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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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Degering, M., Linz, R., Puhlmann, L. M. C., Singer, T., & Engert, V. (2023) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2023.100598 · Cited by 37
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“The number of samples ensured reliable measures of cortisol secretion (Chida & Steptoe, 2009; Rohleder & Nater, 2009).”
BackgroundThe cortisol awakening response and cognition across the adult lifespan
Ennis, G. E., Moffat, S. D., & Hertzog, C. K. (2016) · Brain and Cognition · doi:10.1016/j.bandc.2016.04.001 · Cited by 39
Gloster, A. T., Miché, M., Wersebe, H., Mikoteit, T., Hoyer, J., Imboden, C., Bader, K., Meyer, A. H., Hatzinger, M., & Lieb, R. (2017) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1578 · Cited by 47
“For example the cortisol awakening response (CAR) is a proxy marker of hypothalamic–pituitary adrenal (HPA) axis functioning (Chida & Steptoe, 2009; Fries, Dettenborn, & Kirschbaum, 2009) and it may both depend on and affect symptom fluctuations.”
BackgroundStarr, L. R., Dienes, K., Stroud, C. B., Shaw, Z. A., Li, Y. I., Mlawer, F., & Huang, M. (2017) · Development and Psychopathology · doi:10.1017/s0954579417001468 · Cited by 36
“Although its exact function is uncertain, it has been suggested that the CAR represents the marshaling of resources to deal with the stress of the day (Chida & Steptoe, 2009; Fries, Dettenborn, & Kirschbaum, 2009; Powell & Schlotz, 2012).”
BackgroundMethodResultInfluentialBenefit finding and diurnal cortisol after prostate cancer: The mediating role of positive affect
Wang, A. W., & Hoyt, M. A. (2018) · Psycho-Oncology · doi:10.1002/pon.4647 · Cited by 35
“Furthermore, cortisol morning peak is positively associated with greater social support and more coping activities and negatively associated with fatigue, exhaustion, and hopelessness.(34,35)”
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“Increasing cortisol levels are related to a number of psychosocial factors,([7]) major depression, and stress,([8]) and emotion regulation influences a variety of cognitive processes.”
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“We elected to use this measure because it has been employed in comparable studies investigating the effects of chronic stress and cortisol (e.g., Chida & Steptoe, 2009) and we wanted to focus on a single measure of cortisol awakening to reduce the number of statistical tests performed relating to…”
BackgroundMethodKim, K. S., Kim, Y. C., Oh, I., Kim, S. S., Choi, J. Y., & Ahn, R. S. (2012) · Chronobiology International · doi:10.3109/07420528.2012.706767 · Cited by 36
“A meta-analysis of 62 published articles on the CAR revealed that altered, i.e., enhanced or reduced, CAR is associated with psychosomatic and psychiatric disorders, such as fatigue, depression, and anxiety (Chida & Steptoe, 2009).”
BackgroundLindholm, H. J., Ahlberg, J., Sinisalo, J. P., Hublin, C., Hirvonen, A., Partinen, M., Sarna, S. J., & Savolainen, A. (2012) · Sleep Disorders · doi:10.1155/2012/789274 · Cited by 35
“response (CAR) is associated with an increased level of stress [15].”
BackgroundWong, J. D., Seltzer, M. M., Greenberg, J. S., Hong, J., Almeida, D. M., & Coe, C. L. (2012) · Aging & Mental Health · doi:10.1080/13607863.2012.688191 · Cited by 37
“While the cortisol literature has focused more on cortisol awakening response (referring to the increase in cortisol release observed over the first 30 min post awakening and often is assessed by the difference between cortisol levels at 30 min post-awakening and upon awakening) than other measurements of cortisol rea…”
Mangold, D. L., Marino, E. N., & Javors, M. A. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.01.001 · Cited by 35
“In linewith this contention, studies have shown a negative association between the CAR, length of time following the onset of trauma or chronic stress and the severity of depressive symptomatology (Chida and Steptoe, 2009; Miller et al., 2007).”
