Cultures under stress: A cross-national meta-analysis of cortisol responses to the Trier Social Stress Test and their association with anxiety-related value orientations and internalizing mental disorders

Acute cortisol changes are physiological indicators (i.e., biomarkers) of psychosocial stress that have been repeatedly assessed using standardized laboratory protocols like the Trier Social Stress Test (TSST). Despite this methodological standardization, however, cortisol stress responses vary considerably across different studies. Based on multilevel meta-analyses of 237 TSST studies (n = 8487 individuals), we demonstrate that similar to 25% of this variability is actually attributable to systematic differences between countries. Particularly North American and European studies show a remarkable effect disparity (d = 0.45 vs. d = 0.73, respectively). Specifically, in-depth analyses suggested that the cultural orientation towards anxiety-related values in English-speaking countries (incl. the UK and Ireland) was associated with decreased cortisol stress responses. This finding was further supported by associations with the regionally varying prevalence of internalizing mental disorders (e.g., major depression or post-traumatic stress disorder) as reported by the WHO World Mental Health Surveys, a larger inequality of family incomes, larger population growth, larger expenses for health and the military, and lower tax rates. The size of these effects is comparable to the most important moderators of cortisol stress responses known to date, that is, male sex and higher age. Based on these observations, we argue that the cortisol stress response may reflect the persistent threats in the sociocultural environment an individual is accustomed too. Highly competitive cultures emphasize the individuals' responsibility for socioeconomic prosperity, but simultaneously increase the collective population stress and thus lower sustainable ontogeny and resilience towards unexpected environmental adversity.