The DOI matches its Crossref record; 106 of the 106 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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
Citations
Cites
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552
Meta-analysis of Observational Studies in Epidemiology<SUBTITLE>A Proposal for Reporting</SUBTITLE>
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623
Physiology and neurobiology of stress and adaptation: central role of the brain
McEwen, B. S. (2007) · Physiological Reviews · doi:10.1152/physrev.00041.2006 · Cited by 5,429 · cited 3×
“…separately as separate studies; (4) we included studies evaluating certain mental health problems such as depressive disorders, anxiety disorders, posttraumatic stress disorder, and chronic fatigue syndrome, since these conditions are thought to be related to HPA axis dysregulation (McEwen, 2007).”
InfluentialThe potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders
Heim, C., Ehlert, U., & Hellhammer, D. H. (2000) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(99)00035-9 · Cited by 1,688
Chida, Y., & Steptoe, A. (2008) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31818105ba · Cited by 1,592
Self-citationPruessner, J. C., Wolf, O. T., Hellhammer, D. H., Buske-Kirschbaum, A., von Auer, K., Jobst, S., Kaspers, F., & Kirschbaum, C. (1997) · Life Sciences · doi:10.1016/s0024-3205(97)01008-4 · Cited by 1,450
Do stress-related psychosocial factors contribute to cancer incidence and survival?
Chida, Y., Hamer, M., Wardle, J., & Steptoe, A. (2008) · Nature Clinical Practice Oncology · doi:10.1038/ncponc1134 · Cited by 1,072
Self-citationThe awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P., & Hucklebridge, F. (2004) · Stress · doi:10.1080/10253890410001667205 · Cited by 856
Burnout, Perceived Stress, and Cortisol Responses to Awakening
Pruessner, J. C., Hellhammer, D. H., & Kirschbaum, C. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00012 · Cited by 822
Cited by
Sorted by citations
Items 501–600 of 998
Alterations of postawakening cortisol parameters during a prolonged stress period
Weik, U., & Deinzer, R. (2010) · Hormones and Behavior · doi:10.1016/j.yhbeh.2010.06.001 · Cited by 17
“AUCG and CAR have been studied extensively under various stress and stress-related conditions and have been found to be altered by them,however thedirection of results is equivocal (for reviewsee: Clow et al., 2010; Fries et al., 2009; Chida and Steptoe, 2009).”
BackgroundDevereux, J. J., Rydstedt, L. W., & Cropley, M. (2011) · Psychological Reports · doi:10.2466/09.14.17.pr0.108.1.274-280 · Cited by 17
“…of the study was that the cortisol awakening response was not assessed, as this measure is thought to be a more sensitive marker of HPA activity (Chida & Steptoe, 2009) and is thus more sensitive to the effects of sex of participants (Wust, Kumsta, Treutlein, Frank, Entringer, Schulze, et al.,…”
BackgroundBeckman, L. J. (2013) · Diva portal (Dalarna University Library) · Cited by 17
Türer, O. U., Özcan, M., Alkaya, B., Demirbilek, F., Alpay, N., Dağlıoğlu, G., Şeydaoğlu, G., & Haytaç, M. C. (2023) · Scientific Reports · doi:10.1038/s41598-023-49092-3 · Cited by 22
“Cortisol is the end product of HPA axis functioning and salivary cortisol is a commonly used measure of physiological stress responses and provides information about cortisol levels and changes over periods of time 22,42,43 .”
BackgroundHow does loneliness “get under the skin” to become biologically embedded?
Freilich, C. D. (2023) · Biodemography and Social Biology · doi:10.1080/19485565.2023.2260742 · Cited by 18
“Associations between the cortisol awa-kening response and other psychosocial factors are similarly mixed across domains and somewhat inconsistent (Chida and Steptoe 2009).”
Backgroundvon Känel, R., Princip, M., Holzgang, S. A., Garefa, C., Rossi, A., Benz, D. C., Giannopoulos, A. A., Kaufmann, P. A., Buechel, R. R., Zuccarella‐Hackl, C., et al. (2023) · BMC Medicine · doi:10.1186/s12916-023-03192-z · Cited by 18
“For instance, one meta-analysis found that the cortisol awakening response was negatively associated with burnout, but positively so with job stress [17].”