ResultAhn, R. S., Choi, J. H., Choi, B. C., Kim, J., Lee, S. H., & Sung, S. S. (2011) · Journal of Endocrinology · doi:10.1530/joe-11-0247 · Cited by 35
“The CAR is used as a reliable index of the HPA axis function in various clinical research areas, and an altered CAR is known to be associated with health issues, such as fatigue, depression, and anxiety, and the prognosis of patients with a severe disease (Sephton et al. 2000, Chida & Steptoe 2009).”
MethodLaudenslager, M. L., Calderone, J., Philips, S., Natvig, C. L., & Carlson, N. E. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.01.006 · Cited by 35
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“However, meta-analytic evidence indicates that the effect of chronic stress on cortisol varies across cortisol measures; whilst diurnal (overall daily output) cortisol, afternoon/evening cortisol, and the CARi (increase in cortisol following awakening) are elevated following chronic stress, basal morning levels are lo…”
BackgroundCortisol awakening response - Are sampling delays of 15minutes acceptable?
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Flexible, low volume detection of chronobiology biomarkers from human sweat
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“Such alterations, in turn, are linked to depression (e.g., Chida & Steptoe, 2009; Vrshek-Schallhorn et al., 2013), as well as to elevated rates of depression following recent stress exposure (Schuler et al., 2017).”
BackgroundParenting stressors and morning cortisol in a sample of working mothers.
Hibel, L. C., Mercado, E., & Trumbell, J. M. (2012) · Journal of Family Psychology · doi:10.1037/a0029340 · Cited by 34
Neuroticism and cortisol: The importance of checking for sex differences
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“Prior research on hypothalamic-pituitary-adrenal (HPA) activation and trait or state characteristics has been specifically noted to be unclear and contradictory as a whole (van Santen et al., 2011; Hill et al., 2013; Ormel et al., 2013; Chida and Steptoe, 2009).”
BackgroundImpact of loneliness on diurnal cortisol in youth
Jopling, E., Rnic, K., Tracy, A., & LeMoult, J. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105345 · Cited by 32
“Indeed, a blunted CAR prospectively predicts worsened mental and physical health (e.g., increases in depressive symptoms and body mass index) across the adolescent period (Nederhof et al., 2015; Ruttle et al., 2013) and into adulthood (Chida and Steptoe, 2009).”
BackgroundEffects of Oral Supplementation with Pyrroloquinoline Quinone on Stress, Fatigue, and Sleep
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Cortisol and Racial Health Disparities Affecting Black Men in Later Life: Evidence From MIDUS II
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“Studies examining relationships between these constructs, however, have generated mixed findings (Chida & Steptoe, 2009; Staufenbiel, Penninx, Spijker, Elzinga, & van Rossum, 2013).”
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“A recent metaanalysis (Chida and Steptoe, 2009) indicated that chronic stress is associated with a more pronounced CAR.”
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Cross-Lagged Associations Between Children’s Stress and Adiposity
Michels, N., Sioen, I., Boone, L., Clays, E., Vanaelst, B., Huybrechts, I., & Henauw, S. D. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000122 · Cited by 33
“Moderation by cortisol in the overall stress-adiposity relation was only seen when using the cortisol awakening response (AUCi), the parameter that reflects the pure increase and as such the cortisol system sensitivity, which has been positively associated with general life stress (70).”
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“The 30-min post-awakening measure was excluded from AUCg calculation [39].”
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Maternal psychological well‐being and salivary cortisol in late pregnancy and early post‐partum
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Unemployment as a chronic stressor: A systematic review of cortisol studies
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“For example, a selection of recent reviews or meta-analyses examining the association between cortisol and other chronic stress factors have yielded the following: 62 articles on psychosocial stress (Chida & Steptoe, 2009); and 84 articles on caregiving (Pinquart & Sörensen, 2003).”
Childhood Adversity and Adult Physical Health
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“clear what may constitute a “healthy” cortisol response, as both elevated and depressed responses have been related to dysfunctional psychosocial health status [34].”
