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Cited by 99Stress Responses and CortisolAdrenal Hormones and DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Psychosocial functioning and the cortisol awakening response: meta-analysis, P-curve analysis, and evaluation of the evidential value in existing studies

Open access
Boggero, Ian A., Hostinar, Camelia E., Haak, Eric A., Murphy, Michael L.M., Segerstrom, Suzanne C.·2017·Biological Psychology
DOI 10.1016/j.biopsycho.2017.08.058PMC PMC5673546
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Abstract

Cortisol levels rise immediately after awakening and peak approximately 30-45 minutes thereafter. Psychosocial functioning influences this cortisol awakening response (CAR), but there is considerable heterogeneity in the literature. The current study used p-curve and metaanalysis on 709 findings from 212 studies to test the evidential value and estimate effect sizes of four sets of findings: those associating worse psychosocial functioning with higher or lower cortisol increase relative to the waking period (CARi) and to the output of the waking period (AUCw). All four sets of findings demonstrated evidential value. Psychosocial predictors explained 1%-3.6% of variance in CARi and AUCw responses. Based on these effect sizes, cross-sectional studies assessing CAR would need a minimum sample size of 617-783 to detect true effects with 80% power. Depression was linked to higher AUCw and posttraumatic stress to lower AUCw, whereas inconclusive results were obtained for predictor-specific effects on CARi. Suggestions for future CAR research are discussed.

AI snapshot

Written from the paper’s full text.

TL;DR

This study combined p-curve and meta-analysis on 709 findings from 212 studies and found evidential value for all four sets of associations between worse psychosocial functioning and higher/lower CARi and AUCw. Effects were small, explaining about 1%–3.6% of variance, with depression linked to higher AUCw and posttraumatic stress to lower AUCw.

Key findings

  • All four sets of findings showed evidential value: worse psychosocial functioning with higher CARi (k = 37, p = .001), lower CARi (k = 42, p < .001), higher AUCw (k = 19, p = .008), and lower AUCw (k = 19, p = .006).
  • Effect sizes were small: p-curve-derived estimates were r = .08 for higher CARi, r = .09 for lower CARi, r = .09 for higher AUCw, and r = .19 for lower AUCw; meta-analytic estimates were r = .09, r = .12, r = .08, and r = .10, respectively. Psychosocial predictors explained approximately 1% of variance in CARi and up to 3.6% in lower AUCw.
  • Predictor-specific results: depression was linked to higher AUCw (r = .07, p < .001), posttraumatic stress to lower AUCw (r = .08, p = .03), and fatigue/burnout/exhaustion was most strongly associated with lower CARi (r = .09, p = .003, with trend-level publication bias p = .07). Other predictor-specific effects were nonsignificant, but p-curves could not rule out evidential value.
  • Power analysis indicated cross-sectional studies would need a minimum sample size of 617–783 to detect true effects with 80% power; approximately 11% of studies had at least this sample size, 58% had N < 100, and 28% had N < 50.

Methods

  • The study updated Chida and Steptoe (2009), searching Medline, PsycINFO, Pubmed, and Web of Science for “cortisol,” “awakening,” and “response”; inclusion required English, peer-reviewed articles with at least one psychosocial functioning measure and one CAR measure, excluding medical conditions and biological predictors. The final sample combined 159 new articles with 54 prior articles, yielding 709 findings from 212 articles.
  • P-curve analyses tested evidential value for four sets of significant findings and estimated effect sizes; random-effects meta-analyses estimated aggregate correlations using Fisher’s z, with Egger’s test for publication bias. Predictor-specific p-curves and meta-analyses examined seven psychosocial predictor categories.
  • Study quality was scored 0–8 based on control for age, gender, smoking, medications, weekday/weekend, waking time, protocol adherence, and clear collection instructions; data were double-checked, with >90% agreement on a 15-article subset.

Limitations

  • Stated: only published literature was included, so unpublished findings and conference abstracts were excluded and true effects may be smaller than reported.
  • Stated: the study tested only bivariate correlations for CARi and AUCw, not more dynamic CAR measures such as flexibility; only linear effects were examined despite some quadratic effects; alternate conceptualizations of psychosocial predictors are possible; the time window of predictors was not assessed; and strict inclusion of healthy participants limits generalization to medically compromised populations.
  • Evident from the text: the study was underpowered to detect moderation and some predictor-specific effects, and some sets had relatively few independent significant findings (e.g., k = 19 for AUCw sets).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.biopsycho.2017.08.058

Cites

251 of 251 references verified0 citation errors · 0 not checkable

Statistics

2 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 51 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Posttraumatic stress predictors contained evidential value.

    “Posttraumatic stress predictors also contained evidential value”
    Quote in the paperSubstantial claim
  • Findingown data

    P-curve analysis indicated that findings linking worse psychosocial functioning to lower AUCw had evidential value (k=19, p=.006).

    “Finally, p-curve analysis revealed that the findings associating worse psychosocial functioning with lower AUCw had evidential value (k = 19; p = .006; see Figure 2d).”
    Quote in the paperSubstantial claim
  • Findingown data

    All four sets of findings showed evidential value.

