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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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“Extant studies (e.g., Clow et al., 2004; Chida & Steptoe, 2009) indicate that measures of stress are associated with the cortisol awakening response, which is defined as the change in cortisol concentration that occurs during the first hour after waking from sleep.”
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“Conversely, a lower CAR may reflect HPA axis dysregulation resulting from prior overacti-vation (i.e., due to exhaustion of physiological systems) and has been associated with conditions such as fatigue and burnout (Chida & Steptoe, 2009; Pruessner et al., 1999).”
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“If sleep quality was disrupted, participants may get aroused to levels close to consciousness before they define themselves as awake (Chida & Steptoe, 2009).”
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“Similarly, reduced CAR is reported in populations experiencing continuous stress, like fatigue or burnout, whereas enhanced CAR is associated with general life stress [12].”
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“Chida and Steptoe [26] reported that the magnitude of the cortisolawakening response was influenced by sleep deprivation.”
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“We extracted the following metrics of CAR, based on previous work: area under the curve with respect to increase (AUCi), area under the curve with respect to ground (AUCg), regression-based slope, and mean value of cortisol values post-awakening minus wakening value [MINC]; [21].”
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“Extant studies (e.g., Clow et al., 2004; Chida & Steptoe, 2009) indicated that measures of stress are associated with the CAR.”
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“In another meta-analysis, CAR positively correlated with general life stress and negatively with fatigue, burnout and exhaustion (Chida and Steptoe, 2009).”
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“CAR and diurnal cortisol are significant measures of health since HPA axis dysfunction can occur in a variety of illnesses.”
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“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 (CAR is taken to be the…”
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“14 15-17 The CAR also has value as a diagnostic biomarker in that it reflects unified stress and time conditions.”
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“In fact, a meta-analysis revealed fatigue, burnout, and exhaustion to predict lower CAR (Chida and Steptoe, 2009).”
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“…reported in several clinical populations, including depression and internalizing disorders (Adam et al., 2017), whereas increased CAR has been observed in individuals with persistent anxiety (Greaves-Lord et al., 2007; Vreeburg et al., 2010) and higher general life stress (Chida & Steptoe, 2009).”
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“…and psychiatric conditions (Chida and Steptoe, 2009; Wang et al., 2022), including depression (Dedovic et al., 2010; Mannie et al., 2007), anxiety (Walker et al., 2011), chronic and posttraumatic stress (Chida and Steptoe, 2009), and increased vulnerability to suicide (O ’ Connor et al., 2021).”
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“22 To determine the relationship of constructive and uncon-structive EP and physiological responding, multiple linear regressions were tested.”
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“However, sufficient recovery is considered to alleviate negative effects and to promote health [26,27].”
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“The following components are included in our construct of AL: Cortisol Awakening Response (CAR) : Ambulatory baseline levels of salivary cortisol or the morning CAR were gathered from participants as a physiological measure of sustained stress and recovery (Chida and Steptoe, 2009).”
Is There a Relationship Between Cortisol and Treatment Response in Chronic Aphasia?
Gravier, M., Hula, W. D., Johnson, J. P., Autenreith, A., & Dickey, M. W. (2022) · Topics in Language Disorders · doi:10.1097/tld.0000000000000291 · Cited by 5
Caetano, I., Amorim, L., Castanho, T. C., Coelho, A., Ferreira, S., Portugal‐Nunes, C., Soares, J. M., Gonçalves, N., Sousa, R., Reis, J. S., et al. (2022) · European Journal of Neuroscience · doi:10.1111/ejn.15809 · Cited by 7
“…levels, besides being involved in several biological processes, usually reflect a response to acute events, conditioning its use as surrogate markers of longitudinal processes (Caetano et al., 2021; Canbolat et al., 2021; Chida & Steptoe, 2009; Halford et al., 2012; Kronenberg et al., 2009).”
BackgroundKim, A. Y., & Kim, N. (2022) · Journal of Korean Biological Nursing Science · doi:10.7586/jkbns.2022.24.4.235 · Cited by 4
“으로 실시한 메타분석에서도 그 결과가 일관되지 않았다는 점과 유사한 맥락이라 할 수 있다[38].”
