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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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In the citing paper
“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
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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)
In the citing paper
“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
In the citing paper
“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)
In the citing paper
“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
In the citing paper
“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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“, 2011) and of CAR studies (Chida and Steptoe, 2009), and features of both were incorporated where appropriate.”
BackgroundPhuong, D., Roux, A. V. D., Hajat, A., Auchincloss, A. H., Merkin, S. S., Ranjit, N., Shea, S., & Seeman, T. E. (2011) · Health & Place · doi:10.1016/j.healthplace.2010.12.019 · Cited by 94
“For example, both a very small and a very large awakening response have been linked to adverse health outcomes (Adam and Kumari, 2009; Chida and Steptoe, 2009).”
The confluence of adverse early experience and puberty on the cortisol awakening response
Quevedo, K. M., Johnson, A. E., Loman, M. M., Lafavor, T. L., & Gunnar, M. R. (2011) · International Journal of Behavioral Development · doi:10.1177/0165025411406860 · Cited by 98
“The cortisol awakening response (CAR) is a sharp increase in cortisol production about 30 minutes postawakening above the already high levels at awakening (Chida & Steptoe, 2009).”
BackgroundMeditation interventions efficiently reduce cortisol levels of at-risk samples: A meta-analysis
Koncz, A., Demetrovics, Z., & Takacs, Z. K. (2021) · Health Psychology Review · doi:10.1080/17437199.2020.1760727 · Cited by 94
“There are several mental disorders (e.g., depression or anxiety disorders) and somatic illnesses (Baričević et al., 2006; Chiodini et al., 2007) or life situations (Chida & Steptoe, 2009) that are characterized by elevated cortisol levels.”
BackgroundMatousek, R. H., Pruessner, J. C., & Dobkin, P. L. (2011) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2010.10.005 · Cited by 93
Adult attachment style and cortisol responses in women in late pregnancy
Costa-Martins, J. M., Moura‐Ramos, M., Cascais, M. J., da Silva, C. F., Costa-Martins, H., Pereira, M., Coelho, R. C., & Tavares, J. (2016) · BMC Psychology · doi:10.1186/s40359-016-0105-8 · Cited by 96
“That the CAR is highly vulnerable to the influence of situational factors [14] may explain, in part, the failure in this study to achieve a significant finding.”
ResultInfluentialGerber, M., Ludyga, S., Mücke, M., Colledge, F., Brand, S., & Pühse, U. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.03.004 · Cited by 108
The Relationship Between Work-Related Rumination and Evening and Morning Salivary Cortisol Secretion
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State variation in the cortisol awakening response
Law, R., Hucklebridge, F., Thorn, L., Evans, P., & Clow, A. (2013) · Stress · doi:10.3109/10253890.2013.817552 · Cited by 89
“It is characterized by marked interindividual variability, and CAR research to date has primarily focused on its application as a biomarker in association with a range of psychosocial and physical variables including health outcomes (Chida & Steptoe, 2009).”
BackgroundMechanistic pathways of mindfulness meditation in combat veterans with posttraumatic stress disorder
Wahbeh, H., Goodrich, E., Goy, E., & Oken, B. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22255 · Cited by 97
“When examined cross-sectionally, CAR is usually noted to be lower in people with PTSD (Chida & Steptoe, 2008; Klaassens, Giltay, Cuijpers, van Veen, & Zitman, 2012; Morris et al., 2012).”
Cortisol Awakening Response and Hippocampal Volume: Vulnerability for Major Depressive Disorder?
Dedovic, K., Engert, V., Duchesne, A., Lue, S. D., Andrews, J., Efanov, S. I., Beaudry, T., & Pruessner, J. C. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.07.025 · Cited by 99
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Biological and psychological correlates of self-reported and objective sleep measures
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“Namely, while global sleep ratings on the PSQI were associated with lower CAR, objective sleep latency was longer in participants with higher diastolic BP.”
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“However, when including only the three high quality studies a reduced CAR was associated with PTSD (Chida & Steptoe, 2008).”
BackgroundInfluentialNeuroticism and cortisol: Pinning down an expected effect
García‐Banda, G., Chellew, K., Fornes, J., Pérez, G., Servera, M., & Evans, P. D. (2013) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2013.12.005 · Cited by 84
“Finally, Neuroticism was not associated with differences in CAR magnitude in the meta-analyses done by Chida and Steptoe (2009).”