BackgroundDaly, M., Delaney, L. D., Doran, P., & MacLachlan, M. (2011) · Emotion · doi:10.1037/a0022590 · Cited by 16
Hodyl, N. A., Schneider, L. A., Vallence, A., Clow, A., Ridding, M. C., & Pitcher, J. B. (2015) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2015.12.007 · Cited by 16
“This has clear implications for both ageing and clinical conditions, where alterations in the normal diurnal cortisol rhythm, impaired sleep, stress and anxiety are features: all of which affect the magnitude of the CAR (Chida and Steptoe, 2009).”
BackgroundSchwartz, B., Kapellusch, J. M., Schrempf, A., Probst, K., Haller, M., & Baca, A. (2016) · BMC Public Health · doi:10.1186/s12889-016-3271-y · Cited by 20
“Salivary samples were collected after each break during the study protocol and on the following morning, 20 min after waking up, to ascertain cortisol awakening response (CAR).”
MethodInfluentialRobinson, H., Ravikulan, A., Nater, U. M., Skoluda, N., Jarrett, P., & Broadbent, E. (2017) · Health Psychology · doi:10.1037/hea0000492 · Cited by 16
Valentino, K., Alba, A. D., Hibel, L. C., Fondren, K., & McDonnell, C. G. (2017) · Child Maltreatment · doi:10.1177/1077559517725208 · Cited by 16
de Assis, D. C., de Resende, D. V., & Marziale, M. H. P. (2018) · Escola Anna Nery · doi:10.1590/2177-9465-ean-2017-0125 · Cited by 16
Interactive effects of early life stress and CACNA1C genotype on cortisol awakening response
Klaus, K., Butler, K., Gutiérrez, H., Durrant, S. J., & Pennington, K. (2018) · Biological Psychology · doi:10.1016/j.biopsycho.2018.05.002 · Cited by 16
Manigault, A. W., Figueroa, W. S., Hollenbeck, C. R., Mendlein, A. E., Woody, A., Hamilton, K. R., Scanlin, M. C., Johnson, R. C., & Zoccola, P. M. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000625 · Cited by 16
Roberts, L. R., Boostrom, G. G., Dehom, S. O., & Neece, C. L. (2019) · Biological Research For Nursing · doi:10.1177/1099800419890125 · Cited by 17
“In more chronic situations, such as posttraumatic stress, the CAR flattens or reduces as chronic stress symptoms increase and the body’s physiological stress response is suppressed (Chida & Steptoe, 2009).”
BackgroundOkamura, H., Tsuda, A., & Matsuishi, T. (2011) · Japanese Psychological Research · doi:10.1111/j.1468-5884.2011.00459.x · Cited by 16
Do waking salivary cortisol levels correlate with anesthesiologist’s job involvement?
Klein, M., Weksler, N., Gidron, Y., Heldman, E., Gurski, E., Smith, O. R. F., & Gurman, G. M. (2012) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-012-9367-8 · Cited by 16
Hypothalamic–pituitary–adrenal axis function in patients with complex regional pain syndrome type 1
Park, J. Y., & Ahn, R. S. (2012) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.02.016 · Cited by 17
“An altered CAR and DCD slope are known to be associated with health issues, such as fatigue, depression and anxiety, and with the prognosis of patients with severe diseases (Chida and Steptoe, 2009; Sephton et al., 2000).”
BackgroundMatsuo, H., Iwamoto, A., Otsuka, T., Hishida, Y., Akiduki, S., Aoki, M., Furuse, M., & Yasuo, S. (2014) · Chronobiology International · doi:10.3109/07420528.2014.965312 · Cited by 16
Aschbacher, K., Derakhshandeh, R., Flores, A. J., Narayan, S., Mendes, W. B., & Springer, M. L. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.02.019 · Cited by 17
“The CAR captures the diurnal cortisol peak in the first 30 minutes post-awakening (Clow et al., 2010), and a higher CAR is associated with life stress (Chida and Steptoe, 2009).”
