Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis
Abstract
The magnitude of the cortisol awakening response, a relatively new indicator of hypothalamic-pituitary-adrenocortical (HPA) axis activation, has been related to a number of psychosocial factors. But findings have been inconsistent across studies. We systematically reviewed previous studies investigating the association between the cortisol awakening response and psychosocial factors. 147 eligible studies from 62 articles were identified. Separate analyses were carried out on the increase in cortisol following waking (CARi), and the integrated volume of cortisol released over the waking period (CARauc). We found that the CARi was positively associated with job stress and general life stress. It was negatively associated with fatigue, burnout, or exhaustion. There were less reliable negative associations between the CARi and positive affects. The CARauc was positively related to general life stress and negatively related to posttraumatic stress syndrome. This review concludes that different psychosocial factors are associated with an enhanced or reduced cortisol awakening response.
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Greater cortisol awakening responses are linked to higher appraisals of general life and job stress.
“According to a meta-analysis, higher CARs are associated with increased appraisals of general life and job stress (Chida & Steptoe, 2009).”
From It's not what you think, it's how you relate to it: Dispositional mindfulness moderates the relationship between psychological distress and the cortisol awakening response (2014) · cites this paper as Chida & Steptoe, 2009
Anxiety, rumination, and negative affect do not show a reliable link to the cortisol awakening response.
“However, negative affect, anxiety, and rumination are not reliably associated with the CAR (Chida & Steptoe, 2009; Zoccola &Dickerson, 2012).”
From It's not what you think, it's how you relate to it: Dispositional mindfulness moderates the relationship between psychological distress and the cortisol awakening response (2014) · cites this paper as Chida & Steptoe, 2009
CAR may be a unique component of the HPA-axis, representing its response to awakening, and is less likely to be influenced by stressors throughout the day.
“Specifically, CAR may be a unique component of the HPA-axis, representing its response to awakening, and is less likely to be influenced by stressors throughout the day.32,33”
From DIURNAL CORTISOL INTERACTS WITH STRESSFUL EVENTS TO PROSPECTIVELY PREDICT DEPRESSIVE SYMPTOMS IN ADOLESCENT GIRLS (2017) · cites this paper as [32]
A lower post-awakening increase in cortisol is associated with higher symptoms of fatigue, burnout or exhaustion.
“Furthermore, it has been concluded in a systematic review that a lower post-awakening increase in cortisol was associated with higher symptoms of fatigue, burnout or exhaustion [60].”
From Preliminary Results: The Impact of Smartphone Use and Short-Wavelength Light during the Evening on Circadian Rhythm, Sleep and Alertness (2021) · cites this paper as [60]
A prior meta-analysis of 62 studies found substantial inconsistency in results linking psychosocial functioning with the CAR.
“A meta-analysis of 62 studies revealed considerable heterogeneity in findings linking psychosocial functioning to the CAR (Chida & Steptoe, 2009).”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
AUCw was negatively associated with posttraumatic stress.
“AUCw was positively related to general life stress but negatively related to posttraumatic stress (Chida & Steptoe, 2009).”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
Chida and Steptoe (2009) classified psychosocial predictors into seven categories, including job stress, general life stress, depression, anxiety, fatigue or burnout, posttraumatic stress, and positive traits.
“Chida and Steptoe (2009) described seven different types of psychosocial predictors: job stress, general life stress (non-work-related), depression, anxiety (including neuroticism and negative affect), fatigue/burnout/exhaustion, posttraumatic stress, and positive psychosocial traits.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
CARi was negatively associated with fatigue, burnout, or exhaustion.
“CARi was positively correlated with job stress and general life stress but negatively correlated with fatigue, burnout, or exhaustion and not reliably associated with positive affect.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
When both CARi and AUCw were measured, their associations with psychosocial functioning measures differed.
“In studies in which both CARi and AUCw were measured, their relationships to measures of psychosocial functioning were not the same (e.g., Bhattacharyya et al., 2008; Chida & Steptoe, 2009; Ellenbogen et al., 2006; Mommersteeg et al., 2006; Sonnenschein et al., 2007; Whitehead et al., 2007)”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
AUCw was positively associated with general life stress.
“AUCw was positively related to general life stress but negatively related to posttraumatic stress (Chida & Steptoe, 2009).”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
CARi was positively associated with general life stress.
“CARi was positively correlated with job stress and general life stress but negatively correlated with fatigue, burnout, or exhaustion and not reliably associated with positive affect.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
CARi was positively associated with job stress.
“CARi was positively correlated with job stress and general life stress but negatively correlated with fatigue, burnout, or exhaustion and not reliably associated with positive affect.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
Inconsistency in the psychosocial-functioning-CAR literature is typical rather than unusual.
“Heterogeneity in the literature linking psychosocial functioning to the CAR is the rule rather than the exception”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
For four of seven psychosocial predictor categories, the literature contains both positive and negative associations with the CAR.
“in four of seven types of psychosocial predictors, studies showing both positive and negative associations exist (Chida & Steptoe, 2009)”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
CARi was not reliably associated with positive affect.
“CARi was positively correlated with job stress and general life stress but negatively correlated with fatigue, burnout, or exhaustion and not reliably associated with positive affect.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
Chida and Steptoe (2009) identified seven categories of psychosocial predictors associated with the CAR: job stress, general life stress, depression, anxiety, fatigue, burnout, or exhaustion, posttraumatic stress, and positive traits.
“Chida and Steptoe (2009) described seven categories of psychosocial predictors that have been associated with the CAR: job stress, general life stress, depression, anxiety, fatigue/burnout/exhaustion, posttraumatic stress, and positive psychosocial traits.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida and Steptoe (2009)
Heterogeneity in the literature is partly due to methodological and operationalization inconsistencies across studies and to potential measure-dependent or predictor-specific associations.