Mathieu, C., Plusquellec, P., Giguère, C., LUPIEN, S. J., & Geoffrion, S. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.105411 · Cited by 5
Endocrine and Mood Responses to two Working Days in Female Teachers
Serrano, M. Á., Moya‐Albiol, L., & Salvador, A. (2014) · The Spanish Journal of Psychology · doi:10.1017/sjp.2014.14 · Cited by 5
“…has been found to be associated with several negative effects, including impairments in cognitive processes, such as memory (Almela et al., 2011; Wolf, 2009) or emotional adjustment (Chida & Steptoe, 2009), as well as immune function disorders and hypertension (Leonard, 2000; McEwen, 1998).”
BackgroundMcCann, B. R., & Roberto, K. A. (2011) · Journal of Family Issues · doi:10.1177/0192513x11414796 · Cited by 5
“Conversely, research on depression, anxiety, and loneliness showed that experiencing relational stress may increase cortisol levels, which can have negative impacts on well-being (see Chida & Steptoe, 2009, for a review).”
BackgroundDie Cortisol-Aufwachreaktion bei Müttern junger Kinder mit Schlafproblemen
Brandhorst, I., Bernhardt, C., Hautzinger, M., & Schlarb, A. A. (2016) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-016-0070-8 · Cited by 5
“Forschungsarbeiten konnten zeigen, dass die AUCbezogenaufdieGrundflächeeingeeignetes Maß darstellt, um allgemeinen Lebensstress zu erfassen [10].”
BackgroundInfluentialPhysiological determinants and assessment of stress and recovery among media workers
Lindholm, H. J. (2013) · Työväentutkimus Vuosikirja · Cited by 5
Methodological Advances in Differential Psychology
Revelle, W., Condon, D. M., & Wilt, J. A. (2011) · Wiley eBooks · doi:10.1002/9781444343120.ch2 · Cited by 6
“A popular physiological measure outside of the brain is salivary cortisol (Chida & Steptoe, 2009), which relates to Hypothalamic Pituitary Axis stress-response.”
BackgroundO’Leary, K. (2015) · Arrow@dit (Dublin Institute of Technology) · Cited by 5
Peter, H. L., Giglberger, M., Frank, J., Streit, F., Zänkert, S., Kreuzpointner, L., Rietschel, M., Kudielka, B. M., & Wüst, S. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105883 · Cited by 4
Malykhin, N. V., Serrano, J., Reiz, B., Hegadoren, K., Pietrasik, W., & Whittal, R. M. (2025) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2025.100458 · Cited by 5
“These studies found that although CAR was positively associated with stress (20,21,56), lower AUCi (53) and blunted CAR (54) were related to smaller hippocampal volumes in a high-risk subclinical depression group (53) and in individuals at ultra-high risk for psychosis (54), while these…”
Puhlmann, L. M. C., & Engert, V. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1415081 · Cited by 5
“To that effect, an increased CAR has been linked to job and general life stress (52), depression (53), and borderline personality disorder (54).”
Neurobiological correlates of burnout
Sousa, A. D., & Sail, D. B. (2021) · Telangana Journal of Psychiatry · doi:10.4103/tjp.tjp_44_21 · Cited by 4
Kinnunen, U. M., Laethem, M. V., Sianoja, M., & de Bloom, J. (2022) · Stress and Health · doi:10.1002/smi.3185 · Cited by 4
Weigensberg, M. J., Wen, C. K. F., Sanogo, F., Toledo‐Corral, C. M., & Ding, L. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106053 · Cited by 4
Feng, Q., Huang, Z., Wang, Y., & Wang, B. (2024) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2024.049010 · Cited by 5
Chan, I. I. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.016 · Cited by 5
Ruiz‐Robledillo, N., Romero‐Martínez, Á., & Moya‐Albiol, L. (2016) · European Eating Disorders Review · doi:10.1002/erv.2455 · Cited by 4
Findling, J. W., & Raff, H. (2016) · Springer eBooks · doi:10.1007/978-3-319-45950-9_6 · Cited by 4
Age, Physical Activity Motivation and Perceived Stress in Minority Girls
Hsu, A. R. C., Nguyen‐Rodriguez, S. T., & Spruijt‐Metz, D. (2019) · Californian Journal of Health Promotion · doi:10.32398/cjhp.v17i2.2285 · Cited by 5
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript cortisol awakening response has been related to stressful events and anxiety (Chida & Steptoe, 2009), while lower responses have been associated with depressive symptoms (Scheyer & Urizar, 2016; Stetler & Miller, 2005).”