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“, the cortisol awakening response or CAR) as indicators of chronic stress, and long-termmental and physical health [1].”
BackgroundChange in parent-child conflict and the HPA-axis: Where should we be looking and for how long?
Kuhlman, K. R., Repetti, R. L., Reynolds, B. M., & Robles, T. F. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.02.029 · Cited by 31
“, 2009), and has most consistently been linked to recent chronic stress (Chida and Steptoe, 2009).”
Imagining a positive future reduces cortisol response to awakening and reactivity to acute stress
Nicolson, N. A., Peters, M. L., & Meevissen, Y. M. C. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104677 · Cited by 31
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The Relationship Between the Cortisol Awakening Response, Mood States, and Performance
Díaz, M. M., Bocanegra, O., Teixeira, R. R., Tavares, M., Soares, S. S., & Espíndola, F. S. (2012) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0b013e318267a612 · Cited by 34
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“The increased CAR can represent a positive boost for the course of the day or it may indicate increased stress on days in which conflict will be avoided (Chida and Steptoe 2009; Fries et al. 2009).”
BackgroundWork hours and cortisol variation from non-working to working days
Marchand, A., Durand, P., & LUPIEN, S. J. (2012) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-012-0788-y · Cited by 30
“This is consistent with what has been previously reported (Chida and Steptoe 2009; Clow et al. 2004).”
ResultMultiple measures of HPA axis function in ultra high risk and first-episode schizophrenia patients
Nordholm, D., Rostrup, E., Mondelli, V., Randers, L., Nielsen, M. Ø., Wulff, S., Nørbak-Emig, H., Broberg, B. V., Krakauer, K., Dazzan, P., et al. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.03.015 · Cited by 33
Cultural neurobiology and the family: Evidence from the daily lives of Latino adolescents
Doane, L. D., Sladek, M. R., Breitenstein, R. S., Park, H. J., Castro, S. A., & Kennedy, J. L. (2018) · Development and Psychopathology · doi:10.1017/s0954579418001104 · Cited by 31
Patterns of salivary cortisol levels can manifest work stress in emergency care providers
Nakajima, Y., Takahashi, T., Shetty, V., & Yamaguchi, M. (2012) · The Journal of Physiological Sciences · doi:10.1007/s12576-012-0197-8 · Cited by 31
“As Chida and Steptoe [35] summarize in a recent systematic review, the magnitude of the cortisol-awakening response is influenced by mediators such as fatigue as well as sleep deprivation and quality.”
BackgroundHolleman, M., Vreeburg, S. A., Dekker, J., & Penninx, B. W. J. H. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.09.012 · Cited by 30
“In a meta-analysis of the CAR and psychosocial factors, Chida and Steptoe (2009) found a positive association between job stressor level and the CAR.”
BackgroundVargas, I., & Lopez‐Duran, N. L. (2017) · Journal of Health Psychology · doi:10.1177/1359105317738323 · Cited by 35
“Yet, despite its growing use in clinical research over the past two decades (Chida and Steptoe, 2009), there is a limited understanding of CAR’s fundamental biopsychosocial function and meaning (Clow et al.”