“This heterogeneity is partially the result of methodological and operationalization inconsistencies across studies and potential measure-dependent and/or predictor-specific associations (Chida & Steptoe, 2009; Stadler et al., 2016).”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida & Steptoe, 2009
These small effects were similar to those reported by Chida and Steptoe (2009), with r's ranging from -.065 to .069 depending on the specific predictor.
“These small effects were similar to those reported by Chida and Steptoe (2009), with r's ranging from -.065 to .069 depending on the specific predictor.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida and Steptoe (2009)
This result agrees with meta-analytic findings from Chida and Steptoe (2009).
“This corroborates meta-analytic results from Chida and Steptoe (2009).”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida and Steptoe, 2009
Among the seven categories defined by Chida and Steptoe (2009), only fatigue/burnout/exhaustion was negatively correlated with CARi.
“Of the seven categories previously defined by Chida and Steptoe (2009), it was found that only fatigue/burnout/exhaustion was negatively correlated with CARi.”
From Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies (2017) · cites this paper as Chida and Steptoe, 2009
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Psychological coping styles and cortisol over the day in healthy older adults
O’Donnell, K., Badrick, E., Meena Kumari, B., & Steptoe, A. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.01.015 · Cited by 115 · see citing works
Self-citationDaytime cortisol and stress reactivity in the offspring of parents with bipolar disorder
Ellenbogen, M. A., Hodgins, S., Walker, C.-D., Couture, S., & Adam, S. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.08.004 · Cited by 114 · see citing works
No morning cortisol response in patients with severe global amnesia
Wolf, O. T., Fujiwara, E., Luwinski, G., Kirschbaum, C., & Markowitsch, H. J. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2004.05.001 · Cited by 112 · see citing works
Mommersteeg, P. M. C., Heijnen, C. J., Verbraak, M. J. P. M., & van Doornen, L. J. P. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.07.003 · Cited by 111 · see citing works
The effect of dawn simulation on the cortisol response to awakening in healthy participants
Thorn, L., Hucklebridge, F. H., Esgate, A., Evans, P. D., & Clow, A. (2003) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2003.08.005 · Cited by 111 · see citing works
Wirtz, P. H., von Känel, R., Emini, L., Rüdisüli, K., Groessbauer, S., Maercker, A. R. A., & Ehlert, U. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.02.006 · Cited by 110 · see citing works
Central adiposity and cortisol responses to waking in middle-aged men and women
Steptoe, A., Kunz-Ebrecht, S., Brydon, L., & Wardle, J. (2004) · International Journal of Obesity · doi:10.1038/sj.ijo.0802715 · Cited by 110 · see citing works
Self-citationDepression is associated with flatter cortisol rhythms in patients with coronary artery disease
Bhattacharyya, M. R., Molloy, G. J., & Steptoe, A. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.03.012 · Cited by 103 · see citing works
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Langelaan, S., Bakker, A. B., Schaufeli, W. B., van Rhenen, W., & van Doornen, L. J. P. (2006) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.1029 · Cited by 88 · see citing works
Coffee, stress and cortisol in nursing staff
Harris, A., Ursin, H., Murison, R. C. C., & Eriksen, H. R. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.01.003 · Cited by 87 · see citing works
Violence exposure and cortisol responses in urban youth
Kliewer, W. L. (2006) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1302_2 · Cited by 86 · see citing works
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Rejection sensitivity relates to hypocortisolism and depressed mood state in young women
Mattie Tops, A., Riese, H., Oldehinkel, A. J., Rijsdijk, F. V., & Ormel, J. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.01.011 · Cited by 81 · see citing works
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Salivary Cortisol Awakening Response in Mild Alzheimer Disease, Caregivers, and Noncaregivers
Wahbeh, H., Kishiyama, S. S., Zajdel, D. P., & Oken, B. (2008) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e31815a9dff · Cited by 75 · see citing works
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Marital-role quality and stress-related psychobiological indicators
BARNETT, R. C., Steptoe, A., & Gareis, K. C. (2005) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3001_5 · Cited by 66 · see citing works
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Self-citationProgression in intima media thickness—the significance of hormonal biomarkers of chronic stress
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Encyclopedia of Stress (2nd ed)
Munafo, M. R., & Flint, J. (2007) · Cited by 62 · see citing works
The effect of an environmental stressor on gender differences on the awakening cortisol response
Weekes, N. Y., Lewis, R. S., Goto, S. G., Garrison-Jakel, J., Patel, F., & LUPIEN, S. J. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.03.003 · Cited by 60 · see citing works
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Awakening cortisol response in relation to psychosocial profiles and eating behaviors
Therrien, F., Drapeau, V., LUPIEN, S. J., Beaulieu, S., Doré, J., Tremblay, A., & Richard, D. (2007) · Physiology & Behavior · doi:10.1016/j.physbeh.2007.08.019 · Cited by 49 · see citing works
Cortisol and severe fatigue: A longitudinal study in adolescent girls
ter Wolbeek, M., van Doornen, L. J. P., Coffeng, L. E., Kavelaars, A., & Heijnen, C. J. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.12.003 · Cited by 38 · see citing works
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Self-citationThe cortisol awakening response—an exploration of intraindividual stability and negative responses
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Schulz (1998) · doi:10.1002/(sici)1099-1700(199804)14:2
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Salivary cortisol as a biomarker in stress research
Hellhammer, D. H., Wüst, S., & Kudielka, B. M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.10.026 · Cited by 1,925 · see citing works
Stress and Health: A Review of Psychobiological Processes
O'Connor, D. B., Thayer, J. F., & Vedhara, K. (2021) · Annual Review of Psychology · doi:10.1146/annurev-psych-062520-122331 · Cited by 948 · see citing works
“The CAR has been linked with stress and a range of health outcomes, though, the pattern of results has been mixed (e.g., Adam et al., 2010; Chida & Steptoe, 2009; Clow et al., 2010; Gartland et al., 2014; Steptoe & Serwinski, 2016; O’Connor et al., 2013).”
