**2.2 Health risks of maladaptive stress responses**

A normal diurnal cortisol pattern indicates individual ability to maintain and return to homeostasis after experiencing stress [16, 18, 19]. However, chronic or repeated stress and subsequent over-activation of the fight-or-flight response can exhaust the HPA axis, resulting in excessive cortisol secretion and eventually, dysregulated diurnal cortisol cycles. Systemically, cortisol influences a wide range of organs and functions including blood pressure regulation and metabolic activity [13, 20]. Thus, long-term, dysregulated cortisol levels significantly increase potential physical and mental illness risks [21]. Physical issues include but are not limited to, compromised immunity, diabetes, hypertension, and cardiovascular disease. Mental health associations include development of depression, anxiety, and psychophysiological PTSD symptoms, such as hyperarousal, and elevated heart rate [22, 23]. Measuring diurnal cortisol patterns, and distinguishing maladaptive patterns and their associated triggers, are critical for identifying potential health risks in populations.
