1 Effect of makeup use on depressive symptoms - Open, randomized, and controlled trial.

2 Marcos C. Veçosoa, Souvenir Zallaa, Newton Andreo-Filhob, Patrícia S. Lopesb, Edileia

3 Bagatina,c, Fernando L. A. Fonsecab, Heather A. E. Bensone, Vânia R. Leite-Silvaa, b, d *

a
5 Programa de Pós-Graduação em Medicina Translacional, Departamento de Medicina,
6 Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
b
7 Departamento de Ciências Farmacêuticas, Instituto de Ciências Ambientais, Químicas e
8 Farmacêuticas, Universidade Federal de São Paulo, Brazil
c
9 Departamento de Dermatologia, Escola Paulista de Medicina, Universidade Federal de Sao
10 Paulo, Brazil
d
11 Frazer Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102,
12 Australia
e
13 Curtin Medical School, Curtin University, GPO Box U1987, Perth, WA 6845, Australia

14

15 * Author for correspondence: vania.leite@unifesp.br

16

17 Acknowledgments:
18 • Prof. Nelson Pinheiro, for his dedication and generosity in preparing and conducting
19 classes (in person and recorded) on makeup.
20 • The Brazilian Association of Cosmetology (Associação Brasileira de Cosmetologia - ABC)
21 which, with its support, contributed decisively to the viability of this work.
22 • Anhembi-Morumbi University (Universidade Anhembi-Morumbi), for providing a
23 specialized space in which the face-to-face activities of this work were carried out and
24 for releasing the students who helped the participants during the activities.
25 • The following companies (in alphabetical order) for donating the products that made up
26 the “kit” used by the participants: Beauty Caps, Beyoung, Grupo Boticario, Catharine Hill,
27 Dailus, Eudora, Ikesaki Cosmetics, Natura, Vult.
28 • The Translational Research Institute.
29 • We also thank all the participants.

30 Funding:
31 This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo -
32 FAPESP, process 2020/01563-2.

33 Conflicts of Interest:
34 The authors declare that they have no known competing financial interests or personal
35 relationships that could have appeared to influence the work reported in this paper.

36 Data Availability:
37 The dataset generated during the current study is available at:

38 https://1drv.ms/f/s!Ao2FRgWr7T6YgpMktKfn-W1pCFoUtw?e=5CkoAA

39 Ethics and Registration

40 The study was carried out in accordance with the Declaration of Helsinki of 1964 and its
41 subsequent amendments, having been approved by the Research Ethics Committee of the
42 Federal University of São Paulo (UNIFESP) - Opinion No. 3,912,288 and registered on
43 Plataforma Brasil under number 28057119.5.0000.5505. Prior to any study activity, all
44 participants agreed to participate and authorized the dissemination of their results, signing
45 the informed consent form.

46 What is already known about this topic?

47 Several studies claim that care for appearance and use of makeup improve self-esteem
48 and quality of life in adults, but little has been produced scientifically to objectively
49 measure this effect, especially involving people from the general population.

50 What does this study add?

51 This study provides an objective measure of the impact that the introduction of frequent
52 use of makeup on women (adults and of medium-low purchasing power) without the habit
53 of wearing makeup provides, using a self-assessment scale of depressive symptoms,
54 salivary cortisol concentration and self-image scores extracted from the Mirror Test.

55 What is the translational message?

56 Adopting a simple procedure such as encouraging care with appearance through frequent
57 use of makeup (a simple and low-cost procedure) can effectively and sustainably contribute
58 to improving the well-being and mental health of a significant portion of the population.

59

60 ABSTRACT
61 The incidence of depression is twice as high in adult women compared to men. Middle-
62 aged women are at an increased risk of mood alterations, anxiety and depression
63 symptoms, likely due to the influence of genetic factors, lifestyle, and hormones. It is one of
64 the most disabling diseases in the world, generating high direct and indirect costs. In 2010,
65 depressive disorders were identified as one of the leading causes of impact on "years lived
66 with disability" (YLDs) and "disability-adjusted life years" (DALYs). Due to its prevalence and
67 morbidity, the World Health Organization (WHO) has recommended the integration of
68 mental health into the focus of primary care, aiming to solve or reduce the "gap between
69 those who need and those who actually receive the adequate care." As for treatment, most
70 mild and moderate cases are referred to psychotherapy and drugs are reserved for
71 moderate and severe conditions. The etiological complexity of depression leads authors to
72 consider that the "treatment strategy must be multimodal". Self-care regarding appearance
73 has a strong relationship with a woman's self-esteem. Additionally, by promoting well-
74 being, adjuvant effects on the mental health of women affected by serious illnesses have
75 been demonstrated.