ResultDietrich, A., Ormel, J., Buitelaar, J. K., Verhulst, F. C., Hoekstra, P. J., & Hartman, C. A. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.11.013 · Cited by 90
“The experience of life stress has been consistently related to a higher CAR as shown in a meta-analysis (Chida and Steptoe, 2009).”
ResultHolland, B. J. V., Frings‐Dresen, M. H. W., & Sluiter, J. K. (2011) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-011-0727-3 · Cited by 84
“Over the past decade, stress has received increasing attention, particularly in relation to stress factors experienced by workers, self-reported stress and objective measurements of stress (Chida and Steptoe 2009; Maina et al. 2008; Sluiter et al. 1998).”
BackgroundThe psychophysiological impact of childhood autism spectrum disorder on siblings
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“Conversely, reduced CAR has also been found to be associated with fatigue, exhaustion and burnout (Chida and Steptoe, 2009).”
A brief mindfulness-based intervention (bMBI) to reduce teacher stress and burnout
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“The CAR is significantly related to various psychosocial factors, chronic stress, health and physical conditions [17–20].”
BackgroundResultYoung adults’ psychological and physiological reactions to the 2016 U.S. presidential election
Hoyt, L. T., Zeiders, K. H., Chaku, N., Toomey, R. B., & Nair, R. L. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.03.011 · Cited by 84
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“Two studies reported a negative relation, with a lower CAR related to higher scores on different well-being measures in an adult and adolescent sample respectively (Miller et al., 2016; Rickard et al., 2016, CAR11,12), whereas Pasquali et al. (2021), CAR16) reported a significant positive relation, with a higher CAR r…”
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“…authors have demonstrated that salivary cortisol levels can be influenced by possible confounders, such as age, gender, smoking habit, waking time, sleep quality, physical activity, persisting pain, and perceived stress (Federenko et al., 2004; Hellhammer et al., 2007; Chida and Steptoe, 2009).”
BackgroundThe incidence of stress symptoms and heart rate variability during sleep and orthostatic test
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“Previous studies have suggested that exposure to psychological stress may acutely increase the release of stress hormones (e.g. cortisol), while prolonged stress may decrease them (Melamed et al. 2006; Chida and Steptoe 2009).”
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“An affected psychological state seems to be associated with worse disease outcome and an impaired immune and cortisol response (Reiche et al. 2004; Chida and Steptoe 2009).”
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“Therefore, our secondary aim was to explore potential long-lasting consequences of psychosocial stress exposure on 24-hour HR and HRV, as indicators of resting autonomic function, and the cortisol awakening response (CAR), and to investigate whether these changes would be moderated by previous excitatory stimulation o…”
BackgroundInfluentialPhysical activity and cortisol regulation: A meta-analysis
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Momentary Work Worries, Marital Disclosure, and Salivary Cortisol Among Parents of Young Children
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“psychological stress (38) and perceived work overload (39) and is greater on”
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“As the peak cortisol awakening response occurs within a narrow time window (20–45 min after awakening; Chida and Steptoe, 2009; Clow et al., 2010), samples were excluded from CAR and AUCi analyses if the time between samples fell outside of 20–45 min after awakening.”
BackgroundMethodResultInfluentialExercise and the cortisol awakening response: a systematic review
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“Although normative ranges have been developed for several populations [36], it is still unclear what may constitute a “healthy” CAR, as both elevated and depressed responses have been related to dysfunctional psychosocial health status [37].”
BackgroundStigma and diurnal cortisol among transitioning transgender men
DuBois, L. Z., Powers, S. I., Everett, B. G., & Juster, R. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.05.008 · Cited by 75
The Role of Saliva Cortisol Measurement in Health and Disease
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Kuhlman, K. R., Vargas, I., Geiss, E. G., & Lopez‐Duran, N. L. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.22054 · Cited by 75
“The CAR refers to a rise in cortisol that occurs immediately after awakening (Fries, Dettenborn, & Kirschbaum, 2009), and is influenced by multiple factors including sleep (Vargas & Lopez-Duran, 2014), and daily stress (Chida & Steptoe, 2009).”