BackgroundResultAssessing salivary cortisol in large-scale, epidemiological research
Adam, E. K., & Kumari, M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.06.011 · Cited by 936 · see citing works
“The exact interpretation of each of the elements of diurnal HPA axis functioning is still subject to debate, but recent reviews are beginning to close in on the meaning and relevance of the different aspects of the rhythm (Saxbe, 2008; Chida and Steptoe, 2009).”
Adam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.05.018 · Cited by 905 · see citing works
“For the purposes of this review, any measure that provides an indication of the magnitude of the difference between morning and evening cortisol values is considered a measure of the DCS. Common types of slopes include: 1) wake-to-bed slopes, which examine the absolute change or rate of change in cortisol from immedia…”
BackgroundResultInfluentialAssessment of the cortisol awakening response: Expert consensus guidelines
Stalder, T., Kirschbaum, C., Kudielka, B. M., Adam, E. K., Pruessner, J. C., Wüst, S., Dockray, S., Smyth, N., Evans, P., Hellhammer, D. H., et al. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.10.010 · Cited by 967 · see citing works
“For in-depth discussions of CAR covariates interested readers are referred to the respective review articles (state factors: Law et al., 2013; trait factors: Fries et al., 2009; Chida & Steptoe, 2009; sleep-related: Elder et al., 2014).”
InfluentialBurnout–Depression Overlap: A Review
Bianchi, R., Schonfeld, I. S., & Laurent, E. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.01.004 · Cited by 868 · see citing works
Stress-related and basic determinants of hair cortisol in humans: a meta-analysis
Stalder, T., Steudte-Schmiedgen, S., Alexander, N., Klucken, T., Vater, A., Wichmann, S., Kirschbaum, C., & Miller, R. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.12.017 · Cited by 855 · see citing works
“It is also noteworthy that our findings did not reveal significant associations of HCC with measures of the CAR or overall post-awakening cortisol secretion.”
InfluentialWork Stress and Employee Health
Ganster, D. C., & Rosen, C. C. (2013) · Journal of Management · doi:10.1177/0149206313475815 · Cited by 914 · see citing works
“…literature have found little consistent evidence relating work stress to cortisol from serum and urine (Hansen, larsen, Rugulies, Garde, & Knudsen, 2009), but a review by Chida and Steptoe (2009) concluded that work stress was positively related to cortisol CAR (assayed mostly from saliva).”
BackgroundInfluentialChronic stress, cognitive functioning and mental health
Marin, M.-F., Lord, C., Andrews, J., Juster, R.-P., Sindi, S., Arsenault-Lapierre, G., Fiocco, A. J., & Lupien, S. J. (2011) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2011.02.016 · Cited by 654 · see citing works
“…instance, the diurnal pattern of cortisol (e.g., awakening cortisol response (Pruessner et al., 1997)) in depression appears to be more hypercortisolemic in nature, while that found in burnout is a hypocortisolemic profile more akin to PTSD (Chida & Steptoe, 2009); however, this remains debatable.”
Joseph, J. J., & Golden, S. H. (2017) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13217 · Cited by 574 · see citing works
Diamond, L. M., & Alley, J. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104720 · Cited by 412 · see citing works
LUPIEN, S. J., Juster, R., Raymond, C., & Marin, M. (2018) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2018.02.001 · Cited by 400 · see citing works
Regional brain volume in depression and anxiety disorders
van Tol, M.-J., van der Wee, N. J. A., van den Heuvel, O. A., Nielen, M. M. A., Demenescu, L. R., Aleman, A., Renken, R., van Buchem, M. A., Zitman, F. G., & Veltman, D. J. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.121 · Cited by 370 · see citing works
“Therefore, decreased hippocampal volume may be considered a long-term effect of the disease process, as supported by the longitudinal findings of Frodl et al.59 Regarding the amygdala, Hamilton et al18 concluded in their meta-analysis that volume is dependent on medication use in MDD.”
BackgroundInfluentialNiedhammer, I., Bertrais, S., & Witt, K. (2021) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3968 · Cited by 403 · see citing works
Effects of prenatal stress on fetal and child development: A critical literature review
Graignic-Philippe, R., Dayan, J., Sylvie Chokron, A., Jacquet, A.-Y., & Tordjman, S. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.03.022 · Cited by 369 · see citing works
Emotional plasticity: Conditions and effects of improving emotional competence in adulthood.
Kotsou, I., Nelis, D., Grégoire, J., & Mikolajczak, M. (2011) · Journal of Applied Psychology · doi:10.1037/a0023047 · Cited by 335 · see citing works
Daubenmier, J., Kristeller, J., Hecht, F. M., Maninger, N., Kuwata, M., Jhaveri, K., Lustig, R. H., Kemeny, M., Karan, L., & Epel, E. (2011) · Journal of Obesity · doi:10.1155/2011/651936 · Cited by 322 · see citing works
“However, a lower CAR is also related to fatigue and posttraumatic stress disorder, and norms have not been established to differentiate hypo- from hyper-CAR; thus, careful consideration of sample characteristics is needed when interpreting CAR [29].”
BackgroundProspective prediction of major depressive disorder from cortisol awakening responses in adolescence
Adam, E. K., Doane, L. D., Zinbarg, R. E., Mineka, S., Craske, M. G., & Griffith, J. W. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.12.007 · Cited by 315 · see citing works
“Given that several known risk factors for MDD including high levels of life stress, sadness, and loneliness are associated with elevated, rather than blunted CARs (Adam et al., 2006; Chida and Steptoe, 2009; Clow et al., 2004; Schulz et al., 1998), we hypothesized that youth with higher baseline CARs would be at incre…”
Pruessner, M., Cullen, A. E., Aas, M., & Walker, E. F. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.12.013 · Cited by 315 · see citing works
Diurnal cortisol rhythm as a predictor of lung cancer survival
Sephton, S. E., Cash, E. D., Dedert, E. A., Floyd, A. R., Rebholz, W. N., Dhabhar, F. S., Spiegel, D., & Salmon, P. M. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.07.019 · Cited by 312 · see citing works
“Medication side effects, physical, existential, and interpersonal stressors can all exact a toll on circadian systems (Sephton and Spiegel 2003; Eismann et al., 2010; Chida and Steptoe, 2009).”