BackgroundLiu, K., Ruggero, C. J., Goldstein, B. L., Klein, D. N., Perlman, G., Broderick, J. E., & Kotov, R. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.04.003 · Cited by 16
Jahangard, L., Hedayati, M., Abbasalipourkabir, R., Haghighi, M., Ahmadpanah, M., Faryadras, M., Mikoteit, T., Bahmani, D. S., & Brand, S. (2019) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.104384 · Cited by 19
Stress-Related Trajectories of Diurnal Cortisol in Older Adulthood Over 12 Years
Herriot, H., Wrosch, C., Hamm, J. M., & Pruessner, J. C. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104826 · Cited by 16
Wilcox, R. R. (2021) · Journal of Data Science · doi:10.6339/jds.2013.11(2).1146 · Cited by 16
“Extant studies (e.g., Clow et al., 2004; Chida and Steptoe, 2009) indicate that measures of stress are associated with the cortisol awakening response (CAR), which is defined as the change in cortisol concentration that occurs during the first hour after waking from sleep.”
BackgroundLee, E., Hong, J. K., Choi, H., & Yoon, I. (2024) · Journal of Korean Medical Science · doi:10.3346/jkms.2024.39.e94 · Cited by 17
Methodische Aspekte der Stressforschung
Kasten, N., & Fuchs, R. (2017) · Springer eBooks · doi:10.1007/978-3-662-49322-9_7 · Cited by 15
Lin, Y., Jen, H., Lin, Y., Seo, J., & Chang, W. (2022) · BioMed Research International · doi:10.1155/2022/9506583 · Cited by 14
“A meta-analysis conducted by Chida and Steptoe revealed that CAR is positively correlated with work stress and life stress and negatively correlated with fatigue or burnout [28].”
Psychological health throughout life and adult cortisol patterns at age 45 y
Power, C., Li, L., Atherton, K., & Hertzman, C. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.06.010 · Cited by 15
“review of cortisol awakening response published after the time of our data collection gives a range of 20—45 min after waking as the period of peak concentration (Chida and Steptoe, 2009).”
BackgroundCatherine, N. L. A., Schonert-Reichl, K. A., Hertzman, C., & Oberlander, T. F. (2012) · School Mental Health · doi:10.1007/s12310-012-9076-y · Cited by 16
Tops, M., Montero‐Marín, J., & Quirin, M. (2016) · Advances in motivation and achievement · doi:10.1108/s0749-742320160000019012 · Cited by 16
Cortisol Awakening Response, Internalizing Symptoms, and Life Satisfaction in Emerging Adults
Chong, L. S., Thai, M., Cullen, K. R., Lim, K. O., & Klimes‐Dougan, B. (2017) · International Journal of Molecular Sciences · doi:10.3390/ijms18122501 · Cited by 16
“Measures of job stress and general life stress were positively correlated with CAR, whereas fatigue, burnout, and exhaustion were negatively correlated with CAR [18].”
BackgroundSchmidt, K., Weber, N., Steiner, M. S., Meyer, N., Dubberke, A., Rutenberg, D., & Hellhammer, D. H. (2018) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2018.01.067 · Cited by 15
“Since the CAR and cortisol evening levels are connected to some diseases [6,14], salivary cortisol was assessed during 4 times in the morning (0, 30, 45 and 60 min after awakening) and once (8 pm) in the evening on 2 consecutive days in the follicular and the luteal phase of cycle 1 and cycle 4.”
BackgroundThe influence of mindfulness and social support on stress reactivity during pregnancy
Hernández, H. S., Urizar, G. G., & Yim, I. S. (2019) · Stress and Health · doi:10.1002/smi.2865 · Cited by 20
Dornbierer, D., Boxler, M. I., Voegel, C. D., Stucky, B., Steuer, A. E., Binz, T. M., Baumgartner, M. R., Baur, D. M., Quednow, B. B., Kræmer, T., et al. (2019) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyz047 · Cited by 15
“However, evidence from meta-analyses point towards negative associations with fatigue, burnout and post-traumatic stress disorder and a positive association with depression and general life stress (Chida and Steptoe, 2009; Boggero et al., 2017).”
