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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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“However, we were primarily interested in cortisol activity as an index of vulnerability to depression and anxiety, and it is unclear whether the CAR is the optimal index of cortisol activity for this purpose, as there is relatively limited evidence supporting an association between CAR and psychopathology (Jessop and…”
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“In a recent review of CMR literature, Chida and Steptoe (2009) do not discuss race or ethnicity.”
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“The log transformed CARi was used as a predictor, since CARi has previously been found to be a more appropriate measure of HPA-axis activation following awakening than CARg (Chida and Steptoe, 2009; Wilhelm et al., 2007).”
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“Variations in the neuroendocrine profiles of depressed patients across studies may relate to the severity of depression considered in each study, which ranges from heightened depressed mood within the normal range of symptomatology to major depressive disorder (Chida & Steptoe, 2009).”
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“However, Chida and Steptoe (2009) found a robust positive correlation between job stress or general life stress and cortisol release, and a strong negative correlation between fatigue, burnout, or exhaustion and cortisol release. Therefore, it is difficult to interpret results from the present study. Police officers f…”
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“org 5 As we anticipated that the degree and direction of concordance would vary across different cortisol measures and stressor types (41, 42), we next performed planned stratified analyses to examine group differences within individual stressor-cortisol pairings.”
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“secretion occurring during the first hour after awakening (cortisol awakening response, CAR) under chronic job and general life stress conditions [19, 20].”
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“The cortisol awakening response (CAR) has been previously linked to both psychosocial stress exposure (Chida and Steptoe, 2009), and to mental health outcomes; for example, a recent meta-analysis has linked increased CAR to depression (Boggero et al., 2017).”
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“Therefore, the CAR is an important physiological parameter to consider in relation to long-term stress, health conditions, and psychological traits (Chida & Steptoe, 2009; Fries, Dettenborn, & Kirschbaum, 2009; Kudielka & Kirschbaum, 2003; Wüst, Wolf, et al., 2000).”
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“In a review of CAR and psychosocial factors, the authors found that increased CAR was associated with both job strain and general life stress (Chida & Steptoe, 2009).”
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“To determine post-awakening cortisol, repeat cortisol levels are taken and this overcomes the difficulty of accurately sampling cortisol due to its pulsatile release (Chida & Steptoe, 2009).”
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“…with CAR and cortisol declining slopes (Clow, Thorn, Evans, & Hucklebridge, 2004; Stawski, Cichy, Piazza, & Almeida, 2013), the nature of association varied with some studies showing cortisol elevation and others showing lower cortisol levels and attenuated slopes (Chida & Steptoe, 2009).”
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“This includes higher levels of cortisol awakening responses (Kivimäki et al., 2006; Chida and Steptoe, 2009; Chandola et al., 2010).”
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“By contrast, a low or blunted CAR is associated with exhaustion, burnout, and perceived fatigue in adults (Adam, Hawkley, Kudielka, & Cacioppo, 2006; Chida & Steptoe, 2009).”
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“A metaanalysis of the cortisol awakening response (CAR) might support this idea by showing that the CAR is positively related to perceived stress levels and negatively to fatigue, burnout, or exhaustion [94].”
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Rnic, K., Jopling, E. N., Tracy, A., & LeMoult, J. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108212 · Cited by 19
Eddy, P. J., Wertheim, E. H., Hale, M. W., & Wright, B. J. (2023) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001155 · Cited by 24
“For instance, the meta-analysis by Chida and Steptoe (13) reported an association with CAR change but not CAR AUC with workplace stress.”
BackgroundMethodResultInfluentialSalivary Cortisol and Cold Pain Sensitivity in Female Twins
Godfrey, K. M., Strachan, E. D., Dansie, E. J., Crofford, L. J., Buchwald, D., Goldberg, J. H., Poeschla, B., Succop, A., Noonan, C., & Afari, N. (2013) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9532-4 · Cited by 20
“However, the association between stress and HPA axis function in the cortisol awakening response may depend on the type of stressor (39).”