76 The objective of this study was to measure the influence of the introduction of frequent
77 use of makeup on the improvement of depressive symptoms in adult women of medium-
78 low purchasing power. To classify and compare the level of symptoms the Zung Self-Rating
79 Depression Scale was used, as well as self-image perception from the Mirror Test and
80 salivary cortisol level.

81 The results showed a sustained reduction in depressive symptoms (reduction of 8.3

82 percentage points in the Average Zung Idex (P<0.05)), with a significant improvement in
83 self-perception of the image (25% increase in the average score obtained by the Mirror Test
84 (P<0.05)) and a punctual influence on salivary cortisol levels (55% reduction in salivary
85 cortisol concentration (P<0.05) after the 1st makeup).

86 In conclusion, encouraging the frequent use of makeup, a habit accessible to most people,
87 simple and inexpensive to implement, can effectively and sustainably contribute to
88 improving the well-being and mental health of a significant portion of the population.

89

90 Keywords: mental health, depressive symptoms, self-care, self-esteem, makeup, beauty,

91 depressive symptoms, Zung scale, cortisol.

92

93 GRAPHICAL ABSTRACT
 94
95

96

97 BACKGROUND
98 Depression has been identified by the World Health Organisation (WHO) as a global health
99 priority that accounts for 10 percent of the total non-fatal disease burden (1). In 2010 the
100 economic burden of major depressive disorder in the USA was estimated at US$210.5
101 billion, and in 2020 it had risen to US$326.2 billion (2). Depression is characterised by a
102 depressed mood or lack of pleasure and/or interest in activities for prolonged periods. It
103 negatively affects all aspects of life including relationships, education, work productivity
104 and self-worth. It can contribute to or worsen physical co-morbidities and can lead to self-
105 harm and suicide.

106 Depression disproportionally affects women and girls, with the incidence approximately
107 50% higher than in males (3). The gender difference in depression, with twice as many
108 women diagnosed than men, was first reported in the 1970s(4), and has since been
109 supported by a large body of epidemiological studies. A recent meta-analysis focussed on
110 the incidence of depression through the lifespan and demonstrated that the gender
111 difference for depression diagnosis exists at 12 years, peaks at 13-15 years and persists
112 throughout the lifespan (5). Developmental and hormonal changes associated with
113 puberty, premenstrual problems, pregnancy and post-partum, and menopause can all be
114 associated with increased incidence of depression. Given the disparity in the incidence of
115 depression, there is a need for gender specific management of the condition.

116 Management of depressive disorder is multifactorial including psychological treatment

117 (commonly cognitive behavioural therapy: CBT) and antidepressive medications. The WHO
118 also describes the role that self-care can play in managing symptoms and promoting
119 overall well-being (3). This includes getting regular exercise, improving nutrition, reducing
120 stress, improving sleep patterns, and engaging in positive social interactions. It is an aspect
121 of self-care in depression management that is the focus of this research.

122 Positive self-esteem and self-image are important considerations in good mental health.
123 Skin care and beauty routines are often advocated by self-help groups 1, online influencers
124 and in magazines. Several studies have demonstrated positive trends in psychological
125 measures in response to beauty-related interventions. This is particularly the case where
126 the presence of a disease state is often associated with a reduction in self-image, such as
127 with breast cancer(6,7).

128 As makeup involves three of the human senses (touch, smell, and vision), it can induce
129 pleasure, sensory and psychological feelings. In addition, it modifies the appearance, helps
130 to cope with self-image, emotions and mood. Cosmetics promote well-being by modifying
131 appearance and stimulating attractiveness. Among them, it has been shown that makeup
132 provides supporting effects on mental health of women affected by serious diseases (8). In
133 a recent survey of 2400 Brazilian women, we demonstrated that regular use of makeup
134 was associated with a lower incidence of mild depression and lower intensity of depressive
135 symptoms (9). To further examine this finding, the current study was developed to
136 investigate the effect of the introduction of frequent use of makeup on depressive
137 symptoms in adult women, of medium-low purchasing power, who were not previously in
138 the regular habit of applying makeup. Products and instructions were provided to
139 encourage frequent use of makeup. The evolution of depressive symptoms was performed
140 based on the application of the Zung Self-Assessment Scale for Depressive Symptoms.

