salivary biomarkers of stress, anxiety, and depression. J Clin Med.2021; 10 (3): 517.
  7. Moisan MP. Sexual Dimorphism in Glucocorticoid Stress Response. Int. J. Mol. Sci. 2021; 22 (3139): 1-14.
  8. Spiljak B, Vilibic M, Glavina A, Crnkovic M, Seserko A, and Lugovic-Mihi LA. A review of psychological stress among students and its assessment using salivary biomarkers. Behav Sci. 2022; 12 (400): 1-15.
  9. Whisnubrata TM, Fadlyana E and Rahayuningsih SE. Hubungan kortisol saliva dan masalah mental emosional pada anak usia 3-5 tahun. Sari Pediatri. 2016; 18 (1): 63-7.
  10. Chen C, Nakagawa S, An Y, Ito K, Kitaichi Y, and Kusumi I. The exercise- glucocorticoid paradox: how exercise is beneficial to cognition, mood. And the brain while increasing glucocorticoid levels. Front Neuroendocrinol. 2016; 44: 83-102.
  11. Li M, Lan Q, Qiu L, Yuan Y, He F, Zhang C, and Zhang L. Diurnal cortisol in left-behind adolescents: relations to negative family expressiveness and internalizing problems. Front.Public Health. 2022; 10: 844014.
  12. Lacasa F, Mitjavila M, Ochoa S, and Balluerka N. The relationship between attachment styles and internalizing or externalizing symptoms in clinical and nonclinical adolescents. Anales de Psicología. 2015; 31(2): 422-32.
  13. Irwanto, Melani NAD, Ikhtiar I and Nurmala I. Internal reliability and validity of Pediatric Symptom Checklist-17 Indonesian version for behavioral problem identification in adolescent population. Sapporo Med J. 2020; 54 (8): 1-11.
  14. Butler N, Qiugg Z, Bates R, Jones L, Asworth E, Gowland S, and Jones M. The contributing role of family, school and peer supportive relationships in protecting the mental wellbeing of children and adolescents. School Ment Health. 2022; 14 (3): 776-88.
  15. Kehusmaa J, Ruotslainen H, Manniko N, Alakokkare AC, Niemela M, Jaaskelainen E, and Meittunen J. The association between the social environment of childhood and adolescence and depression in young adulthood-a prospective cohort study. J Affect Disord. 2022; 305: 37-46.
  16. Gordon WT, Schwatrz D, Mayeux L, and Mc Wood LM. Peers and psychopathology. Encyclopedia of Child and Adolescent Health. 2021. Available at:
  17. Rivers AS, Russon J, Lindeboom PW, Lu LR, and Diamond G. Family and peer relationships in residential youth sample:exploring unique, non-linear, and interactive association with depressive symptoms and suicide risk. J Youth Adolesc. 2022; 51 (6): 1062-73.
  18. Georgiou, SN and Symeou M. Parenting Practices and the Development of Internalizing/ Externalizing Problems in Adolescence. Parenting -Empirical Advances and Intervention Resources. 2018. Available at:
  19. Roosch S and Cederqvist C. Adolescent’s experience of parental reactions and its relation to externalizing and internalizing problems. 2015. Available at:
  20. Sillekens S and Notten N. Parental Divorce and Externalizing Problem Behavior in Adulthood. A Study on Lasting Individual, Family and Peer Risk Factors for Externalizing Problem Behavior when Experiencing a Parental Divorce, Deviant Behavior. 2018. Available at
  21. Shi X, Wang J, and Zou H. Family functioning and Internet addiction among Chinese adolescents: The mediating roles of self-esteem and loneliness. Comput. Hum. Behav. 2017; 76: 201–10.
  22. Wang JL, Rost DH, Qiao RJ, and Monk R. Academic Stress and Smartphone Dependence among Chinese Adolescents: A Moderated Mediation Model. J.Child Youth. 2020: 105029. Available at 5029
  23. Wu LC, Hattangadi N, Stoneman CDGK, Maguire JL, Birken C, Stremier R, Constantin E, and Charach . Sleep duration and internalizing symptoms in children. J Can Acad Child Adolesc Psychiatry. 2022; 31 (3): 115-23.
  24. Rosar JV, Barbosa TS, and Dias IOV. Effect of interocclusal appliance on bite force, sleep quality, salivary control levels and signs and symptoms of temporomandibular dysfunction in adults with sleep bruxism. Arch Oral Biol. 2017; 82 : 62-70.
  25. Dhamayanti M. Buku Ajar Perkembangan Bahasa dan Mental Emosi Anak Usia Dini. 2020;1 Bandung : Unpad Press, pp: 127-53.
  26. Hidayat A, Emila O, Dewi FST, Sumarni S. Spiritual emotional freedom technique (SEFT) improved autonomic nervous activity in primipara. Bali Med J. [Internet]. 2021 Apr. 30 [cited 2023 May 3];10(1):361-5. Available from:
  27. Arifin MZ, Setiabudi A, Faried A. Correlation between post-traumatic amnesia with behavioral disorders in the mild- and moderate-traumatic brain injury patient. Bali Med J. [Internet]. 2021 Jun. 7 [cited 2023 May 3];10(2):491-4. Available from:
  28. Pramono A, Soetikno R, Kartamihardja AHS, Maskoen TT, Putranto TA, Setiawan E. Utilization of modified digital subtraction angiography in a child with cerebral venous sinus thrombosis presenting with autism spectrum disorder symptoms: A novel approach. Bali Med J. [Internet]. 2019 Apr. 1 [cited 2023 May 3];8(1):322-7. Available from:

How to Cite

Sanjaya, A. (2023). The relationship between salivary cortisol levels with risk of behavioral-psychosocial-emotional disorders in adolescents aged 12-16 years. Bali Medical Journal, 12(2), 1451–1458.




Search Panel