BackgroundGhaemmaghami, P., & Ehlert, U. (2015) · European Psychologist · doi:10.1027/1016-9040/a000195 · Cited by 77
Bosch, N. M., Riese, H., Dietrich, A., Ormel, J., Verhulst, F. C., & Oldehinkel, A. J. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181bc756b · Cited by 73
“Bhattacharyya MR, Molloy GJ, Steptoe A. Depression is associated with flatter cortisol rhythms in patients with coronary artery disease.”
BackgroundInfluentialShift work and sleep disorder comorbidity tend to go hand in hand
KERKHOF, G. A. (2017) · Chronobiology International · doi:10.1080/07420528.2017.1392552 · Cited by 76
“The CAR is considered a reliable marker of the activity of the HPA (hypothalamic — pituitary — adrenocortical) axis and its magnitude appears to be positively related to work stress, adverse prior day experiences and anticipation of forthcoming challenges (Chida & Steptoe, 2009; Elder et al., 2014).”
Chen, P.-J., Chou, C., Yang, L., Tsai, Y., Chang, Y.-C., & Liaw, J. (2017) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2016.0426 · Cited by 73
Prenatal stress changes learning strategies in adulthood
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“Furthermore, there were no group differences in the reported level of chronic stress and the cortisol awakening response (all P > 0.15), a physiological indicator of chronic stress (Chida and Steptoe, 2009).”
BackgroundInfluentialByrd‐Craven, J., Auer, B. J., Granger, D. A., & Massey-Abernathy, A. R. (2011) · Journal of Family Psychology · doi:10.1037/a0026588 · Cited by 69
“The magnitude of the awakening response is related to psychosocial stressors and health in meaningful ways and provides a useful index of HPA function and dysfunction (Chida & Steptoe, 2008).”
BackgroundCircadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery
Cash, E. D., Sephton, S. E., Chagpar, A. B., Spiegel, D., Rebholz, W. N., Zimmaro, L. A., Tillie, J. M., & Dhabhar, F. S. (2015) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2015.02.017 · Cited by 70
Childhood psychosocial adversity and adult cortisol patterns
Power, C., Thomas, C., Li, L., & Hertzman, C. (2012) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.111.096032 · Cited by 68
Elevated Social Stress Levels and Depressive Symptoms in Primary Hyperhidrosis
Gross, K. M., Schote, A. B., Schneider, K. K., Schulz, A., & Meyer, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0092412 · Cited by 68
“However, measurable changes of the CAR are particularly expected in highly to pathologically stressed persons [20].”
BackgroundResultInfluentialSui, H. X., Sun, N., Zhan, L., Lu, X., Chen, T., & Mao, X. (2016) · PLoS ONE · doi:10.1371/journal.pone.0159978 · Cited by 68
Amsterdam, J. D., Li, Q. S., Xie, S. X., & Mao, J. J. J. (2019) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2019.0252 · Cited by 74
“For example, lower cortisol awakening levels have been observed in GAD subjects, as has lower HPA axis activity during chronic stress with subsequent enhanced cortisol activation in depression.(41,42) In addition, other studies suggest that chamomile may exert an antidepressant effect by modulating HPA axis activity.”
BackgroundBuchanan, T. W., McMullin, S. D., Baxley, C., & Weinstock, J. (2019) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2019.09.004 · Cited by 66
Altered stress patterns and increased risk for postpartum depression among low-income pregnant women
Scheyer, K., & Urizar, G. G. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0563-7 · Cited by 66
Gabriels, R. L., Agnew, J., Pan, Z., Holt, K. D., Reynolds, A., & Laudenslager, M. L. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.02.017 · Cited by 67
Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion
Kanthak, M. K., Stalder, T., Hill, L. K., Thayer, J. F., Penz, M. S., & Kirschbaum, C. (2017) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3647 · Cited by 64
“Previous studies have also reported EE as the primary burnout subscale showing associations with physiological stress markers such as allostatic load (43, 44), and HPA axis function (review: 45, 46).”
Höhn, C., Schmid, S. R., Plamberger, C. P., Bothe, K., Angerer, M., Gruber, G., Pletzer, B., & Hoedlmoser, K. (2021) · Clocks & Sleep · doi:10.3390/clockssleep3010005 · Cited by 61
“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].”