141 MATERIAL, METHODS AND CASUISTIC

142 Design: The study used an open, randomized, prospective and controlled trial design.

143 Population: 240 participants were identified and recruited from a previous national
144 survey conducted by our group (observational, cross-sectional, population-based study)
145 based on a representative sample of the target population (n = 2,400), which aimed to

1 1
For example:
2 https://www.hellomagazine.com/healthandbeauty/health-and-fitness/20221214159573/beauty-
3 rituals-depression-mental-health/
146 estimate the prevalence of depressive symptoms and demonstrated the existence of an
147 association between a lower prevalence of symptoms suggestive of mild depression
148 among participants with frequent use of makeup (9).

149 The inclusion criteria were: self-reported infrequent use of makeup (never or almost never,
150 only on special occasions or only on weekends) and a Zung depression scale score between
151 30 and 60: minimum of depressive symptoms in order to measure the effect of introducing
152 frequent use of makeup.

153 The exclusion criteria were the self-report of having received from a doctor, at some point
154 of life, a diagnosis of mood disorders, current or previous use (90 days before the
155 interview) of any medication with action on the central nervous system (for this approach,
156 non-technical language was used, asking them about the use of medicines considered as
157 "soothing", to "facilitate sleep", or any other for "some emotional problem").

158 In addition, those presenting with an initial gross score by on the Zung Scale below 30, or
159 above 60, were excluded, as illustrated in figure 1.

160

161 Figure 1. Schematic representation of the Zung Scale range selected to compose the
162 studied population.

163 The recruited participants were randomized (simple alternation of groups according to
164 order of recruitment) between "test" and "control" groups. Among 120 participants
165 recruited for the "Test" intervention group, 95 were included. Those who lived in São Paulo
166 city were invited to constitute a subgroup for "in-person" participation (n=22); the
167 remaining 73 were allocated in the subgroup for remote/online participation. In the same
168 way, from 120 participants randomized for the "Control " group, 50 were included. Those
169 from São Paulo city were invited to participate in the "in-person" subgroup (n=16), and 34
170 were part of the subgroup for “remote/online participation" (Figure 2).
171

172 Figure 2. Flow chart of the clinical trial

173 Makeup Workshops:
174 1
- Sending video lesson + Product Kit
175 2-
In-person class + 1st makeup + Sending video lesson and Product Kit.
176 Where:
177 Zung 2, 3: Refer to the 2nd and 3rd applications of the Zung Scale
178 Cortisol 1, 2, 3: Refer to the 1st, 2nd and 3rd cortisol levels performed.
179 Mirror 1.2: refer to the 1st and 2nd achievements of the Mirror Test
180 1A and 1D: refer to the achievements of the "Before" and "After" tests of the Makeup Workshop
181
182 Intervention:
183 After signing the ICF (Informed Consent Form), the test group (In-person and online)
184 received an incentive to adopt a frequent use of makeup (experimental treatment) after a
185 Makeup Workshop and supply of products with sufficient variety and volume to comply
186 with the provided guidelines for 60 days.

187 For the subgroup “in-person”, the makeup workshop was carried out in a face-to-face class
188 on self-makeup with a professional teacher/makeup artist. The participants were
189 encouraged to perform a first makeup application, assisted by students of the Aesthetics
190 Course and they received a product kit, as shown in Figure 3.
191

192 Figure 3: Makeup kit provided to each participant.

193

194 They also received a link (https://youtu.be/TXwL539IE8Y) for a 20 min video lesson on self-
195 makeup taught by the same teacher. It contains explanations about the use and
196 techniques of application of the products for 3 options of makeups: basic for day to day,
197 basic with eye enhancement and for night. It also encourages them to see videos sent 15
198 and 45 days after the workshop, lasting 10 seconds, to reinforce the use of makeup and
199 rewatch the video class in case of doubts.

200 For the subgroup with online participation, after signing the ICF, the same product kit and a
201 video lesson were sent. After 15 and 45 days, the videos of encouragement were also sent.