BackgroundSouza‐Talarico, J. N., Alves, A. R., Brucki, S. M. D., Nitríni, R., LUPIEN, S. J., & Suchecki, D. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104601 · Cited by 15
Ji, E., Weickert, C. S., Purves-Tyson, T. D., White, C., Handelsman, D. J., Desai, R., O׳Donnell, M., Liu, D., Galletly, C. A., Lenroot, R., et al. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104916 · Cited by 16
“of hours slept, iatrogenic effects) factors (Chida and Steptoe, 2009; Hucklebridge et al., 2005).”
OPTIMISMO DISPOSICIONAL Y ESTRÉS: CLAVES PARA PROMOVER EL BIENESTAR PSICOLÓGICO
Puig‐Pérez, S., Grupo de Investigación en Psicología y Calidad de Vida (PsiCal), U. I. D. V., Costa, M. A., Grupo de Investigación en Psicología y Calidad de Vida (PsiCal), U. I. D. V., Duque, A., Grupo de Investigación en Psicología y Calidad de Vida (PsiCal), U. I. D. V., Cano‐López, I., Grupo de Investigación en Psicología y Calidad de Vida (PsiCal), U. I. D. V., López, P. M., Grupo de Investigación en Psicología y Calidad de Vida (PsiCal), U. I. D. V., et al. (2020) · Papeles del Psicólogo - Psychologist Papers · doi:10.23923/pap.psicol2021.2953 · Cited by 25
“Asimismo, se observan alteraciones en indica-dores del perfil circadiano del cortisol, como la respuesta matutina de cortisol o la curva diaria de cortisol (Chida y Steptoe, 2009; Clow et al., 2004; Fries et al., 2009; Herriot et al., 2020; Kudielka y Wüst, 2010; Miller et al., 2007).”
BackgroundDiurnal cortisol secretion and health-related quality of life in healthy older people
Hidalgo, V., Pulopulos, M. M., Puig‐Pérez, S., Montoliu, T., & Salvador, A. (2021) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2021.05.012 · Cited by 17
Feasibility of home-based sampling of salivary cortisol and cortisone in healthy adults
Sørensen, S. O., Pedersen, J., Rasmussen, M. G. B., Kristensen, P. L., & Grøntved, A. (2021) · BMC Research Notes · doi:10.1186/s13104-021-05820-4 · Cited by 15
“The cortisol awakening response (CAR) is positively related to general life stress [2] and alterations of the cortisol awakening response are associated with chronic stress [3].”
BackgroundBäumler, D., Kliegel, M., Kirschbaum, C., Miller, R. E., Alexander, N., & Tobias Stalder, A. (2014) · Biological Psychology · doi:10.1016/j.biopsycho.2014.08.005 · Cited by 15
Puig‐Pérez, S., Pulopulos, M. M., Hidalgo, V., & Salvador, A. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1408807 · Cited by 15
“Interestingly, higher depressive and anxiety symptomatology has been related to enhanced CAR (Steptoe, 2007), particularly in studies that assessed CAR on two days or more (Chida & Steptoe, 2009).”
BackgroundRiscos Psicossociais Relacionados ao Trabalho: Perspectivas Teóricas e Conceituais
Carlotto, P. A. C., Cruz, R. M., Guilland, R., da Rocha, R. E. R., Dalagasperina, P., & Ariño, D. O. (2018) · Revista Interamericana de Psicología Ocupacional · doi:10.21772/ripo.v37n1a04 · Cited by 15
Diurnal cortisol and decision making under risk in problem gambling.
Buchanan, T. W., McMullin, S. D., Mulhauser, K. R. W., Weinstock, J., & Weller, J. A. (2019) · Psychology of Addictive Behaviors · doi:10.1037/adb0000474 · Cited by 16
Szabo, Y. Z., Breeding, T., Hejl, C., Guleria, R. S., Nelson, S. M., & Zambrano‐Vazquez, L. (2020) · Journal of Dual Diagnosis · doi:10.1080/15504263.2020.1771504 · Cited by 15
“For example, cortisol awakening response, the change in cortisol concentration that occurs in the first hour after waking from sleep, has been found to be higher in those with recent life stress and job stress in one meta-analysis (Chida & Steptoe, 2009).”