BackgroundAssociations between the cortisol awakening response and heart rate variability
Tobias Stalder, A., Evans, P. D., Hucklebridge, F. H., & Clow, A. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.07.020 · Cited by 64
“…with regard to the CAR have been characterised by some inconsistency (see Fries et al., 2009), a recent meta-analysis suggests that across studies the CAR tends to be positively associated with indices of stress and inversely associated with fatigue, burnout or exhaustion (Chida and Steptoe, 2009).”
BackgroundResultLife-course socioeconomic trajectories and diurnal cortisol regulation in adulthood
Gustafsson, P. E., Janlert, U., Theorell, T., & Hammarström, A. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.09.019 · Cited by 64
“The negative results of current SES and CAR are somewhat surprising, considering the relatively consistent findings of increasedCARormorning cortisol levels in chronically stressful life circumstances (Chida and Steptoe, 2009).”
BackgroundAltered functioning of the HPA axis in depressed postpartum women
de Rezende, M. G., Garcia-Leal, C., de Figueiredo, F. P., Cavalli, R. D. C., Schaufelberger, M. S., Barbieri, M. A., Bettiol, H., de Castro, M., & Del‐Ben, C. M. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.12.065 · Cited by 65
“The attenuation of the CAR is also observed for other causes of hypocortisolism and seems to be associated with chronic stress and sleep disturbances (Chida and Steptoe, 2009).”
BackgroundOstiguy, C. S., Ellenbogen, M. A., Walker, C.-D., Walker, E. F., & Hodgins, S. (2011) · Psychological Medicine · doi:10.1017/s0033291711000523 · Cited by 62
“…following awakening was examined using the area under the curve ‘with respect to increase ’ (AUCi), a reactivity measure sensitive to changes over time (Pruessner et al. 2003) and described as the most appropriate construct to examine in relation to psychosocial factors (Chida & Steptoe, 2009).”
MethodSteptoe, A., & Serwinski, B. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-800951-2.00034-0 · Cited by 71
Self-citationFranz, C. E., York, T. P., Eaves, L. J., Mendoza, S. P., Hauger, R. L., Hellhammer, D. H., Jacobson, K. C., Levine, S. D., LUPIEN, S. J., Lyons, M. J., et al. (2010) · Behavior Genetics · doi:10.1007/s10519-010-9352-2 · Cited by 62
“Past research reports a variety of health and lifestyle factors that influence cortisol concentrations, though recent reviews report mixed results for most of these factors (Chida and Steptoe 2009; Hellhammer et al. 2009; Kudielka et al. 2009) and there is little evidence from previous twin studies that they affect co…”
InfluentialDaubenmier, J., Hayden, D., Chang, V., & Epel, E. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.05.012 · Cited by 62
“However, negative affect, anxity, and rumination are not reliably associated with the CAR Chida and Steptoe, 2009; Zoccola and Dickerson, 2012).”
Ganster, D. C., Crain, T. L., & Brossoit, R. M. (2017) · Annual Review of Organizational Psychology and Organizational Behavior · doi:10.1146/annurev-orgpsych-032117-104613 · Cited by 62
Relation between salivary cortisol as stress biomarker and dietary pattern in children
Michels, N., Sioen, I., Braet, C., Huybrechts, I., Vanaelst, B., Wolters, M., & Henauw, S. D. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.12.020 · Cited by 62
“Furthermore, a recent meta-analysis found a global positive relation of the CAR with life stress (Chida and Steptoe, 2009).”
BackgroundGerber, M., Kalak, N., Elliot, C., Holsboer‐Trachsler, E., Pühse, U., & Brand, S. (2013) · Neuropsychobiology · doi:10.1159/000351735 · Cited by 61
Mikolajczak, M., Quoidbach, J., Vanootighem, V., Lambert, F., Lahaye, M., Fillée, C., & de Timary, P. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.11.003 · Cited by 62
“, 2009) and comprehensive meta-analyses (Chida and Steptoe, 2009) could not make sense of all contradictions.”
