Compared with healthy participants, Chinese patients with hepatitis B (HB) experience more psychosocial stress. The present study provided the first examination of physiological and subjective responses to stress in Chinese HB patients. A standard psychosocial stressor, the Trier Social Stress Test (TSST), was administered to 26 Chinese HB patients and 24 healthy control participants. Cortisol concentrations were measured in blood samples collected before and after the stressor. Self-reported emotional responses and cardiovascular measures were examined before and after the TSST. Depression and anxiety were assessed using Hospital Anxiety and Depression Scale. Chinese HB patients exhibited higher cortisol response to the stressor than healthy control participants. Compared with healthy participants, Chinese HB patients showed higher levels of anxiety, depression and nervousness, and lower levels of calmness after the TSST. HB patients reported more negative life events in the previous 6months and obtained higher adversity scores, as compared with control participants. Significant correlations were obtained between adversity scores and change cortisol secretion after TSST in HB patients, but not in healthy participants. This study firstly demonstrates that physiological and subjective responses to psychosocial stress among Chinese HB patients were different from that in healthy control participants. Copyright (c) 2013 John Wiley & Sons, Ltd.