202 After signing the ICF the control group received only guidance on completing follow-up
203 questionnaires, without any encouragement to use products or change habits.

204 Outcomes:
205 Given the prevalence of depression and the need for diagnosis in the primary healthcare
206 setting, several screening instruments have been developed (10). In their review of the
207 existing depression screen guidelines and instruments, Najila et. al. (2015) concluded that
208 the 2-item Patient Health Questionnaire (PHQ-2) provided a suitable primary screening tool
209 for depression that was reliable, brief, and easy to administer. If positive, this should be
210 followed by a suitable instrument such as the "Patient Health Questionnaire" (PHQ-2 and
211 PHQ-9), the "General Health Questionnaire" (GHQ-28) or the "Zung Self-Rating Depression
212 Scale" (ZSDS). The authors concluded that the first 3 instruments were more sensitive, and
213 the fourth (ZSDS) the most specific. The ZSDS was chosen for this study based on its
214 extensive use and validation in female health (13), including translation to Brazilian
215 Portuguese (11). The primary outcome was therefore the change in the level of depressive
216 symptoms measured by the Zung Self-Rating Depression Scale, at baseline, after 30 and 60
217 days. All participants answered the online questionnaire with the Zung Depressive
218 Symptoms Self-Assessment Scale, at the times indicated in Table 1.

MEASURES TIME TEST Group CONTROL Group

Measure 1 Initial Survey (Observational / Cross-Sectional)
After 30 days of receiving the link to After 30 days of the signing
Measure 2 + 30 days
the video lesson / Makeup Workshop of the ETS
60 days after receiving the link to the 60 days after the signing of
Measure 3 + 60 days
video lesson / Makeup Workshop the ETS

219 Table 1 - Times of answers to self-assessments of depressive symptoms

220

221 Cortisol is a hormone released in stress situations (12) . Its role in the genesis of depression
222 is considered important, including a temporal dimension related to the phases of life, and
223 specific variations during environmental events. It can also predispose to or trigger the
224 beginning of a depression episode (13).

225 Saliva was collected with Salivette® for cortisol measurement, after ingestion of water and
226 light mouthwashes to eliminate any food residues. Participants were instructed to not
227 touch the collection cotton; chew it for 2 minutes; deposit it in the proper sterile container
228 and add some additional saliva. The samples were collected by qualified personnel,
229 properly packed, and transported centrifuged at 3000 rpm for 10 minutes at room
230 temperature; the supernatant was transferred into the sample cup and allocated in the
231 CObas 8000 equipment for cortisol measurement. The method used was the immunoassay
232 with electrochemiluminescence reading, brand Roche.

233 The mirror test was originally developed by American psychologist Gordon Gallup Jr. for
234 testing on animal cognition (14). Although the purpose used here has not been validated,
235 thus representing an opportunity for studies in this regard, it has been frequently used by
236 companies operating in the beauty and aesthetics segment, which is why it was included in
237 the experiment. The logic of mirror testing relates to the person’s confrontation with their
238 own reflection. This confrontation is relevant for studies involving cosmetics because it is a
239 powerful psychological trigger characterized as a mild stressor, with significant emotional
240 load and activation aspects related to self-acceptance (15).

241 The mirror test was applied in a neutral room with air conditioning and the participants
242 answered the following open questions:
243 1) What do you see in front of the mirror? Describe, and

244 2) How would someone else describe you on a first date?

245 The answers were recorded and transcribed. The adjectives contained in the answers were
246 organized and associated with scores, according to table 2, for statistical analysis. Higher
247 scores were attributed to the most positive adjectives.

248 The secondary outcomes were only measured in the in-person participants: salivary
249 cortisol concentration, at baseline and after 30 and 60 days, and self-perception of the
250 image from the Mirror Test, at baseline and after 60 days.