BackgroundUrech, C., Scherer, S., Emmenegger, M., Gaab, J., Tschudin, S., Hoesli, I., Berger, T., & Alder, J. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.10.014 · Cited by 29
Schuler, K. L., Ruggero, C. J., Goldstein, B. L., Perlman, G., Klein, D. N., & Kotov, R. (2017) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2017.06.005 · Cited by 30
Sladek, M. R., Doane, L. D., & Stroud, C. B. (2016) · Journal of Youth and Adolescence · doi:10.1007/s10964-016-0591-2 · Cited by 31
“Due to generally mixed literature regarding the cortisol awakening response (Chida and Steptoe 2009) and its distinction from the rest of the diurnal pattern (Clow et al. 2010), we did not make a specific hypothesis for the between-person association of active coping style with the cortisol…”
Blunted HPA axis response to stress is related to a persistent Dysregulation Profile in youth
Ayer, L. A., Greaves‐Lord, K., Althoff, R. R., Hudziak, J. J., Dieleman, G. C., Verhulst, F. C., & van der Ende, J. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.04.002 · Cited by 29
Hypothalamic–pituitary–adrenal axis tonus is associated with hippocampal microstructural asymmetry
Madsen, K. S., Jernigan, T. L., Iversen, P., Frøkjær, V. G., Knudsen, G. M., Siebner, H. R., & Baaré, W. F. C. (2012) · NeuroImage · doi:10.1016/j.neuroimage.2012.06.071 · Cited by 31
“…with fatigue, burnout, and post-traumatic stress disorder (Chida and Steptoe, 2009; Handwerger, 2009), while higher morning cortisol levels have been associated with anxiety disorder (Vreeburg et al., 2010) and major depression (Chida and Steptoe, 2009; Handwerger, 2009; Vreeburg et al., 2009).”
BackgroundInfluentialOta, A., Mase, J., Howteerakul, N., Rajatanun, T., Suwannapong, N., Yatsuya, H., & Ono, Y. (2014) · Scientific Reports · doi:10.1038/srep06402 · Cited by 29
Steinisch, M., Yusuf, R., Li, J., Stalder, T., Bosch, J. A., Rahman, O., Strümpell, C., Ashraf, H. M., Fischer, J. E., & Loerbroks, A. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.08.001 · Cited by 31
Sleep quality and depressive symptoms after prostate cancer: The mechanistic role of cortisol.
Hoyt, M. A., Bower, J. E., Irwin, M. R., Weierich, M. R., & Stanton, A. L. (2016) · Behavioral Neuroscience · doi:10.1037/bne0000107 · Cited by 30
“The 30-min measure was excluded from this calculation as early morning increase of cortisol is relatively independent from overall cortisol volume (Chida & Steptoe, 2009).”
Subjective Health Complaints, Stress, and Coping in Orchestra Musicians
Halleland, H. B., Harris, A., Sørnes, S., Murison, R. C. C., & Ursin, H. (2009) · Medical Problems of Performing Artists · doi:10.21091/mppa.2009.2014 · Cited by 28
Kuhlman, K. R., Irwin, M. R., Ganz, P. A., Crespi, C. M., Petersen, L., Asher, A., & Bower, J. E. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000499 · Cited by 29
“Previous studies have identified sleep quantity (55), early life adversity (56), and recent daily life stress as meaningful predictors of CAR (17,57).”
Johnson, M., & Johnson, E. (2018) · Social Theory & Health · doi:10.1057/s41285-018-0076-3 · Cited by 30
“…and cortisol awakening response (Kunz-Ebrecht, et al., 2004), which has been found in those experiencing depressive symptoms and work and financial stress (Pruessner, et al., 2003) and appears to be an indicator of stress-related hypothalamic-pituitary-adrenal dysfunction (Chida & Steptoe, 2009).”
Backgroundd’Errico, A., Cardano, M., Landriscina, T., Marinacci, C., Pasian, S., Petrelli, A., & Costa, G. (2010) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-010-0586-3 · Cited by 28
“…levels, together with changes in the circadian pattern of cortisol secretion, in both subjects exposed to different types of psychosocial stressors (Steptoe et al. 2000; Evolahti et al. 2006; Chida and Steptoe 2009) and patients affected by depression (Deuschle et al. 1997; Carroll et al. 2007).”
BackgroundGhiciuc, C. M., Cozma, L. C. D., Bercea, R. M., Lupușoru, C. E., Mihăescu, T., Szalontay, A. S., Gianfreda, A., & Patacchioli, F. R. (2013) · Chronobiology International · doi:10.3109/07420528.2013.795155 · Cited by 28
“…that multiple diurnal samples, especially within 1 h after awakening, are necessary to reliably measure HPA activity and monitor changes in salivary cortisol diurnal trajectories, which are thought to have implications for health (Ahn et al., 2007; Chida & Steptoe, 2009; Wolf et al., 2008).”