BackgroundBalint, E. M., Jarczok, M. N., Langgartner, D., Reber, S. O., Endes, S., Schmidt‐Trucksäss, A., Funk, A., Klinghammer, J., Campbell, S., Gündel, H., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.718919 · Cited by 6
Adolescents take more risks on days they have high diurnal cortisol or emotional distress
Armstrong‐Carter, E., & Telzer, E. H. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100106 · Cited by 4
“We operationalized total cortisol output per day as the Area Under the Curve (AUC) which is optimal when moderate or low [33].”
MethodSaranapala, D. M. M., Baranoff, J. A., Rushworth, R. L., Westley, I. S., Collins, K., Burke, A. L. J., Parker, A., Licinio, J., Clifton, P. M., & Torpy, D. J. (2022) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2022.100124 · Cited by 7
“Circadian cortisol rhythms, especially the cortisol awakening response, appear to relate to psychosocial factors, particularly social stress [30].”
BackgroundSamayoa, C., Santana-Ufret, V., Santoyo-Olsson, J., Strassle, P., Stewart, A., Bonilla, J., Escalera, C., Mendez, R., Márquez-Magaña, L., Ortiz, C., et al. (2022) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2022.100153 · Cited by 5
“However, this is not surprising given that a meta-analysis showed mixed relationships between biomarkers and self-reported measures of stress among those experiencing trauma or chronic stress [51,52], and a recent cross-sectional study of cortisol among Latina breast cancer survivors also showed mixed relationships [5…”
ResultRicher, R., Abel, L., Küderle, A., Eskofier, B. M., & Rohleder, N. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106073 · Cited by 4
Pal, R., Gao, K., Li, X., Guragai, B., Li, T., Xie, Q., & Li, G. (2023) · Brain Behavior and Immunity Integrative · doi:10.1016/j.bbii.2023.100029 · Cited by 5
Job Stress and Overcommitment in Cardiac Patients
Cho, E.-Y. N., & von Känel, R. (2012) · Springer eBooks · doi:10.1007/978-1-4419-5650-7_12 · Cited by 16
Raymond, C., Marin, M., Hand, A., Sindi, S., Juster, R., & LUPIEN, S. J. (2015) · Neural Plasticity · doi:10.1155/2016/3136743 · Cited by 4
“Cortisol determination during this time of day appears to represent a response of theHPA axis to an endogenous stimulation and is a reliable indicator of diurnal HPA activity [34].”
BackgroundTrauma Exposure: Consequences to Maternal and Offspring Stress Systems
Martinez‐Torteya, C., D’Amico, J., & Gilchrist, M. (2017) · Integrating psychiatry and primary care · doi:10.1007/978-3-319-65724-0_6 · Cited by 3
Impacto da reabilitação oral na qualidade de vida e nos níveis de cortisol de pacientes geriátricos
Gonçalves, F. P., Alves, G. G., Oliveira, F., Antunes, L. A. A., Soares, J. R. A., Perazzo, M. F., Paiva, S. M., & Scelza, M. Z. (2020) · Research Society and Development · doi:10.33448/rsd-v9i11.9911 · Cited by 4
Moreira, M. A., Guerra, R. O., Freire, A. D. N. F., Gomes, C. D. S., & Maciel, Á. C. C. (2015) · Aging Clinical and Experimental Research · doi:10.1007/s40520-015-0374-8 · Cited by 4
“Recent studies show that among some disorders, such as stress-related disorders, anxiety, sleep disorders and chronic fatigue syndrome [5], depression seems to also & Mayle Andrade Moreira maylinhaandrade@hotmail.”