BackgroundCahn, B. R., Goodman, M. S., Peterson, C. T., Maturi, R., & Mills, P. J. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00315 · Cited by 292 · see citing works
“…also an important and separate relationship between the homeostatic fitness of the autonomic nervous system and robust circadian variations in cortisol levels, with sympathetic hyperactivity demonstrating a tendency to reduce the circadian variability of cortisol levels (Chida and Steptoe, 2009).”
BackgroundPsychophysiological biomarkers of workplace stressors
Chandola, T., Heraclides, A., & Meena Kumari, B. (2009) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2009.11.005 · Cited by 288 · see citing works
“Taken in conjunction with recent reviews (Chida and Steptoe, 2009; Hansen et al., 2009), there is evidence that work stressors are related to elevated stress responses in terms of sympatho-adrenal and HPA axis biomarkers.”
InfluentialGrossi, G., Perski, A., Osika, W., & Savic, I. (2015) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12251 · Cited by 273 · see citing works
“Although the findings relating burnout to low cortisol are in accord with a meta-analysis by Chida and Steptoe (2009),”
ResultThe biological and psychological basis of neuroticism: Current status and future directions
Ormel, J., Bastiaansen, J. A., Riese, H., Bos, E. H., Servaas, M. N., Ellenbogen, M. A., Rosmalen, J. G. M., & Aleman, A. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.09.004 · Cited by 266 · see citing works
Positive affect and psychobiological processes
Dockray, S., & Steptoe, A. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2010.01.006 · Cited by 263 · see citing works
“A few studies have assessed the association of the cortisol awakening response (CAR) and positive affect, and findings are mixed (Chida and Steptoe 2009).”
BackgroundSelf-citationSocial Isolation and Stress-related Cardiovascular, Lipid, and Cortisol Responses
Grant, N., Hamer, M., & Steptoe, A. (2009) · Annals of Behavioral Medicine · doi:10.1007/s12160-009-9081-z · Cited by 263 · see citing works
“A heightened CAR has previously been associated with psychosocial factors such as general and work stress, and financial strain and psychological traits including high neuroticism and low optimism [33, 56].”
BackgroundSelf-citationSimultaneous measurement of salivary cortisol and alpha-amylase: Application and recommendations
Strahler, J., Skoluda, N., Kappert, M. B., & Nater, U. M. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.08.015 · Cited by 254 · see citing works
Paxion, J., Galy, É., & Berthelon, C. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01344 · Cited by 247 · see citing works
Short, S. J., Stalder, T., Marceau, K., Entringer, S., Moog, N. K., Shirtcliff, E. A., Wadhwa, P. D., & Buss, C. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.05.007 · Cited by 239 · see citing works
“Nonetheless, it was possible that HCC would correspond well with the CAR given that the awakening response represents the fastest change in cortisol within a given day and is thought to reflect the flexibility or elasticity of the adrenal axis (Chida and Steptoe, 2009).”
Kumari, M., Badrick, E., Ferrie, J., Perski, A., Marmot, M., & Chandola, T. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0555 · Cited by 229 · see citing works
Treating posttraumatic stress disorder in first responders: a systematic review
Haugen, P. T., Evces, M., & Weiss, D. S. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.04.001 · Cited by 226 · see citing works
Salivary Cortisol in Ambulatory Assessment—Some Dos, Some Don’ts, and Some Open Questions
Kudielka, B. M., Gierens, A., Hellhammer, D. H., Wüst, S., & Schlotz, W. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31825434c7 · Cited by 225 · see citing works
Effect of service dogs on salivary cortisol secretion in autistic children
Viau, R., Arsenault‐Lapierre, G., Fecteau, S.-M., Champagne, N., Walker, C., & LUPIEN, S. J. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.02.004 · Cited by 224 · see citing works
“More precisely, recent single-case and review studies suggest that general stress is correlated with an increased CAR, and that a positive psychological state is correlated with a reduced CAR (Chida and Steptoe, 2009; Stalder et al., 2009).”
BackgroundBurnout and Risk of Coronary Heart Disease
Toker, S., Melamed, S., Berliner, S. A., Zeltser, D., & Shapira, I. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31826c3174 · Cited by 225 · see citing works
“Furthermore, in contrast to the robust finding of reduced cortisol response to awakening in burned-out persons, mixed results with regard to cortisol response have been obtained for persons reporting depressive symptoms (56).”
ResultJudge, T. A., Simon, L., Hurst, C., & Kelley, K. (2013) · Journal of Applied Psychology · doi:10.1037/a0034485 · Cited by 221 · see citing works
Ferguson, E. (2011) · Health Psychology Review · doi:10.1080/17437199.2010.547985 · Cited by 209 · see citing works
“In terms of meta-analytic findings, sub-analyses reported by Chida and Steptoe (2009) showed that positive psychological factors (e.g., positive affect, self-esteem) were related to reduced waking cortisol production.”
BackgroundAdam, E. K., Heissel, J. A., Zeiders, K. H., Richeson, J. A., Ross, E. C., Ehrlich, K. B., Levy, D. J., Kemeny, M. E., Brodish, A. B., Malanchuk, O., et al. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.08.018 · Cited by 213 · see citing works
“The CAR has been found to increase in the presence of acute daily stressors (Adam et al., 2006; Chida and Steptoe, 2009; Fries et al., 2009).”