BackgroundKaess, M., Simmons, J. G., Whittle, S., Jovev, M., Chanen, A. M., Yücel, M., Pantelis, C., & Allen, N. B. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.06.028 · Cited by 27
“Importantly, both CAR and DSL dysregulation have been associated with chronic stress and psychopathology in a range of populations (Chida and Steptoe, 2009; Cohen et al., 2006; Steptoe et al., 2005; Wingenfeld and Wolf, 2011).”
Cortisol and induced cognitive fatigue: Effects on memory activation in healthy males
Klaassen, E. B., de Groot, R. H. M., Evers, E. A. T., Nicolson, N. A., Veltman, D. J., & Jolles, J. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.05.015 · Cited by 27
“Cortisol has been linked to fatigue in studies showing reduced cortisol levels in chronic fatigue syndrome (CFS) (Jerjes et al., 2005; Nater et al., 2008; Silverman et al., 2010) and vital exhaustion (Nicolson and van Diest, 2000); a blunted cortisol response to wakening in relation to fatigue, burnout and exhaustion…”
BackgroundNicholson, L., Miller, A. M., Schwertz, D. W., & Sorokin, O. (2012) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-012-9752-x · Cited by 28
“Prolonged or chronic stress can lead to disregulation of the HPA axis, which is reflected in changes in cortisol levels and diurnal patterns, most commonly a flattening of a daily cortisol curve (lower morning levels and higher evening levels) [48].”
BackgroundWriting about life goals: Effects on rumination, mood and the cortisol awakening response
Teismann, T., Het, S., Grillenberger, M., Willutzki, U., & Wolf, O. T. (2013) · Journal of Health Psychology · doi:10.1177/1359105313490774 · Cited by 28
“The most robust finding is that work stress and general life stress are associated with an increased CAR (for a recent meta-analysis, see Chida and Steptoe, 2009): In one study, a reduction in financial strain was accompanied by a decrease in the CAR, indicating a parallel between changes in…”
BackgroundSmyth, N., Thorn, L., Hucklebridge, F. H., Clow, A., & Evans, P. D. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.09.026 · Cited by 28
“The utility of the CAR literature is limited by inconsistent associations (see Chida and Steptoe, 2009; Clow et al., 2004; Fries et al., 2009).”
BackgroundVrshek‐Schallhorn, S., Avery, B. M., Ditcheva, M., & Sapuram, V. R. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.11.002 · Cited by 34
“, 2013), and individuals under stress appear to show larger awakening responses (Chida and Steptoe, 2009).”
BackgroundTrait emotion regulation strategies and diurnal cortisol profiles in healthy adults.
Otto, L. R., Sin, N. L., Almeida, D. M., & Sloan, R. P. (2017) · Health Psychology · doi:10.1037/hea0000564 · Cited by 29
“…have been linked to increased CAR, while posttraumatic stress disorder, fatigue syndrome, cardiovascular disorders, depression and, interestingly, positive psychological traits have been related to reduced CAR (for reviews, see Chida & Steptoe, 2009; Fries, Dettenborn, & Kirschbaum, 2008).”
BackgroundPsychophysiological Bases of Disease ☆
Steptoe, A., & Poole, L. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.05144-0 · Cited by 28
Self-citationCompetition stress leads to a blunting of the cortisol awakening response in elite rowers
MacDonald, D., & Wetherell, M. A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01684 · Cited by 27
Burnout, hair cortisol, and timing: Hyper- or hypocortisolism?
Rohleder, N. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.10.008 · Cited by 28
Enduring Association Between Parenting and Cortisol: A Meta-analysis
Hackman, D. A., O’Brien, J. R., & Zalewski, M. (2018) · Child Development · doi:10.1111/cdev.13077 · Cited by 29
Jankovic‐Rankovic, J., Oka, R., Meyer, J. S., Snodgrass, J. J., Eick, G. N., & Gettler, L. T. (2022) · American Journal of Human Biology · doi:10.1002/ajhb.23747 · Cited by 28
“…low social support levels and higher cortisol observed previously (Cacioppo et al., 2000; Matheson et al., 2008) with an effect size (r = 0.21) consistent with those in prior studies of social support, psychosocial stress, and neuroendocrine responses (Chida & Steptoe, 2009; Rosal et al., 2004).”