BackgroundMorning Cortisol in Relation to Behavioral Symptoms of Nursing Home Residents With Dementia
Woods, D. L., Kim, H. T., & Yefimova, M. (2010) · Biological Research For Nursing · doi:10.1177/1099800410385568 · Cited by 16
“Chida and Steptoe (2009) suggested an association between ACR and psychosocial factors, mediated through behavior pathways.”
BackgroundShin, I., Ahn, R. S., Chun, S.-I., Lee, Y.-J., Kim, M., Lee, C.-K., & Sung, S. S. (2011) · Yonsei Medical Journal · doi:10.3349/ymj.2011.52.3.435 · Cited by 15
Dornelas, E. A. (2012) · Springer eBooks · doi:10.1007/978-1-4419-5650-7 · Cited by 15
Souffrance au travail, répression psychique et troubles musculo-squelettiques
Davezies, P. (2013) · Perspectives interdisciplinaires sur le travail et la santé · doi:10.4000/pistes.3376 · Cited by 16
Ericsson, A., Nyström, C., & Mannerkorpi, K. (2014) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2014.915580 · Cited by 14
Relative sensitivity of cortisol indices to psychosocial and physical health factors
Rector, J. L., Tay, L., Wiese, C. W., & Friedman, E. M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213513 · Cited by 15
“These effect sizes are consistent with prior work [14, 42].”
BackgroundResultAssociations of burnout with awakening and diurnal cortisol among police officers
McCanlies, E. C., Leppma, M., Mnatsakanova, A., Allison, P., Fekedulegn, D. B., Andrew, M. E., & Violanti, J. M. (2020) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2020.100016 · Cited by 15
“[16] suggest that CARi (increase) may be a better measure of HPA activity than CARauc (total volume), because CARauc will be large even if the increase in cortisol upon awakening is small, and there is some evidence that the CARauc is correlated to the 12- hour diurnal pattern.”
BackgroundMethodResultInfluentialZhu, L., Zheng, D., Li, R., Shen, C.-J., Cai, R., Lyu, C., Tang, B., Sun, H. X., Wang, X., Ding, Y., et al. (2023) · Neuroscience Bulletin · doi:10.1007/s12264-023-01081-2 · Cited by 15
Chen, S., Kertes, D. A., Benner, A. D., & Kim, S. Y. (2023) · Development and Psychopathology · doi:10.1017/s0954579423001219 · Cited by 14
Early biological effects in outdoor workers exposed to urban air pollution: A systematic review
Sellaro, F., Pernetti, R., & Oddone, E. (2024) · Environmental Pollution · doi:10.1016/j.envpol.2024.124985 · Cited by 15
Kluwe, B., Ortiz, R., Odei, J. B., Zhao, S., Kline, D., Brock, G. N., Echouffo-Tcheugui, J. B., Lee, J., Lazarus, S. A., Seeman, T. E., et al. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.105041 · Cited by 14
Performance evaluations and stress: Field evidence of the hormonal effects of evaluation frequency
Frimanson, L., Hornbach, J., & Hartmann, F. G. H. (2021) · Accounting Organizations and Society · doi:10.1016/j.aos.2021.101279 · Cited by 20
de Rooij, B. H., Ramsey, I., Clouth, F. J., Corsini, N., Heyworth, J. S., Lynch, B. M., Vallance, J. K., & Boyle, T. (2022) · Journal of Cancer Survivorship · doi:10.1007/s11764-022-01189-w · Cited by 15
“This has previously been explained by a dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis in evening types, as indicated by a decreased cortisol awakening response [12, 29].”
BackgroundGoodin, B. R., Quinn, N. B., King, C. D., Page, G. G., Haythornthwaite, J. A., Edwards, R. R., Stapleton, L. M., & McGuire, L. M. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31822cf542 · Cited by 14
“Perceived stress was considered as a potential factor to be controlled in this study because previous reports have suggested that associations between CAR and various health-related outcomes can be influenced by the amount of stress reportedly experienced by individuals during the approximate time of CAR assessment.(6)”
BackgroundMethodResultYoung, R., Sweeting, H. N., & West, P. (2011) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-011-0374-8 · Cited by 14
“awakening response [5], or via basal (i.”