BackgroundLong-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion
Sjörs, A., Ljung, T., & Jónsdóttir, I. H. (2012) · BMJ Open · doi:10.1136/bmjopen-2012-001091 · Cited by 22
“Collecting only two samples was, however, a limitation to the study since three or more samples are recommended to fully cover the awakening response.(9) Resources for the current study did not allow a more extensive cortisol sampling protocol, given the extensive follow-up measurements.”
BackgroundCortisol Awakening Response as an Index of Mental Health and Well-Being in Adolescents
Rickard, N. S., Chin, T.-C., & Vella-Brodrick, D. (2015) · Journal of Happiness Studies · doi:10.1007/s10902-015-9706-9
Miller, K., Margolin, G., Shapiro, L. S., & Timmons, A. C. (2016) · Journal of Research on Adolescence · doi:10.1111/jora.12250 · Cited by 21
“A meta-analysis found reduced CAR in association with posttraumatic stress disorder, fatigue, and burn-out (Chida & Steptoe, 2009).”
InfluentialRecovery of rescuers from a 24-h shift and its association with aerobic fitness
Lyytikäinen, K., Toivonen, L., Hynynen, E., Lindholm, H. J., & Kyröläinen, H. (2017) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.00720 · Cited by 20
Frequent nightmares are associated with blunted cortisol awakening response in women
Nagy, T., Salavecz, G., Simor, P., Purebl, G., Bódizs, R., Dockray, S., & Steptoe, A. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.05.001 · Cited by 20
Self-citationWitbracht, M. G., Loan, M. V., Adams, S. H., Keim, N. L., & Laugero, K. D. (2012) · Journal of Nutrition · doi:10.3945/jn.112.166355 · Cited by 20
“, lunch), and stress (8–10), but there does exist a high degree of person-to-person variability in the responsiveness of cortisol to these stimuli (11,12).”
BackgroundGustafsson, P. E., Janlert, U., Virtanen, P., & Hammarström, A. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.09.011 · Cited by 20
“, 2010), is more pronounced in individuals reporting higher subjective stress at work (Chida and Steptoe, 2009).”
BackgroundMore Evidence that Twitter Language Predicts Heart Disease: A Response and ReplicationPreprint
Eichstaedt, J. C., Schwartz, H. A., Giorgi, S., Kern, M. L., Park, G., Sap, M., Labarthe, D. R., Larson, E. E., Seligman, M. E. P., & Ungar, L. (2018) · PsyArXiv (OSF Preprints) · doi:10.31234/osf.io/p75ku · Cited by 20
Mewes, R., Feneberg, A. C., Doerr, J. M., & Nater, U. M. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001006 · Cited by 19
Obasi, E. M., Shirtcliff, E. A., Brody, G. H., MacKillop, J. M., Pittman, D. M., Cavanagh, L., & Philibert, R. A. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00832 · Cited by 20
“More specifically, a hyperactive CARhas been linked to experiences of general life stress, overload, and worrying (Wust et al., 2000; Chida and Steptoe, 2009; Fries et al., 2009).”
BackgroundResultInfluentialHeart rate variability and salivary cortisol in very preterm children during school age
Urfer-Maurer, N., Ludyga, S., Stalder, T., Brand, S., Holsboer‐Trachsler, E., Gerber, M., Grob, A., Weber, P., & Lemola, S. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.10.004 · Cited by 20
Manigault, A. W., Zoccola, P. M., Hamilton, K. R., & Wymbs, B. T. (2019) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.01.018 · Cited by 19
Evans, J. R., Torres-Pérez, J. V., Petrazzini, M. E. M., Riley, R. J., & Brennan, C. H. (2021) · Scientific Reports · doi:10.1038/s41598-020-79615-1 · Cited by 22
Hong, H., & Lee, J. (2022) · Medical Science Monitor · doi:10.12659/msm.937957 · Cited by 20
“To resolve this disagreement between TSH and the questionnaires, TSH levels should be measured repeatedly to calculate the area under the curve of TSH levels, just as repeated measurements of cortisol levels and the area under the curve of cortisol levels solve the disparity between cortisol levels and questionnaires…”
BackgroundAssociations between stress, resources, and hair cortisol concentration in teachers
Marca, R. L., Schneider, S., Jenni, G., Kühne, F., Holtforth, M. G., & Wettstein, A. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106291 · Cited by 27
“, number of lessons) as well as job stress can be expected (Chida and Steptoe, 2009), findings related to CAR cannot be transferred to HCC.”
