A comparative study on hair cortisol concentration among generalized anxiety disorder patients with and without alcohol dependence syndrome presenting to a tertiary care center: A pilot study.

Background: Generalized anxiety disorder (GAD) affects up to 6% of the population, which if not detected early and adequately treated will continue as a hidden impairment resulting in disability. Aim: The primary objective of the study is to assess the hair cortisol levels (HairF) in persons with GAD with and without alcohol dependence syndrome (ADS), and the secondary objective is to assess whether HairF can be used as a biomarker for assessment of GAD. Materials and Methods: This comparative study was done on 94 subjects (68 persons with GAD with or without ADS and 26 healthy controls) who were divided into three groups. Hamilton Anxiety Rating Scale (HAM-A) and Patient Health Questionnaire-4 (PHQ4) were also used to assess severity of anxiety symptoms. These scores were compared with HairF. Diagnostic accuracy of the HairF analysis test was done. Statistical analysis was done using SPSS version 20. Results: The study found higher levels of HairF in persons with GAD (mean 189.4 ± 33.1) and GAD with ADS (164.2 ± 47.6) compared to healthy controls (mean 45.34 ± 40.7), which were statistically significant. Correlation of HAM-A and PHQ4 scores and HairF also showed positive correlation. The receiver operating characteristic curve suggested the best cutoff point at 88.4 pg/mg with a sensitivity of 98.5% and a specificity of 92.5%, clearly differentiating GAD from healthy controls. Conclusion: HairF were found to be higher in patients with GAD irrespective of ADS as comorbidity. The study supports the possibility of the HairF as a possible biomarker to detect GAD and play a complementary role in a multidimensional approach for management of chronic stress and anxiety.