Intra-individual cortisol variability and low-grade inflammation over 10 years in older adults
Herriot, H., Wrosch, C., Gouin, J.-P., & Miller, G. E. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.12.010 · Cited by 15
“We excluded the 30-min measure from the calculation of daily AUC because early morning increase of cortisol has been shown to be relatively independent from overall cortisol level (Chida & Steptoe, 2009).”
Chen, L., Li, X., Imami, L., Lin, D., Zhao, J., Zhao, G., & Zilioli, S. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000659 · Cited by 14
Ying, L., Fu, S., Qian, X., & Sun, X. (2011) · Neuroscience Letters · doi:10.1016/j.neulet.2011.01.002 · Cited by 14
Cash, T. V., & Lageman, S. K. (2015) · BMC Psychology · doi:10.1186/s40359-015-0101-4 · Cited by 15
“The cortisol awakening response (CAR), captured by assessing cortisol concentrations at intervals after waking, is a metric of HPA axis activation that is associated with psychosocial functioning [8] and has been shown to be a valuable measure for assessing hyper- and hypocortisolemic traits in patients with depressio…”
BackgroundHandley, E. D., Rogosch, F. A., Duprey, E. B., Russotti, J. M., & Cicchetti, D. (2022) · Development and Psychopathology · doi:10.1017/s0954579422000335 · Cited by 13
Carnevali, L., Bignami, E. G., Gambetta, S., Barbetti, M., Procopio, M., Freyrie, A., Carbognani, P., Ampollini, L., & Sgoifo, A. (2023) · BioPsychoSocial Medicine · doi:10.1186/s13030-023-00266-5 · Cited by 13
“For example, blunted CARs are associated with fatigue, burnout, and exhaustion [8].”
BackgroundMakaracı, Y., Makaracı, M., Zorba, E., & Lautenbach, F. (2023) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09589-z · Cited by 19
“4, we explored a form of hypercortisolism before the BFB training and a more normalized CAR after the BFB training (see Chida & Steptoe, 2009).”
BackgroundSchipholt, I. J. L., Coppieters, M. W., Diepens, M., Hoekstra, T., Ostelo, R., Barbe, M. F., Meijer, O. G., Bontkes, H. J., & Scholten-Peeters, G. G. M. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.02.010 · Cited by 15
Rudolph, K. E., Sánchez, B. N., Stuart, E. A., Greenberg, B. M., Fujishiro, K., Wand, G. S., Shrager, S., Seeman, T. E., Roux, A. V. D., & Golden, S. H. (2016) · American Journal of Epidemiology · doi:10.1093/aje/kwv280 · Cited by 15
“In a systematic review, Chida and Steptoe found evidence of a positive association between job stress (broadly defined rather than job strain specifically) and CAR and a negative association between fatigue/burnout and CAR (4).”
BackgroundLian, Y., Sun, Q., Guan, S., Ge, H., Tao, N., Jiang, Y., Zhang, Y., Li, N., Xiao, J., & Liu, J. (2017) · Diabetes Care · doi:10.2337/dc17-0749 · Cited by 13
Effort–reward imbalance in police work: associations with the cortisol awakening response
Violanti, J. M., Fekedulegn, D. B., Gu, J. K., Allison, P., Mnatsakanova, A., Tinney-Zara, C. A., & Andrew, M. E. (2018) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-018-1300-0 · Cited by 13
“A meta-analysis of 62 studies concluded that job stress and general life stress were positively associated with changes in awakening cortisol measures (Chida and Steptoe 2009).”
Johnson, E., Johnson, M., & Webber, L. (2020) · Evidence & Policy · doi:10.1332/174426420x15820274674068 · Cited by 14
“This is indicated by studies that find no significant association between biological stress and mood (Chida and Steptoe 2009).”
BackgroundStressful life events and breast cancer risk: a hospital-based case-control study.
