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Circulating Biomarkers of Military-Specific Performance Resilience: A Systematic Review

Van Cutsem J, van den Berg NH, Flores B, Aïdara Y, Martin A, Musat A, Pattyn N, Simonelli G

Current psychiatry reports, 2026

Abstract

Purpose of review: To systematically examine the available literature on circulating biomarkers of performance resilience in a military environment, with the goal of identifying the most promising circulating biomarkers.

Recent findings: The construct 'resilience' is hypothesized to play an important role in increasing Special Operations Forces' and other military personnel's capacity for withstanding exposure to various military-specific stressors. However, objectively measuring resilience is challenging. Some of the most important and well-studied circulating biomarkers that affect military-specific resilience are cortisol, dehydroepiandrosterone (sulfate) [DHEA(S)], noradrenaline, serotonin, neuropeptide-Y (NPY) and brain-derived neurotrophic factor. Despite growing evidence, the available knowledge is yet to be summarized and reviewed while considering the intensity and duration of military-specific stressors, military experience, and methodological differences between studies. Cortisol, Insulin-like growth factor-1 (IGF-1), NPY and DHEA(S) provide a physiological window into military-specific resilience. In general, individuals who exhibit a pronounced but controlled biomarker response to an acute stressor, combined with a quick recovery to baseline, demonstrate physiological flexibility that is associated with greater military-specific resilience. Future research will need to determine relative thresholds for the acute stressor-related change in circulating biomarkers…

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