ResultInfluentialNoisy spit: Parental noncompliance with child salivary cortisol sampling
Smith, V. C., & Dougherty, L. R. (2013) · Developmental Psychobiology · doi:10.1002/dev.21133 · Cited by 27
“Research examining the CAR has flourished in recent years as the CAR has been linked to physical and psychological health conditions, including chronic life stress and fatigue, post-traumatic stress disorder, and depression (for a review see Chida & Steptoe, 2009).”
BackgroundThomas, K. S., Bower, J. E., Williamson, T. J., Hoyt, M. A., Wellisch, D. K., Stanton, A. L., & Irwin, M. R. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.12.008 · Cited by 26
“However, several studies have found lower CAR in individuals who suffer from PTSD (Chida and Steptoe, 2009; Rohleder et al., 2004; Wessa et al., 2006).”
BackgroundSjörs, A., Larsson, B. K., Karlson, B., Österberg, K., Dahlman, J., & Gerdle, B. U. C. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.10.007 · Cited by 28
“, sleeping problems, anxiety and catastrophizing are prevalent in chronic pain it appears, based on both our study and other studies (McBeth et al., 2007; Chida and Steptoe, 2009), important to understand this complex interplay and to take the most important factors into consideration when analyzing circadian cortisol…”
BackgroundThe relation of the cortisol awakening response and prospective memory functioning in young children
Bäumler, D., Voigt, B., Miller, R. E., Tobias Stalder, A., Kirschbaum, C., & Kliegel, M. (2014) · Biological Psychology · doi:10.1016/j.biopsycho.2014.02.011 · Cited by 27
“The CAR is a frequently used measure in psychoneuroendocrinological research and has been linked to a number of demographic, psychosocial and health-related factors (Chida & Steptoe, 2009; Fries, Dettenborn, & Kirschbaum, 2009).”
BackgroundLeneman, K. B., Donzella, B., Desjardins, C. D., Miller, B. S., & Gunnar, M. R. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.06.011 · Cited by 27
“Studies of chronic stress in adults have revealed both increases and blunting of the initial 30 min of the cortisol awakening response (Chida and Steptoe, 2009).”
BackgroundLoneliness and Diurnal Salivary Cortisol in Emerging Adults
Lai, J. C. L., Leung, M. O. Y., Lee, D. Y. H., Lam, Y. W., & Berning, K. (2018) · International Journal of Molecular Sciences · doi:10.3390/ijms19071944 · Cited by 33
“Dysregulation in the secretion or diurnal rhythm of cortisol has been shown to be detrimental to both physical and mental health [7,8].”
BackgroundHakamata, Y., Mizukami, S., Izawa, S., Moriguchi, Y., Hori, H., Kim, Y., Hanakawa, T., Inoue, Y., & Tagaya, H. (2019) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2019.11.008 · Cited by 27
Tops, M., Schlinkert, C., Tjew-A-Sin, M., Samur, D., & Koole, S. (2015) · Springer eBooks · doi:10.1007/978-1-4939-1236-0_6 · Cited by 29
“porting the sensitivity of the CAR to PRISM, in a meta-analysis the CAR was positively associated with job stress and general life stress; it was negatively associated with fatigue, burnout, or exhaustion (Chida and Steptoe 2009).”
MethodIzawa, S., Miki, K., Tsuchiya, M., Yamada, H., & Nagayama, M. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.11.021 · Cited by 26
Cornwell, E. Y., & Goldman, A. W. (2020) · Journal of Health and Social Behavior · doi:10.1177/0022146520967660 · Cited by 29
“Fatigue, or a lack of energy, has also been linked with the stress response, although the timing and mechanisms are not fully understood (see e.g., Chida and Steptoe 2009; Doerr et al. 2015).”