Kocić, B., Filipovic, S., Vrbić, S., Pejcic, I., Rancic, N. K., Cvetanović, A., & Milenković, D. (2015) · PubMed · Cited by 13
Sudhaus, S., Möllenberg, T., Plaas, H., Willburger, R., Schmieder, K., & Hasenbring, M. I. (2012) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-012-9186-1 · Cited by 13
PCLO rs2522833 impacts HPA system activity in healthy young adults
Kuehner, C., Huffziger, S., Witt, S. H., & Rietschel, M. (2011) · Translational Psychiatry · doi:10.1038/tp.2011.11 · Cited by 13
“The CAR reflects the sensitivity of the HPA axis in response to a naturally occurring stressor (awakening) and has gained growing attention because of its distinct association with stress and psychopathology,(6) and its higher genetic liability than daytime cortisol levels.(7) In depression, both increased and blunted…”
BackgroundGarland, E. L., Beck, A. C., Lipschitz, D. L., & Nakamura, Y. (2014) · Journal of Cancer Survivorship · doi:10.1007/s11764-014-0402-2 · Cited by 13
“In considering the methodological and clinical implications of the aforementioned findings, it should be noted that waking cortisol response is operationally distinct from the CAR and diurnal cortisol rhythm, and thus may reflect different underlying neuroendocrine and psychological processes [16, 27].”
BackgroundTrousselard, M., Steiler, D., Lebreton, A., Beers, P. V., Drogout, C., Denis, J., Chennaoui, M., & Canini, F. (2014) · Psychology · doi:10.4236/psych.2014.51013 · Cited by 13
Reduced corticosteroid‐binding globulin cleavage in active rheumatoid arthritis
Nenke, M. A., Lewis, J. G., Rankin, W., McWilliams, L., Metcalf, R. G., Proudman, S. M., & Torpy, D. J. (2016) · Clinical Endocrinology · doi:10.1111/cen.13081 · Cited by 13
Chen, Y., Osika, W., Dangardt, F., & Friberg, P. (2017) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2017.03.012 · Cited by 13
“A metaanalysis has shown that in adults, job stress and general life stress are associated with an heightened CAR, whereas fatigue, burnout, or exhaustion are characterized by a blunted CAR [14].”
BackgroundEffects of a Soccer Tournament on the Psychohormonal States of Collegiate Female Players
Broodryk, A., Pienaar, C., Edwards, D., & Sparks, M. (2019) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002993 · Cited by 13
“Mentally, it is plausible that stress, anticipation, or poor sleep increased cortisol and subsequently, exhausted the players (12).”
BackgroundHartley, S. L., DaWalt, L. S., Hong, J., Greenberg, J. S., & Seltzer, M. M. (2019) · American Journal on Intellectual and Developmental Disabilities · doi:10.1352/1944-7558-124.5.411 · Cited by 13
Kwon, O. J., Kim, M., Lee, H. S., Sung, K.-K., & Lee, S. (2015) · BioMed Research International · doi:10.1155/2015/709230 · Cited by 14
“A recent meta-analysis study specifically looking at the AUCi or absolute increase of cortisol secretion found a negative relationship between theCARand severity of depression [43], which is consistent with our finding.”
ResultPersistent Burnout Theory of Chronic Fatigue Syndrome
Jameson, D. (2016) · Neuroscience & Medicine · doi:10.4236/nm.2016.72008 · Cited by 16
“During periods of stress, the CAR is elevated, whereas in CFS, chronic pain disorders, functional gastrointestinal disorders and PTSD, it tends to be blunted [24].”
InfluentialSalivary testosterone and cortisol are jointly related to pro-environmental behavior in men
Sollberger, S., Bernauer, T., & Ehlert, U. (2015) · Social Neuroscience · doi:10.1080/17470919.2015.1117987 · Cited by 13
“It is widely used since it allows participants to collect samples non-invasively in their natural environment directly after awakening (see, e.g., Chida & Steptoe, 2009; Gettler, McDade, & Kuzawa, 2011; Perini, Ditzen, Fischbacher, & Ehlert, 2012).”