BackgroundPresland, A., Clare, I. C. H., Broughton, S., Luke, L., Wheeler, E., Fairchild, G. F., Watson, P., Chan, S. W. Y., Kearns, A., & RING, H. A. (2012) · Journal of Intellectual Disability Research · doi:10.1111/j.1365-2788.2012.01557.x · Cited by 5
Hirokawa, K., Taniguchi, T., & Fujii, Y. (2014) · International Journal of Behavioral Medicine · doi:10.1007/s12529-014-9403-9 · Cited by 5
“Ameta-analysis of cortisol awakening responses and psychosocial factors revealed that chronic psychological stress levels such as job stress and general life stress were associated with an increased cortisol awakening response [3].”
BackgroundIglesias, S. L., Azzara, S. H., Granchetti, H. N., Lagomarsino, E., & Vigo, D. E. (2013) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2013.11.004 · Cited by 4
“An enhanced CAR is associated to job stress and general life stress, while a reduced CAR is related to fatigue, burnout, exhaustion or post-traumatic stress syndrome [11].”
BackgroundSharpley, C. F., Bitsika, V., McMillan, M., & Agnew, L. L. (2018) · Research in Autism · doi:10.1016/j.rasd.2018.11.001 · Cited by 4
Sex Differences in Work-Stress Memory Bias and Stress Hormones
Dumont, L., Marin, M., LUPIEN, S. J., & Juster, R. (2020) · Brain Sciences · doi:10.3390/brainsci10070432 · Cited by 4
“Potential differences in socio-demographic information, BMI [58] and self-reported chronic stress [59] were verified in order to make sure that men and women sub-samples were comparable.”
BackgroundBiocultural Perspectives on Gender, Transitions, Stress, and Immune Function
DuBois, L. Z. (2019) · ScholarWorks@UMassAmherst (University of Massachusetts Amherst) · doi:10.7275/qvcd-fb20 · Cited by 5
Perinatal health epidemiology in multi-ethnic Amsterdam: psychobiological processes
Wolf, G. (2010) · UvA-DARE (University of Amsterdam) · Cited by 4
Hynynen, E. (2011) · Jyväskylä University Digital Archive (University of Jyväskylä) · Cited by 4
Atypical secretion of cortisol in Nursing professionals.
Yamaguti, S. T. F., de Mendonça, A. R. B., Coelho, D. D. P., Machado, A. L., & Souza‐Talarico, J. N. (2015) · PubMed · doi:10.1590/s0080-623420150000700016 · Cited by 3
Sex differences in impact of daily and chronic psychological stressors on diurnal cortisol level
Malykhin, N. V., Serrano, J., Hegadoren, K., & Pietrasik, W. (2026) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2026.174165 · Cited by 4
Within Groups Designs: Inferences Based on A Robust Nonparametric Measure of Effect Size
Wilcox, R. R. (2023) · Sankhya B · doi:10.1007/s13571-023-00311-x · Cited by 3
“Past studies indicate that cortisol has a connection with psychosocial factors (Kirschbaum et al. 1995; Chida and Steptoe, 2009) including depression and anxiety disorders (e.g., Stetler and Miller, 2005; Bhattacharyya et al., 2008).”
BackgroundZaplatosch, M. E., Wideman, L., McNeil, J., Sims, J. N. L., & Adams, W. M. (2025) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2024.100281 · Cited by 3
“…complicating this relationship is the divergent effects of different types of uncontrolled stressors on circadian profiles of cortisol, particularly the CAR, with some forms of stress increasing (job stress and general life stress) or decreasing (fatigue, burnout, or exhaustion) this metric [47].”
Cortisol awakening response in drug-naïve panic disorder
Jakuszkowiak‐Wojten, K., Landowski, J., Wiglusz, M. S., & Cubała, W. J. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s107547 · Cited by 3
“an increase in CAR, while chronic, prolonged, or traumatic stress seem to be associated with a blunting of the cortisol levels after awakening, indicating deficits in the integrity of the HPA axis with maladaptive response to stressors.(5) Therefore, the CAR may also be viewed as a measure of arousal that may vary in…”
Cortisol response to awakening in prepubertal children and adults: Magnitude and variability
Bernsdorf, M., & Schwabe, L. (2018) · Psychophysiology · doi:10.1111/psyp.13273 · Cited by 3
Managing Psychological Disturbances in Performing Artists
Mainwaring, L. M., & Mor, S. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-58182-0.00016-x · Cited by 3
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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