Juster, R., Sindi, S., Marin, M., Perna, A., Hashemi, A., Pruessner, J. C., & LUPIEN, S. J. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.11.001 · Cited by 204 · see citing works
Juster, R., Smith, N. G., Ouellet, É., Sindi, S., & LUPIEN, S. J. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182826881 · Cited by 204 · see citing works
“Excessive and blunted CAR profiles are linked to distinct psychiatric symptoms of anxiety, depression, and fatigue/burnout (96).”
BackgroundOlafsdottir, G., Cloke, P., Schulz, A., van Dyck, Z., Eysteinsson, T., Thorleifsdottir, B., & Vögele, C. (2020) · Environment and Behavior · doi:10.1177/0013916518800798 · Cited by 193 · see citing works
“…in various chronic psychosocial stress conditions (e.g., job stress, general life stress), there were no associations between chronic psychosocial stress and stress reactivity or recovery as assessed by parameters of sympathetic and parasympathetic nervous system activity (Chida & Steptoe, 2009).”
BackgroundBiological Basis of Depression in Adults with Diabetes
Champaneri, S., Wand, G. S., Malhotra, S., Casagrande, S. S., & Golden, S. H. (2010) · Current Diabetes Reports · doi:10.1007/s11892-010-0148-9 · Cited by 196 · see citing works
“This measure has been used as a marker of HPA axis activity not only in depression, but also in other disease states such as posttraumatic stress disorder, anxiety, chronic fatigue, or even certain emotionally stressed states [10].”
MethodGolkar, A., Johansson, E., Kasahara, M., Osika, W., Perski, A., & Savic, I. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104550 · Cited by 201 · see citing works
“Measurements of cortisol levels after awakening in these subjects have hitherto yielded inconclusive results [9], with reports of normal [10–11], reduced [12–15], and elevated levels [16–18].”
ResultThe cortisol awakening response and major depression: examining the evidence
Dedovic, K., & Ngiam, J. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s62289 · Cited by 191 · see citing works
The cortisol awakening response – Applications and implications for sleep medicine
Elder, G. J., Wetherell, M. A., Barclay, N. L., & Ellis, J. G. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.05.001 · Cited by 190 · see citing works
Stress and breast cancer: from epidemiology to molecular biology
Antonova, L., Aronson, K. J., & Mueller, C. R. (2011) · Breast Cancer Research · doi:10.1186/bcr2836 · Cited by 184 · see citing works
“Studies indicate that stressful life events, as well as job stress, produce elevated cortisol levels years after the exposure [46-48].”
BackgroundAdulthood trauma and HPA-axis functioning in healthy subjects and PTSD patients: A meta-analysis
Klaassens, E. R., Giltay, E. J., Cuijpers, P. J., van Veen, T., & Zitman, F. G. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.07.003 · Cited by 179 · see citing works
“In addition, reference lists of the selected articles were checked for further relevant publications, as were reference lists of other relevant meta-analyses and reviews (Burke et al., 2005; Otte et al., 2005; de Kloet et al., 2006; Meewisse et al., 2007; Chida and Steptoe, 2009; Handwerger, 2009).”
MethodSchumacher, S., Kirschbaum, C., Fydrich, T., & Ströhle, A. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.02.003 · Cited by 181 · see citing works
“Additionally, the authors point out that similar abnormalities in the awakening response in PTSD patients were found with regard to cortisol, representing the activation of the HPA system (Chida and Steptoe, 2009; Wessa et al., 2006) and it was suggested that there was an association between hypocortisolism in PTSD an…”
BackgroundDifferential associations between childhood trauma subtypes and adolescent HPA-axis functioning
Kuhlman, K. R., Geiss, E. G., Vargas, I., & Lopez-Duran, N. L. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.01.020 · Cited by 178 · see citing works
“In adults, greater CAR is most consistently associated with recent stress (Chida and Steptoe, 2009).”
BackgroundInfluentialIn Search of HPA Axis Dysregulation in Child and Adolescent Depression
Guerry, J. D., & Hastings, P. D. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-011-0084-5 · Cited by 195 · see citing works
“MDD T10 also showed elevated cortisol levels 100 min prior and 100 min after sleep onset, but lower levels of cortisol secretion 2-4 h after sleep onset b Youths with MDD that persisted over 24 months had higher cortisol:DHEA ratios in morning saliva samples than at-risk youths without depression, and at-risk youths w…”
BackgroundInfluentialA meta-analytic review of the effects of mindfulness meditation on telomerase activity
Schutte, N. S., & Malouff, J. M. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.12.017 · Cited by 171 · see citing works
“Less experience of stress and fewer symptoms of anxiety and depression may be associated with cortisol level (Chida and Steptoe, 2009; Lin et al., 2012; Puterman and Epel, 2012), and cortisol level in turn may be associated with telomerase activity (Choi et al.”
BackgroundThe burden of online friends: The effects of giving up Facebook on stress and well-being
Vanman, E. J., Baker, R., & Tobin, S. J. (2018) · The Journal of Social Psychology · doi:10.1080/00224545.2018.1453467 · Cited by 168 · see citing works
“Discrepancies between salivary cortisol responses and subjective measures of stress are common in studies of stress (e.g., Brant, Wetherell, Lightman, Crown, & Vedhara, 2010; Chida & Steptoe, 2009; Simpson et al., 2008), and thus may reflect methodological issues that go beyond this study.”
BackgroundThe biology of burnout: Causes and consequences
Bayes, A. J., Tavella, G., & Parker, G. B. (2021) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2021.1907713 · Cited by 191 · see citing works
“One meta-analysis (Chida and Steptoe 2009) of 62 studies found CAR was positively associated with psychological distress 688 A.”