BackgroundHuang, Q., Monzel, A. S., Rausser, S., Haahr, R., Indik, C. E., Savin, M. J., Bobba‐Alves, N., Liu, C. C., Devine, J., Thompson, E., et al. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.04.19.590241 · Cited by 16
“Morning and evening timepoints were not correlated, possibly pointing to different drivers of saliva GDF15 levels between morning and evening.”
Vandenabeele, R., Joosen, M. C. W., & van Dam, A. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1712340 · Cited by 17
Borghi, F., Rocha-Teles, C. M., Fadden, S. M., da Silva, P. C., de Souza, A. L., & Kassisse, D. M. G. (2021) · Personality and Individual Differences · doi:10.1016/j.paid.2021.110928 · Cited by 12
Mitsuishi, H., Okamura, H., Moriguchi, Y., & Aoki, Y. (2022) · Japanese Psychological Research · doi:10.1111/jpr.12402 · Cited by 12
Longitudinal association between saliva and hair cortisol concentration: A systematic comparison
Solorzano, C. S., Serwinski, B., Grano, C., & Steptoe, A. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106340 · Cited by 12
“The overall volume of cortisol released over the morning period (CAR auc ) was derived for the trapezoid formula using the waking and the 30 min post-awakening cortisol values to obtain a total post-awakening cortisol secretion measure (Chida and Steptoe, 2009; Stalder et al., 2016).”
Self-citationCooke, Z., Resciniti, S. M., Wright, B. J., Hale, M. W., Yao, C. K., Tuck, C. J., & Biesiekierski, J. R. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14684 · Cited by 12
Laakso, M., Fagerlund, Å., & Lagerström, M. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12616 · Cited by 17
Pathogen burden and cortisol profiles over the day
Steptoe, A., Gylfe, Å., Shamaei‐Tousi, A., Bergström, S., & Henderson, B. E. (2009) · Epidemiology and Infection · doi:10.1017/s0950268809002738 · Cited by 11
Self-citationTiming of Early Maternal Mental Health and Child Cortisol Regulation
Vänskä, M., Punamäki, R., Lindblom, J., Tolvanen, A. J., Flykt, M. S., Unkila‐Kallio, L., Tulppala, M., & Tiitinen, A. E. (2015) · Infant and Child Development · doi:10.1002/icd.1948 · Cited by 13
Adverse childhood experiences and diurnal cortisol patterns in older people in England
Demakakos, P., & Steptoe, A. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105798 · Cited by 16
Self-citationNagendra, R. P., Sathyaprabha, T. N., & Kutty, B. M. (2022) · Sleep Science · doi:10.5935/1984-0063.20220039 · Cited by 12
“Evening cortisol reflects the stress levels of the day 71 .”
BackgroundShinto, T., Tahara, Y., Watabe, A., Makino, N., Tomonaga, M., Kimura, H., Nozawa, Y., Kobayashi, K., Takahashi, M., & Shibata, S. (2022) · SLEEP Advances · doi:10.1093/sleepadvances/zpac035 · Cited by 17
Cortisol levels and history of depression in acute coronary syndrome patients
Messerli‐Bürgy, N., Molloy, G. J., Wikman, A., Perkins-Porras, L., Randall, G., & Steptoe, A. (2012) · Psychological Medicine · doi:10.1017/s0033291711002959 · Cited by 12
Self-citationMaina, G., Bovenzi, M., Palmas, A., Rossi, F., & Filon, F. L. (2011) · Toxicology Letters · doi:10.1016/j.toxlet.2011.08.019 · Cited by 12
“is currently unclear (for reviews see Chandola et al., 2010; Chida and Steptoe, 2009).”
Madsen, I. E. H., Larsen, A. D., Thorsen, S. V., Pejtersen, J. H., Rugulies, R., & Sivertsen, B. (2016) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3571 · Cited by 12
Jiang, Y., Li, X., Chen, L., Zhou, G., Zhao, J., & Zhao, G. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.07.010 · Cited by 12
Lim, Y. K., Cho, S. J., Min, S., Park, J. H., & Park, S. H. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15112576 · Cited by 12
“because cortisol level follows a circadian rhythm [36].”
Background
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