InfluentialVargas, I., & Lopez‐Duran, N. L. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.01.030 · Cited by 62
Exhaustion-related changes in cardiovascular and cortisol reactivity to acute psychosocial stress
Jönsson, P., Österberg, K., Wallergård, M., Hansen, Å. M., Garde, A. H., Johansson, G. I., & Karlson, B. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.07.020 · Cited by 63
“In support of this, a review of 62 articles found that the cortisol awakening response (CAR) co-varied positively with work stress and general life stress, while clinical burnout/exhaustion and fatigue were associated with reduced CAR [5].”
Bostock, S., & Steptoe, A. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.07.012 · Cited by 65
“For example, the magnitude of the awakening response was positively correlated with job stress in a recent meta-analysis (Chida and Steptoe, 2009); increased cortisol secretion over the day was predictive of depression (Stetler and Miller, 2011) and a flatter diurnal slope predicted cardiovascular mortality in over 40…”
Self-citationSin, N. L., Ong, A. D., Stawski, R. S., & Almeida, D. M. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.06.001 · Cited by 61
“This is inconsistent with the stress-buffering hypothesis, yet some previous research has linked positive affect with smaller CAR (Chida and Steptoe, 2009).”
BackgroundResultInfluentialO'Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O'Carroll, R. E., & O'Connor, R. C. (2020) · Journal of Abnormal Psychology · doi:10.1037/abn0000482 · Cited by 60
Peris-Pastor, G., Azorín, C., Grau, J., Benedé, J. L., & Chisvert, A. (2023) · TrAC Trends in Analytical Chemistry · doi:10.1016/j.trac.2023.117434 · Cited by 61
Hair cortisol: A new tool for evaluating stress in programs of stress management
Iglesias, S. L., Jacobsen, D., González, D., Azzara, S. H., Repetto, E. M., Jamardo, J., Gómez, S. G., Mesch, V., Berg, G. A., & Fabre, B. R. (2015) · Life Sciences · doi:10.1016/j.lfs.2015.10.006 · Cited by 69
McLachlan, K., Rasmussen, C., Oberlander, T. F., Loock, C., Pei, J. R., Andrew, G., Reynolds, J. N., & Weinberg, J. (2016) · Alcohol · doi:10.1016/j.alcohol.2016.03.003 · Cited by 62
“…on HPA axis regulation and diurnal cortisol activity, the reported nature and directionality of changes over the day remain inconsistent across the literature and complicated by effects of moderating and mediating factors on developmental outcomes (Chida & Steptoe, 2009; Cicchetti et al., 2010).”
Dissecting the impact of sleep and stress on the cortisol awakening response in young adults
Vargas, I., & Lopez‐Duran, N. L. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.10.009 · Cited by 59
“, 2000; Kudielka and Kirschbaum, 2003) and contextual factors (e.g., stressful events, day of week, sleep patterns; Kunz-Ebrecht et al., 2004; Chida and Steptoe, 2009), suggesting it can also reflect processes beyond basic neuroendocrine functioning.”
InfluentialSalivary cortisol measurement in developmental research: where do we go from here?
Clements, A. D. (2013) · Developmental Psychobiology · doi:10.1002/dev.21025 · Cited by 57
Endrighi, R., Hamer, M., & Steptoe, A. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31822f9cd7 · Cited by 57
“Age, sex, employment grade, smoking status, BMI, depressive symptoms, and awakening time are the covariates in the model because all these factors have been related to cortisol levels (17,36,37).”
BackgroundSelf-citationYan, Y., Dong, J., Liu, Y.-Q., Zhang, J., Song, M., He, Y. L., & Wang, W. (2014) · Stress · doi:10.3109/10253890.2014.999233 · Cited by 56
“A recent meta-analysis showed an undisputed positive relation between the CAR and job stress (Chida & Steptoe, 2009).”
BackgroundNeural Correlates of the Cortisol Awakening Response in Humans
Böhringer, A., Tost, H., Haddad, L., Lederbogen, F., Wüst, S., Schwarz, E., & Meyer‐Lindenberg, A. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.77 · Cited by 56
Sladek, M. R., & Doane, L. D. (2014) · Journal of Youth and Adolescence · doi:10.1007/s10964-014-0244-2 · Cited by 58
“Whether positive psychosocial factors are more consistently related to an enhanced or reduced CAR remains relatively unclear (Chida and Steptoe 2009), but the direction of our finding is consistent with limited available literature examining possible social regulatory influences on the CAR.”