BackgroundThe Cortisol Awakening Response in Context
Clow, A., Hucklebridge, F. H., & Thorn, L. (2010) · International review of neurobiology · doi:10.1016/s0074-7742(10)93007-9 · Cited by 170 · see citing works
Qigong improves quality of life in women undergoing radiotherapy for breast cancer
Chen, Z., Meng, Z., Milbury, K., Bei, W., Zhang, Y., Thornton, B., Liao, Z. X., Wei, Q., Chen, J., Guo, X., et al. (2013) · Cancer · doi:10.1002/cncr.27904 · Cited by 164 · see citing works
“To determine the circadian slope of cortisol, 4 saliva samples per day (waking, 45 minutes later, 8 hours later, and at bedtime) were obtained for 2 consecutive days.(33) Levels of cortisol”
MethodHeraclides, A., Chandola, T., Witte, D. R., & Brunner, E. J. (2011) · Obesity · doi:10.1038/oby.2011.95 · Cited by 163 · see citing works
“Given that cortisol levels are elevated by exposure to psychosocial stressors (28), a plausible explanation for the observed effect is that stress-related elevations in cortisol levels carry a bigger pathophysiological burden among obese than nonobese individuals.”
BackgroundSanada, K., Montero-Marin, J., Alda Díez, M., Salas-Valero, M., Pérez-Yus, M. C., Morillo, H., Demarzo, M. M. P., García-Toro, M., & García-Campayo, J. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00471 · Cited by 161 · see citing works
“N /A N o 3 0 tim e p o in ts p re a n d p o st in te rv e n tio n e a c h 2 c o n se c u tiv e d a ys c o lle c te d a t ∼ 7 a .m ., a t 1 p .m ., a n d a t 1 0 p .m . o n c e p e r w e e k d u rin g in te rv e n tio n c o lle c te d a t ∼ 7 a .m ., a t 1 p .m ., a n d a t 1 0 p .m .”
BackgroundThe impact of a brief gratitude intervention on subjective well-being, biology and sleep
Jackowska, M., Brown, J., Ronaldson, A., & Steptoe, A. (2015) · Journal of Health Psychology · doi:10.1177/1359105315572455 · Cited by 166 · see citing works
“First, the cortisol awakening response (CAR) was calculated as the difference between the sample taken on awakening and 30 minutes later (Chida and Steptoe, 2009).”
MethodSelf-citationLuo, H., Hu, X., Liu, X., Ma, X., Guo, W., Qiu, C., Wang, Y., Wang, Q., Zhang, X., Zhang, W., et al. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.12.020 · Cited by 149 · see citing works
Assessing the relationship between rumination and cortisol: a review
Zoccola, P. M., & Dickerson, S. S. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.03.007 · Cited by 178 · see citing works
“It is possible that this inconsistency may simply reflect the conflicting cortisol findings among individuals with depression [41,42].”
BackgroundResultMorningness-Eveningness Preferences and Academic Achievement of University Students
Beşoluk, Ş., Önder, İ., & Deveci, İ. (2011) · Chronobiology International · doi:10.3109/07420528.2010.540729 · Cited by 152 · see citing works
“Cortisol levels are low during the night but rise in the early hours before waking (Chida & Steptoe, 2009).”
Morningness-eveningness, habitual sleep-wake variables and cortisol level
Randler, C., & Schaal, S. (2010) · Biological Psychology · doi:10.1016/j.biopsycho.2010.04.006 · Cited by 150 · see citing works
Children's heart rate variability as stress indicator: Association with reported stress and cortisol
Michels, N., Sioen, I., Clays, E., De Buyzere, M., Ahrens, W., Huybrechts, I., Vanaelst, B., & De Henauw, S. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.08.005 · Cited by 162 · see citing works
Fibromyalgia syndrome is associated with hypocortisolism
Riva, R., Mork, P. J., Westgaard, R. H., Rø, M., & Lundberg, U. (2010) · International Journal of Behavioral Medicine · doi:10.1007/s12529-010-9097-6 · Cited by 143 · see citing works
“Moreover, it has been demonstrated that cortisol values can be influenced by a series of potential confounders, such as age, gender, smoking habit, waking time, sleep quality, physical activity, persisting pain, and perceived stress [40, 53, 54].”
BackgroundHPA-axis and inflammatory reactivity to acute stress is related with basal HPA-axis activity
Chen, X., Gianferante, D., Hanlin, L. C., Fiksdal, A. S., Breines, J. G., Thoma, M. V., & Rohleder, N. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.01.035 · Cited by 144 · see citing works
“In general, higher CAR seems to be related with exposure to psychological stressors, and lower CAR with adverse health consequences (Chida and Steptoe, 2009).”
BackgroundLong-Term Occupational Stress Is Associated with Regional Reductions in Brain Tissue Volumes
Blix, E., Perski, A., Berglund, H., & Savic, I. (2013) · PLoS ONE · doi:10.1371/journal.pone.0064065 · Cited by 150 · see citing works
“Although subjects suffering from symptoms attributed to chronic occupational stress are believed to have an altered reactivity of the HPA system, it is unknown whether this is a consistent finding [9], and both normal [10,11], reduced [12,13,14,15], and elevated [16,17,18] cortisol levels after awakening have been rep…”
BackgroundThomas, J. C., APrON Study Team, Letourneau, N. L., Campbell, T. S., Tomfohr‐Madsen, L. M., & Giesbrecht, G. F. (2017) · Developmental Psychology · doi:10.1037/dev0000279 · Cited by 142 · see citing works
Meena Kumari, B., Chandola, T., Brunner, E. J., & Mika Kivimaki, B. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2105 · Cited by 140 · see citing works
Extended work availability and its relation with start-of-day mood and cortisol.
Dettmers, J., Vahle‐Hinz, T., Bamberg, E., Friedrich, N., & Keller, M. (2015) · Journal of Occupational Health Psychology · doi:10.1037/a0039602 · Cited by 140 · see citing works
“Furthermore, the CAR is proposed to be a reliable marker of HPA axis activity (Kudielka & Wüst, 2010; Pruessner et al., 1997) and has been shown to be related to work stress (Chida & Steptoe, 2009).”