BackgroundPlasma cortisol concentrations and lifestyle in a population of outdoor workers
Rosati, M. V., Sancini, A., Tomei, F., Andreozzi, G., Scimitto, L., Schifano, M. P., Ponticiello, B. G., Fiaschetti, M., & Tomei, G. (2011) · International Journal of Environmental Health Research · doi:10.1080/09603123.2010.506675 · Cited by 26
“The role of cortisol in mediating the stress response is well known, but several studies in literature indicate many physical and chemical pollutants can play a role in altering the levels of the hormone (Chida and Steptoe 2009).”
BackgroundAmbulatory assessed implicit affect is associated with salivary cortisol
Mossink, J. C. L., Verkuil, B., Burger, A. M., Tollenaar, M. S., & BROSSCHOT, J. F. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00111 · Cited by 26
“The CAR is defined as the increase in cortisol secretion that is observed within the first hour after awakening (Chida and Steptoe, 2009).”
BackgroundResultInfluentialEveryday Support to Aging Parents: Links to Middle-Aged Children’s Diurnal Cortisol and Daily Mood
Bangerter, L. R., Liu, Y., Kim, K., Zarit, S. H., Birditt, K. S., & Fingerman, K. L. (2016) · The Gerontologist · doi:10.1093/geront/gnw207 · Cited by 26
“CAR is an indicator of negative psychosocial factors, health, well-being, and daily stressors (Chida & Steptoe, 2009; Fries et al., 2009).”
Long-term stability of diurnal salivary cortisol and alpha-amylase secretion patterns
Skoluda, N., Marca, R. L., Gollwitzer, M., Müller, A., Limm, H., Marten‐Mittag, B., Gündel, H., Angerer, P., & Nater, U. M. (2017) · Physiology & Behavior · doi:10.1016/j.physbeh.2017.03.021 · Cited by 26
Stressed-Out Oral Immunity: A Gateway From Socioeconomic Adversity to Periodontal Disease
Gomaa, N., Glogauer, M., Nicolau, B., Tenenbaum, H., Siddiqi, A., Fine, N., & Quiñonez, C. (2020) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000774 · Cited by 25
Pathophysiology of Major Depression by Clinical Stages
de Menezes Galvão, A. C., Almeida, R. N., de Sousa, G. M., Leocadio-Miguel, M. A., Palhano-Fontes, F., de Araujo, D. B., Lobão-Soares, B., Maia-de-Oliveira, J. P., Nunes, E. A., Hallak, J. E. C., et al. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.641779 · Cited by 31
Chiaie, R. D., Trabucchi, G., Girardi, N., Marini, I., Pannese, R., Vergnani, L., Caredda, M., Zerella, M. P., Minichino, A., Corrado, A., et al. (2013) · Psychotherapy and Psychosomatics · doi:10.1159/000348609 · Cited by 25
Towards a Biopsychological Understanding of Costly Punishment: The Role of Basal Cortisol
Pfattheicher, S., & Keller, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0085691 · Cited by 25
“The activation of the HPA axis and cortisol in turn are related to important cognitive, affective and behavioral tendencies such as general life stress, deficits in cognitive functioning, mood disorders like depression, and food consumption [2–5].”
BackgroundThe Effects of Multivitamin Supplementation on Diurnal Cortisol Secretion and Perceived Stress
Camfield, D., Wetherell, M. A., Scholey, A. B., Cox, K., Fogg, E., White, D., Sarris, J. J., Kras, M., Stough, C. K. K., Sali, A., et al. (2013) · Nutrients · doi:10.3390/nu5114429 · Cited by 25
“Similarly, when the Pearson’s r values from the meta-analysis by Chida and Steptoe [40] are converted to Cohen’s d values, values range from d = 0.12 for the effect of general life stress on the CAR, to d = −0.28 for the effect of post-traumatic stress disorder.”
BackgroundMethodInfluential
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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