CORTISOL
TIME TEST Group CONTROL Group
DOSAGES
Collection BEFORE Class + 1st Makeup / 30
Collection 30 minutes after
Dosage 1 Day 1 minutes after setting
setting
Collection AFTER Class + 1st Makeup
Dosage 2 + 30 days Collection 30 minutes after setting
Dosage 2 + 60 days Collection 30 minutes after setting
MIRROR
TIME TEST Group CONTROL Group
TEST
Collection BEFORE Class + 1st Makeup /
After saliva collection
Test 1 Day 1 After saliva collection
Collection AFTER Class + 1st Makeup,
before saliva collection
Test 2 + 60 days After saliva collection
ANSWERS TO MIRROR TEST
SCORES ADJECTIVES
5 Beautiful, powerful, diva, confident, attractive, + superlatives
4 Pretty, well, good self-esteem, I like what I see
3 Normal, OK, average, neither pretty nor ugly
2 Ugly, I don't feel good, bad, low self-esteem, I don't like what I see
1 Horrible, terrible

251 Table 2: Times of cortisol dosages and Mirror Test (times and answers).

252
253 Analysis of data: The results were analyzed using the Software SPSS v.21. Hypothesis
254 tests were conducted with a significance level of 5%:

255 • Between two means of independent samples: Student's T test

256 • Between two means of dependent samples: Paired T Test
257 • Between more than two means of dependent samples: Repeated Measures ANOVA -
258 Intragroup Comparisons

259 RESULTS
260 Participant Compliance: Among the 95 participants in the Test group, despite the stimuli
261 and orientations, only 82 reported an increase in the frequency of makeup use, and only 66
262 effectively reached "frequent use". Although there was no stimulus or guidance, from the
263 50 participants of the Control group, 20 reported a spontaneous increase in the frequency
264 of makeup use, and 11 started the “frequent use”. The diagram presented in Figure 4
265 shows that the procedures “change or not" the frequency of makeup use, determined new
266 subgroups. The analysis was preserved in the originally defined subgroups only in cases
267 where the change in frequency of makeup use over time would not be a determining factor
268 of bias.

269

270 Figure 4. Composition of subgroups and results about use of makeup

271

272

273 Zung depression scale:

274 Regarding depressive symptoms, Figure 5 shows that, considering the total number of
275 participants and comparing the averages of the three Zung index measurements,
276 significant reductions (P = 0,04) were identified in the intragroup comparison between
277 second and third measures compared to the first, in the subgroup that increased the
278 frequency of makeup use.

279 No difference was observed among the participants who did not increase the frequency of
280 makeup use.

281

282

283 Figure 5 - Zung Index Average Variation Between Measurements - Comparison between
284 subgroups: Increase X Did not increase the frequency of makeup use.

285 Considering the total number of participants and analyzing the subgroups "adopted or not
286 the frequent use of makeup", figure 6 shows significant reduction between the average of
287 second (P = 0,04) and third (P = 0,003) measurements compared to the first, among those
288 who started frequent use of makeup. Additionally, for this subgroup a significant reduction
289 (P = 0,04) was identified in the average between the third versus the second measurement.

290 No difference was observed among the participants who did not reach frequent use of
291 makeup (3 or more times per week)
292

293 Figure 6 - Zung Index Average Variation Between Measurements - Comparison between
294 subgroups: Adopted X Did not adopt the frequent use of makeup.

295

296 Salivary cortisol:

297 Figure 7 shows a significant reduction in the average of salivary cortisol levels when the
298 dosages performed before and after the Makeup Workshop and first makeup were
299 compared (Paired T Test, P = 0,000), and comparing the test and control group (Students T
300 Test, P = 0,019). This result indicates that the interventions generated impact for the
301 participants.
302

303 Figure 7 - Average of Salivary Cortisol levels, before vs. after the Workshop and 1st
304 makeup in Test and Control Groups
305 1A = Measurement before the workshop + 1st makeup | 1D = Measure after the workshop + 1st makeup

306 When analyzing the variation of these average levels at the follow-up of 30 and 60 days,
307 figure 8 shows no significant results. The non-significant differences suggests that the
308 effect generated by the workshop and first makeup was not maintained over time, being
309 restricted to the period of the activities. The role of cortisol, especially in its proximal
310 dimension2 (13), was evidenced between the dosages before and after the Workshop and
311 first makeup. The non-routine situation in which the participants participated may be
312 related to this result, which did not last in the follow-up period.

4 2
According to Herbert (2013) Cortisol exerts its influence across two dimensions: a time-related one
5 based on phases of the lifespan that regulate levels of risk, and a more proximal one during the
6 processes leading to the onset and course of an episode of MDD.
7
313

314 Figure 8 – Average of Salivary Cortisol levels after 30 and 60 days

315 * Increase frequency of use, but did not reach frequent use
316 ** Reached the frequent use (3 or more times per week)

317

318 Mirror Test:

319 Regarding the mirror test, figure 9 illustrates a significant increase in the score obtained in
320 the test before and after the workshop and first makeup (Paired T Test, P = 0,000) and
321 compared to the Control Group (T Test, P = 0,002). The two comparisons indicate that there
322 was a positive impact of the intervention, reinforced by the fact that the initial average in
323 the test group was lower than in the control group.