BackgroundA review of selected candidate endophenotypes for depression
Goldstein, B. L., & Klein, D. N. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.06.003 · Cited by 128 · see citing works
“Similar to neuroticism, aberrant cortisol activity may not be specific to depression (e.g., Chida & Steptoe, 2009).”
BackgroundDaily Life Stress and the Cortisol Awakening Response: Testing the Anticipation Hypothesis
Powell, D., & Schlotz, W. (2012) · PLoS ONE · doi:10.1371/journal.pone.0052067 · Cited by 133 · see citing works
“Studies found evidence for associations with a variety of psychosocial factors [4] as well as physical and mental disorders and associated risk factors.”
BackgroundThe cortisol awakening response (CAR) across the female menstrual cycle
Wolfram, M., Bellingrath, S., & Kudielka, B. M. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.12.006 · Cited by 130 · see citing works
“If not controlled for, such an effect might add additional variance to study results that is not related to the original study question, analogous to a variety of earlier reported intervening variables (for reviews see Wüst et al., 2000b; Clow et al., 2004; Chida and Steptoe, 2009; Fries et al., 2009; Kudielka et al.,…”
ResultStructural Changes of the Brain in Relation to Occupational Stress
Savic, I. (2013) · Cerebral Cortex · doi:10.1093/cercor/bht348 · Cited by 133 · see citing works
Brief review on physiological and biochemical evaluations of human mental workload
Le-an, Y., & Fu, S. (2011) · Human Factors and Ergonomics in Manufacturing & Service Industries · doi:10.1002/hfm.20269 · Cited by 124 · see citing works
“As an indicator of hypothalamic-pituitaryadrenocortical (HPA) axis activation, cortisol awakening response is related to a number of psychosocial factors (Chida & Steptoe, 2009).”
BackgroundSalivary cortisol levels and the 2-year course of depressive and anxiety disorders
Vreeburg, S. A., Hoogendijk, W. J. G., DeRijk, R. H., van Dyck, R., Smit, J. H., Zitman, F. G., & Penninx, B. W. J. H. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.12.017 · Cited by 121 · see citing works
“An attenuated as well as an increased CAR have been associated with adverse psychosocial factors and psychopathology (e.g. Chida and Steptoe, 2009).”
Expression of Anger and Ill Health in Two Cultures
Kitayama, S., Park, J., Boylan, J. M., Miyamoto, Y., Levine, C. S., Markus, H. R., Karasawa, M., Coe, C. L., Kawakami, N., Love, G. D., et al. (2015) · Psychological Science · doi:10.1177/0956797614561268 · Cited by 119 · see citing works
Stress, the cortisol awakening response and cognitive function
Law, R. J., & Clow, A. (2020) · International review of neurobiology · doi:10.1016/bs.irn.2020.01.001 · Cited by 114 · see citing works
Spencer, R. L., Chun, L. E., Hartsock, M. J., & Woodruff, E. R. (2017) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2017.12.005 · Cited by 113 · see citing works
The perception of work stressors is related to reduced parasympathetic activity
Clays, E., Bacquer, D. D., Crasset, V., Kittel, F., Smet, P. D., Kornitzer, M., Karasek, R. A., & Backer, G. D. (2010) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-010-0537-z · Cited by 113 · see citing works
“In recent years, the cortisol awakening response has been more and more assessed as an indicator of HPA axis activation and has been related to a number of psychosocial factors including job stress ( Chida and Steptoe 2009 ).”
BackgroundDysfunction of stress responsive systems as a risk factor for functional somatic syndromes
Tak, L. M., & Rosmalen, J. G. M. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2009.12.004 · Cited by 112 · see citing works
“Recent reviews are beginning to elucidate the meaning and relevance of the different aspects of the diurnal rhythm of the HPA axis [46,47].”
Hypothalamic-pituitary-adrenal axis, childhood adversity and adolescent nonsuicidal self-injury
Reichl, C., Heyer, A., Brunner, R. M., Parzer, P., Völker, J. M., Resch, F., & Kaess, M. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.09.011 · Cited by 112 · see citing works
Wüst, S., Kumsta, R., Treutlein, J., Frank, J., Entringer, S., Schulze, T. G., & Rietschel, M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.01.011 · Cited by 109 · see citing works
“In recent review papers a comprehensive overview of findings related to this measure and a discussion of potential mechanisms mediating the CAR can be found (Clow et al., 2004; Fries et al., 2009; Chida and Steptoe, 2009).”
BackgroundCortisol awakening response in patients with psychosis: systematic review and meta-analysis
Berger, M., Kraeuter, A. K., Romanik, D., Malouf, P., Amminger, G. P., & Sarnyai, Z. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.027 · Cited by 109 · see citing works
Adam, E. K., Vrshek‐Schallhorn, S., Kendall, A. D., Mineka, S., Zinbarg, R. E., & Craske, M. G. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.02.014 · Cited by 110 · see citing works
“Some studies show an elevated cortisol awakening response but others show a reduced CAR among those with adverse early experiences such as parental loss, or childhood trauma (Chida and Steptoe, 2009).”
InfluentialHeaney, J. L. J., Phillips, A. C., & Carroll, D. (2010) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2010.07.009 · Cited by 109 · see citing works
“…Psychophysiology, 78, 201 ‐ 208. http://dx.doi.org/10.1016/j.ijpsycho.2010.07.009 of consensus may also be partly explained by methodological considerations such as the age of the participants and failure to control for possible confounders ( [Chida and Steptoe, 2009] and [Vreeburg et al., 2009a]).”
InfluentialViolence and Vigilance: The Acute Effects of Community Violent Crime on Sleep and Cortisol
Heissel, J. A., Sharkey, P. T., Torrats‐Espinosa, G., Grant, K. E., & Adam, E. K. (2017) · Child Development · doi:10.1111/cdev.12889 · Cited by 112 · see citing works
“Acute stress is associated with an elevated CAR, with more chronic stress and burnout associated with a blunted CAR (Chida & Steptoe, 2009).”