ResultShiftwork Duration and the Awakening Cortisol Response Among Police Officers
Wirth, M. D., Burch, J. B., Violanti, J. M., Burchfiel, C. M., Fekedulegn, D. B., Andrew, M. E., Zhang, H., Miller, D. B., Hébert, J. R., & Vena, J. E. (2011) · Chronobiology International · doi:10.3109/07420528.2011.573112 · Cited by 62
“…a relatively a high degree of heritability, good intraindividual stability over several days (Bartels et al., 2003; Pruessner et al., 1997; Wust et al., 2000), and altered values have been consistently associated with psychometric measures of stress (Chida & Steptoe, 2009; Maina et al., 2009).”
BackgroundMethodEngert, V., Efanov, S. I., Dedovic, K., Dagher, A., & Pruessner, J. C. (2010) · Psychopharmacology · doi:10.1007/s00213-010-1918-4 · Cited by 58
“Among numerous psychological variables, depression (or symptoms of depressed mood) and anxiety have been shown to be associated with the CAR (Chida and Steptoe 2009; Fries et al. 2009) and different measures of diurnal cortisol levels (den Hartog et al.”
How stress and glucocorticoids timing-dependently affect extinction and relapse
Drexler, S. M., Merz, C. J., Jentsch, V. L., & Wolf, O. T. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.12.029 · Cited by 63
Economic instability and household chaos relate to cortisol for children in poverty.
Brown, E. D., Anderson, K. E., Garnett, M. L., & Hill, E. M. (2019) · Journal of Family Psychology · doi:10.1037/fam0000545 · Cited by 61
Attitudes and cardiovascular disease
Tindle, H. A., Davis, E. M., & Kuller, L. H. (2010) · Maturitas · doi:10.1016/j.maturitas.2010.04.020 · Cited by 56
“(38) In addition, individuals reporting positive affect and optimism have a lower cortisol awakening response (a marker of HPA axis functioning)(10, 39, 40).”
BackgroundWolfram, M., Bellingrath, S., Feuerhahn, N., & Kudielka, B. M. (2012) · Stress and Health · doi:10.1002/smi.2439 · Cited by 53
“Especially the CAR as marker of chronic psychosocial stress has been empirically related to measures of chronic work stress in numerous studies, although evidence so far remains inconsistent (Chida & Steptoe, 2009; Kudielka et al., 2006).”
BackgroundResultWilliams, S. R., Cash, E. D., Daup, M., Geronimi, E. M. C., Sephton, S. E., & Woodruff‐Borden, J. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.02.015 · Cited by 56
Daily family stress and HPA axis functioning during adolescence: The moderating role of sleep
Chiang, J. J., Tsai, K. M., Park, H., Bower, J. E., Almeida, D. M., Dahl, R. E., Irwin, M. R., Seeman, T. E., & Fuligni, A. J. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.05.009 · Cited by 54
“Under burnout conditions, owever, the HPA axis exhibits hypocortisolism, characterized by blunted CAR (Chida and Steptoe, 2009; Oosterholt et al., 2015). iven that poorer sleep can be a stressor itself and lead to greater eelings of fatigue, family demands in the context of poorer sleep ay become…”
BackgroundEddy, P. J., Wertheim, E. H., Hale, M. W., & Wright, B. J. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000505 · Cited by 55
“A systematic review andmeta-analysis of 22 studies investigating the associations these two CARmeasurement approaches have with various psychosocial factors (work stress, general life stress, depression/hopelessness, anxiety/neuroticism/negative affect, fatigue/ burnout/exhaustion, posttraumatic stress disorder, and p…”
InfluentialRetractedThoma, M. V., Joksimovic, L., Kirschbaum, C., Wolf, J. M., & Rohleder, N. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.09.013 · Cited by 64
“…it might be too early to speculate about mechanisms underlying the altered sAA awakening response, it is interesting that similar alterations of the wake-up response are found for another stress system with a strong diurnal rhythm, i.e. the HPA axis (Chida and Steptoe, 2009; Wessa et al., 2006).”
Metadata
- 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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