324
325 Figure 9 - Average Score through Mirror Test: Test X Control (Before X After the
326 Workshop and first makeup, in the case of the Test Group).

327

328 Figure 10 shows no significant variation in the average score between the first and second
329 measurements in the subgroups that do not increase the frequency of makeup use. On the
330 other hands, in the group that did it, there was a significant increase (P = 0,000) between
331 the first and second measurements. This was also observed among the second
332 measurements of the subgroup that reached the frequent use of makeup use (P = 0,000),
333 compared to those that did not.

334

335 Figure 10 - Average Mirror Test Score - Comparison between measurements

336 * Increase frequency of use, but did not reach frequent use
337 ** Reached the frequent use (3 or more times per week)

338

339 Discussion
340 These findings suggest that persistent and frequent use of makeup could progressively
341 contribute to the reduction of depressive symptoms, in a follow-up period. Our results
342 corroborate those described in a study including 39 patients with breast cancer (16), which
343 demonstrated improvement in outcomes such as depressive symptoms from brief and
344 low-cost interventions involving beauty care. Stotland discussed concepts related to
345 depression recovery, stating that fewer patients return to the mood they had prior to
346 episodes of depression and questioned factors that could improve treatment results,
347 applied alone or in combination (17). Our results showed that the answer may not be
348 unique and definitive, but at least in part, we may suggest that an affordable measure,
349 such as makeup, has the potential to contribute to the improvement of depressive
350 symptoms, mood swings and low self-esteem.

351 An analysis performed with a sample of Psychology students indicated positive correlation
352 between makeup use and low physical self-esteem (8), reinforcing the idea that it is a
353 resource to strengthen it. However, little has been produced scientifically to measure the
354 impact of this habit, especially for general population. We have only found 3 other studies
355 that have addressed the theme of interest for our study.

356 A review article on the role of cortisol in situations of competitive stress (18) concluded
357 that there is an increasing rise in its production triggered by stressful situations, with an
358 evident "anticipatory" effect. This finding justifies the higher average level in the test group
359 prior to the Makeup Workshop (anticipatory effect) compared to the average level obtained
360 in the Control group and suggests that we may be seeing a stress reducing effect.

361 We noted significant improvements in mirror test scores in the intervention group,
362 indicating improved self-perception. We did not find data for comparisons with our
363 findings for the mirror test in the searched literature. This is an area that requires further
364 investigation.

365 This type of research should be expanded to other segments of the population or specific
366 profiles of participants with the potential to demonstrate the benefits of the interventions
367 we have described. A relevant perspective, already discussed in the literature would be the
368 objective evaluation of the role of makeup, even light, in women with chronic inflammatory
369 dermatoses (acne, rosacea, discoid lupus erythematosus, seborrheic dermatitis) or with
370 pigmentation changes (melasma, post-inflammatory macules, vitiligo etc.) that affect the
371 face(19–24). The negative impact of these conditions on quality of life is well documented.
372 The orientation on the use of makeup and camouflage is already considered part of the
373 therapeutic management (25). For acne, for example, it has been shown that makeup can
374 be compatible with the topical treatments (26). Additionally, three benefits are determined
375 by makeup in facial acne: it avoids manipulation of lesions, contributes to photoprotection
376 and, due to effective covering, improves quality of life and self-esteem, with positive social
377 and professional repercussions, particularly in adult women (27,28).

378 CONCLUSION
379 A positive relationship has been proven shown between the introduction of frequent use of
380 makeup and sustained reduction of depressive symptoms, with significant improvement in
381 self-perception of the image and punctual a short-term influence on salivary cortisol levels.
382 Translational research aims to benefit people by generating scientifically solid knowledge
383 and new therapeutic concepts with real practical applicability. By identifying that simple
384 actions such as encouraging the frequent use of makeup can effectively and sustainably
385 contribute to improving the well-being and mental health of a significant portion of the
386 population, our research group is convinced that this purpose was adequately and
387 completely fulfilled.

388
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