der Holst, H. M. L., & KERKHOF, G. A. (2015) · Chronobiology International · doi:10.3109/07420528.2015.1064130 · Cited by 20
“These results match those of earlier studies (see reviews by Chida & Steptoe, 2009; Elder et al., 2014), demonstrating that the levels of perceived workload and lack of control are positively related to the magnitude of the CAR.”
BackgroundResultDiurnal patterns and associations among salivary cortisol, DHEA and alpha-amylase in older adults
Wilcox, R. R., Granger, D. A., Szanton, S. L., & Clark, F. A. (2014) · Physiology & Behavior · doi:10.1016/j.physbeh.2014.02.012 · Cited by 19
“Both enhanced and reduced CARs are associated with various psychosocial factors (Kirschbaum et al. 1995; Chida and Steptoe 2009), including depression and anxiety disorders (e.g., Pruessner et al., 2003; Stetler and Miller, 2005; Bhattacharyya et al., 2008; Vreeburg et al., 2009, 2010).”
InfluentialNeuroendocrine recovery after 2-week 12-h day and night shifts: an 11-day follow-up
Merkus, S. L., Holte, K. A., Huysmans, M. A., Hansen, Å. M., van de Ven, P. M., van Mechelen, W., & van der Beek, A. J. (2014) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-014-0954-5 · Cited by 19
“The cortisol diurnal rhythm is characterised by an increase in excretion in the early morning, reaching a peak approximately 30–45 min after awakening, and a trough late at night (Chida and Steptoe 2009; Edwards et al. 2001; Kumari et al. 2010).”
BackgroundInfluentialBergen‐Cico, D., Lane, S. D., Thompson, M. L., Wozny, S., Zajdel, M., Barduhn, M. S., & Noce, J. (2015) · International Paramedic Practice · doi:10.12968/ippr.2015.5.3.78 · Cited by 18
“…(hormone) changes that can result in poor sleep quality, hypertension, anxiety, depression and increased health risk behaviours such as heavy use of tobacco and alcohol (McEwen, 2000; Chida and Steptoe, 2009; McFarlane et al, 2009; Juster et al, 2010; American Psychiatric Association, 2013).”
BackgroundVargas, I., Mayer, S. E., & Lopez‐Duran, N. L. (2016) · Stress and Health · doi:10.1002/smi.2691 · Cited by 20
“This has led to a plethora of studies investigating whether atypical CAR reflects an underlying neuroendocrine sensitivity to stress that can play a role in depression (Chida & Steptoe, 2009).”
BackgroundKorpa, T., Pervanidou, P., Angeli, E., Apostolakou, F., Papanikolaou, Κ., Papassotiriou, I., Chrousos, G. P., & Kolaitis, G. A. (2017) · Stress · doi:10.1080/10253890.2017.1303472 · Cited by 20
“Resonating with previous research (Chida & Steptoe, 2009; Freitag et al., 2009), the CAR was highlighted as a sensitive neurobiological indicator of HPAA functioning in middle childhood.”
MethodDienes, K., Gartland, N., & Ferguson, E. (2019) · British Journal of Health Psychology · doi:10.1111/bjhp.12352 · Cited by 19
Tuning Trophoblast Motility in a Gelatin Hydrogel via Soluble Cues from the Maternal–Fetal Interface
Zambuto, S. G., Clancy, K. B. H., & Harley, B. A. C. (2020) · Tissue Engineering Part A · doi:10.1089/ten.tea.2020.0097 · Cited by 19
Child Care and Cortisol Across Infancy and Toddlerhood: Poverty, Peers, and Developmental Timing
Berry, D. J., Blair, C., Granger, D. A., & The Family Life Project Key Investigators (2016) · Family Relations · doi:10.1111/fare.12184 · Cited by 23
“Of note, though, is that the cortisol awakening response is typically considered to be a process that is distinct from typical HPA axis functioning throughout the day (Chida & Steptoe, 2009).”