BackgroundThe multilevel determinants of workers’ mental health: results from the SALVEO study
Marchand, A., Durand, P., Haines, V. Y., & Harvey, S. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0932-y · Cited by 107 · see citing works
“Indeed, a recent study found that workers’ cortisol secretions, which is a hormone associated with the physiological stress response of an individual and correlated with mental health symptoms [21], varied across workplaces even after adjusting for work hours, gender, age and work–non-work days [50].”
BackgroundA systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes
Lawrence, J. A., Kawachi, I. I., White, K., Bassett, M. T., Priest, N., Masunga, J. G., Cory, H. J., Mita, C., & Williams, D. R. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105772 · Cited by 110 · see citing works
The Cortisol Awakening Response: Regulation and Functional Significance
Tobias Stalder, A., Oster, H., Abelson, J. L., Huthsteiner, K., Klucken, T., & Clow, A. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae024 · Cited by 120 · see citing works
A systematic review of the effects of mindfulness interventions on cortisol
O’Leary, K., O’Neill, S., & Dockray, S. (2016) · Journal of Health Psychology · doi:10.1177/1359105315569095 · Cited by 103 · see citing works
“The CAR is not strongly associated with cortisol levels for the rest of the day but both the CAR and diurnal patterns are associated with psychological and physical wellbeing (Chida and Steptoe, 2009).”
BackgroundInfluentialWeber, J., Angerer, P., & Apolinário-Hagen, J. (2022) · PLoS ONE · doi:10.1371/journal.pone.0271996 · Cited by 107 · see citing works
Glucocorticoid Sensitivity in Mood Disorders
Spijker, A. T., & van Rossum, E. F. C. (2011) · Neuroendocrinology · doi:10.1159/000329846 · Cited by 102 · see citing works
Vanaelst, B., Huybrechts, I., Bammann, K., Michels, N., Vriendt, T. D., Vyncke, K. E., Sioen, I., Iacoviello, L., Günther, K., Molnár, D., et al. (2012) · Psychophysiology · doi:10.1111/j.1469-8986.2012.01396.x · Cited by 101 · see citing works
Frequency of bullying at work, physiological response, and mental health
Hansen, Å. M., Høgh, A., & Persson, R. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.05.010 · Cited by 103 · see citing works
Maternal cortisol and offspring birthweight: results from a large prospective cohort study
Goedhart, G., Vrijkotte, T. G. M., Roseboom, T. J., van der Wal, M. F., Cuijpers, P., & Bonsel, G. J. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.10.003 · Cited by 96 · see citing works
Boggero, I. A., Hostinar, C. E., Haak, E. A., Murphy, M. L. M., & Segerstrom, S. C. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.08.058 · Cited by 97 · see citing works
“This corroborates meta-analytic results from Chida and Steptoe (2009).”
BackgroundMethodResultInfluentialSanada, K., Montero-Marin, J., Barceló-Soler, A., Ikuse, D., Ota, M., Hirata, A., Yoshizawa, A., Hatanaka, R., Valero, M. S., Demarzo, M., et al. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21072484 · Cited by 96 · see citing works
“with low health states such as fatigue and burnout [8,47].”
BackgroundAllostatic load and comorbidities: A mitochondrial, epigenetic, and evolutionary perspective
Juster, R., Russell, J. J., Almeida, D., & Picard, M. (2016) · Development and Psychopathology · doi:10.1017/s0954579416000730 · Cited by 87 · see citing works
“…that the cortisol awakening response, a normal circadian mechanism that metabolically prepares us for the day, is positively associated with workplace stress and general life stress, but is otherwise negatively associated with symptoms of burnout, fatigue, and exhaustion (Chida & Steptoe, 2009).”
BackgroundGoedhart, G., Snijders, A. C., Hesselink, A. E., van Poppel, M. N. M., Bonsel, G. J., & Vrijkotte, T. G. M. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181ee4a62 · Cited by 96 · see citing works
Effects of a Humor Therapy Program on Stress Levels in Pediatric Inpatients
Sánchez, J. C., Echeverri, L. F., Londoño-Builes, M. J., Orozco, S. A. O., Quiroz, A. F., Romero, C. R., & Ruiz-Villa, J. O. (2017) · Hospital Pediatrics · doi:10.1542/hpeds.2016-0128 · Cited by 96 · see citing works
Antonelli, M., & Donelli, D. (2018) · International Journal of Biometeorology · doi:10.1007/s00484-018-1504-8 · Cited by 102 · see citing works
- Authors
- Chida, Y., & Steptoe, A.
- Affiliations
- University College London (GB)
- Corresponding author
- Chida, Yoichi
- ORCID
- Steptoe, Andrew
- Venue
- Biological Psychology
- Publisher
- Elsevier BV
- Published
- 2009-03
- Volume
- 80
- Issue
- 3
- Pages
- 265-278
- ISSN
- 0301-0511 (ISSN-L)
- OpenAlex
- W1987445189
- Cited by
- 1,032
- References
- 106
- Citations by year
- 2026: 35 · 2025: 36 · 2024: 32 · 2023: 43 · 2022: 69 · 2021: 58 · 2020: 68 · 2019: 68 · 2018: 59 · 2017: 80 · 2016: 74 · 2015: 75 · 2014: 72 · 2013: 70 · 2012: 63
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- cortisol awakening response, hypothalamic-pituitary-adrenal axis, occupational stress, life events, burnout, fatigue, exhaustion, positive affect, post-traumatic stress disorder, psychosocial factors, cortisol
- MeSH terms
- Animals, Humans, Hydrocortisone, Psychology, Wakefulness, Meta-Analysis as Topic, Databases, Bibliographic
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