BackgroundCortisol Awakening Response and Walking Speed in Older People
Pulopulos, M. M., Puig‐Pérez, S., Hidalgo, V., Villada, C., & Salvador, A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0152071 · Cited by 19
“Additionally, none of these studies controlled for the perceived stress of the individuals during the previous months, an issue that has been associated with an increased CAR [11].”
BackgroundExamining stress: an investigation of stress, mood and exercise in medical students
O’Flynn, J., Dinan, T. G., & Kelly, J. R. (2017) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2017.54 · Cited by 20
“This has been shown to be increased in response to an acute stressor in healthy populations, though with individual variability (Pruessner et al. 1997; Chida & Steptoe, 2009; Kudielka et al. 2009).”
BackgroundGriffin, S. M., Lebedová, A., Cruwys, T., McMahon, G., Foran, A., Skrodzka, M., Gallagher, S. M., Ginty, A. T., & Muldoon, O. T. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12608 · Cited by 25
“It is a neuroendocrine manifestation of the HPA axis to face anticipated stress (Chida & Steptoe, 2009).”
Villegas, E., Hartsock, M. J., Aben, B. L. L. G., Lenahan, K. N., Hernández, T. D., & Spencer, R. L. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2021.0495 · Cited by 18
“…relevant to mTBI research is that dysregulation of cortisol profiles is associated with stress-related disorders such as major depression and PTSD. 24,27,46 47–49 Thus, altered cortisol profiles present in subjects with mTBI with these comorbid disorders may reflect more complex underlying processes.”
Shibuya, I., Nagamitsu, S., Okamura, H., Ozono, S., Chiba, H., Ohya, T., Yamashita, Y., & Matsuishi, T. (2014) · BioPsychoSocial Medicine · doi:10.1186/1751-0759-8-9 · Cited by 18
“Excessive or chronic stressful events might cause decreased diurnal cortisol secretion due to hypo-activation of the HPA [22]; however, CAR may reflect recent or upcoming daily general stressful events [23,24].”
BackgroundCastonguay, A. L., Wrosch, C., & Sabiston, C. M. (2017) · Health Psychology · doi:10.1037/hea0000477 · Cited by 20
“The 30 minutes measure was excluded from the calculation of AUC because the cortisol awakening response has been shown to be independent NEGATIVE AFFECT, PHYSICAL ACTIVITY, AND CORTISOL 11 from the diurnal rhythm of cortisol (Chida & Steptoe, 2009).”
MethodTell, D., Mathews, H. L., Burr, R. L., & Janusek, L. W. (2018) · Stress · doi:10.1080/10253890.2018.1424132 · Cited by 17
“Black solid line represents CTQ lower quartile values; gray dashed line represents CTQ upper quartile values. higher cortisol (Chida & Steptoe, 2009) and lower cortisol levels (Phillips, Ginty, & Hughes, 2013) are associated with adverse physical and mental health outcomes.”
BackgroundSpecific reduction in the cortisol awakening response after socio-affective mental training
Engert, V., Hoehne, K., & Singer, T. (2023) · Mindfulness · doi:10.1007/s12671-023-02074-y · Cited by 17
“To that effect, an increased CAR has been linked to job and general life stress (Chida & Steptoe, 2009), depression (Boggero et al., 2017), and borderline personality disorder (Rausch et al., 2021).”
BackgroundLi-Tempel, T., Larra, M. F., Winnikes, U., Tempel, T., DeRijk, R. H., Schulz, A., Schächinger, H., Meyer, J., & Schote, A. B. (2016) · Biological Psychology · doi:10.1016/j.biopsycho.2016.07.010 · Cited by 18
Kwak, K., Kim, B.-K., Jang, T. W., Sim, C. S., Ahn, Y., Choi, K., & Jeong, K. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17134647 · Cited by 18
“Since a cortisol response is known to be associated with work stress, it can be interpreted that stress level has increased due to shift work [45,46].”
BackgroundThe Relationship Between Family Socioeconomic Status and Adolescent Sleep and Diurnal Cortisol
Rocha, S., Almeida, D. M., Chiang, J. J., Cole, S. W., Irwin, M. R., Seeman, T. E., & Fuligni, A. J. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001104 · Cited by 17
“Adding to this complexity, both large and small values of CAR may be indicative of dysregulation (29).”
BackgroundShulei, W., Zhang, C., Sun, M., Zhang, D., Luo, Y., Liang, K., Xu, T., Pan, X., Zheng, R., Shangguan, F., et al. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1073494 · Cited by 26
“(2011) on cancer patients with poor physical functioning, CAR was negatively correlated with fatigue, and the patients had lower cortisol levels than healthy people (Chida and Steptoe, 2009).”
BackgroundWork-related stress and the risk of type 2 diabetes mellitus
Brunner, E. J., & Mika Kivimaki, B. (2013) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2013.124 · Cited by 17
Heritability of Cortisol Regulation in Children
Gustafsson, P. A., Gustafsson, P. E., Anckarsäter, H. S., Lichtenstein, P., Ljung, T., Nelson, N., & Larsson, H. (2011) · Twin Research and Human Genetics · doi:10.1375/twin.14.6.553 · Cited by 17
“The CAR has been given increased attention during the last decade (Chida & Steptoe, 2009; Fries et al., 2009) as a conveniently measured part of the circadian rhythm.”
BackgroundSharpley, C. F., Bitsika, V., Andronicos, N. M., & Agnew, L. L. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.12.020 · Cited by 18
Torrente, P., Kinnunen, U. M., Sianoja, M., de Bloom, J., Korpela, K., Tuomisto, M. T., & Lindfors, P. (2017) · Scandinavian Journal of Work and Organizational Psychology · doi:10.16993/sjwop.19 · Cited by 18
“Meta-analytic findings (Chida & Steptoe 2009) suggest that high CARi is positively but weakly associated with a number of psychosocial factors including job stress and other forms of life stress.”
BackgroundUpasham, S., Bhadsavle, S., & Prasad, S. (2019) · Analytical Methods · doi:10.1039/c8ay02620c · Cited by 17
Comparison of Cortisol level by Shift Cycle in Korean Firefighters
Lim, G.-Y., Jang, T. W., Sim, C.-S., Ahn, Y. S., & Jeong, K. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17134760 · Cited by 17
“Many previous studies indicate that the cortisol response is positively related to work stress [46,47] and the increase of serum cortisol levels indicates acute stress [10].”
BackgroundZhang, H., Shao, M., Lin, X., Cheng, L., Ovlyakulov, B., Chen, B., & Chen, K. (2020) · Brain and Behavior · doi:10.1002/brb3.2014 · Cited by 21
“The potential mechanism linking occupational stress and blood lipids is via the hypothalamic–pituitary–adrenal axis (HPA), affecting lipid intake and metabolism (Chida & Steptoe, 2009).”
BackgroundHolistic measurement of early childhood educators’ well-being: a protocol
Wong, S., Cumming, T., MacQuarrie, A., Bull, R., Robertson, C. V., Saha, M., McFarland, L., & Logan, H. (2022) · International Journal of Research & Method in Education · doi:10.1080/1743727x.2022.2128746 · Cited by 17
“Previous studies have found a link between CAR and psychosocial stress and health (Chida and Steptoe 2009, Clow et al .”
Zhang, L., Duan, H., Qin, S., Yuan, Y., Buchanan, T. W., Zhang, K., & Wu, J. (2015) · Stress · doi:10.3109/10253890.2015.1058356 · Cited by 17
“This measure of CAR is very commonly used in the literature and it emphasizes changes over time and is related to the sensitivity of the HPA axis (Chida & Steptoe, 2009; Pruessner et al., 2003).”
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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