    “All four sets of findings demonstrated evidential value.”
    Quote in the paperSubstantial claim
  • Findingown data

    Mean study quality did not differ among findings associating worse psychosocial functioning to higher CARi, lower CARi, higher AUCw, or lower AUCw (F(3,203) = 0.25, p = .83).

    “There was no difference in mean study quality among those findings associating worse psychosocial functioning to higher CARi (M = 6.00, SD = 1.70), lower CARi (M = 6.08, SD = 1.73), higher AUCw (M = 6.14, SD = 1.49), or lower AUCw (M = 6.38, SD = 1.20), F (3,203) = 0.25, p = .83.”
    • Also stated in: § Evidential Value of Findings Associating Psychosocial Predictors to the CAR · hedged
      “Analysis revealed that study quality among different CAR measures and different predictor types was similar”
    Quote in the paperSubstantial claim
  • Findingown data

    The p-curve-derived effect size for worse psychosocial functioning with lower CARi was r = .09.

    “The p-curve-derived estimate of effect size for this set of findings was r = .09.”
    Quote in the paperSubstantial claim
  • May combine two claims. 33
  • Classified as probably not a substantial claim. 38

  • May combine two claims.

    Findingown data

    For significant findings linking worse psychosocial functioning to lower AUCw, the proportions were: life stress 22%, positive traits 18%, anxiety/neuroticism/negative affect 16%, posttraumatic stress 14%, job stress 11%, depression 10%, and fatigue/burnout/exhaustion 9%.

    “Approximately 22% of the significant findings in this set involved general life stress, 18% positive psychosocial traits, 16% anxiety/neuroticism/negative affect, 14% posttraumatic stress, 11% job stress, 10% depression, and 9% fatigue/burnout/exhaustion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For significant findings linking worse psychosocial functioning to higher CARi, the proportions were: life stress 37%, depression 15%, anxiety/neuroticism/negative affect 14%, positive traits 12%, job stress 11%, posttraumatic stress 8%, and fatigue/burnout/exhaustion 3%.

    “Approximately 37% of the significant findings in this set involved general life stress, 15% depression, 14% anxiety/neuroticism/negative affect, 12% positive psychosocial traits, 11% job stress, 8% posttraumatic stress, and 3% fatigue/burnout/exhaustion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Findings associating worse psychosocial functioning to lower AUCw had a larger effect, accounting for approximately 3.6% of variance (r = .19 from p-curve-derived estimate and .10 from meta-analytic estimate).

    “However, findings associating worse psychosocial functioning to lower AUCw had a larger effect, with approximately 3.6% of variance being accounted for (r = .19 from the p-curve-derived estimate and .10 from the meta-analytic estimate).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sampling days averaged slightly more than two.

    “The average number of sampling days was just over two days.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    159 articles met the criteria for the updated literature review.

    “In total, 159 articles met criteria for the updated literature review.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    On average, the studies were of medium to high quality, but quality scores varied considerably.

    “Table 1 reveals that studies were, on average, of medium to high quality, although quality scores varied considerably.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    The meta-analysis included 709 findings from 212 articles.

    “Thus, the current study included 709 findings from 212 articles.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of 32 authors contacted for additional data, 19 responded and 17 provided data.

    “Of 32 authors contacted, 19 responded, and 17 provided additional data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    General life stress, depression, positive traits, and anxiety, neuroticism, or negative affect were the most frequently assessed predictors.

    “The most frequently assessed psychosocial predictors were those assessing general life stress, depression, positive psychosocial traits, and anxiety/neuroticism/negative affect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For significant findings linking worse psychosocial functioning to lower CARi, the proportions were: life stress 33%, positive traits 23%, depression 17%, anxiety/neuroticism/negative affect 9%, posttraumatic stress 7%, fatigue/burnout/exhaustion 6%, and job stress 5%.

    “Approximately 33% of the significant findings in this set involved general life stress, 23% positive psychosocial traits, 17% depression, 9% anxiety/neuroticism/negative affect, 7% posttraumatic stress, 6% fatigue/burnout/exhaustion, and 5% job stress.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For significant findings linking worse psychosocial functioning to higher AUCw, the proportions were: depression 24%, life stress 19%, positive traits 17%, anxiety/neuroticism/negative affect 16%, job stress 12%, fatigue/burnout/exhaustion 7%, and posttraumatic stress 5%.

    “Approximately 24% of the significant findings in this set involved depression, 19% general life stress, 17% positive psychosocial traits, 16% anxiety/neuroticism/negative affect, 12% job stress, 7% fatigue/burnout/exhaustion, and 5% posttraumatic stress.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sensitivity analyses using alternative approaches to handle non-independence produced results that did not differ, so all effect sizes were included in the reported results.

    “Results did not differ with these approaches; thus, reported results include all effect sizes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the current study, approximately 11% of studies had at least this sample size; approximately 58% had a sample size less than 100, and 28% had a sample size less than 50.

    “In the current study, approximately 11% of the studies had at least this sample size; approximately 58% had a sample size less than 100, and 28% had a sample size less than 50.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Even though not statistically significant, the correlation directions showed job stress and anxiety/neuroticism/negative affect were positively related to CARi and AUCw, while general life stress and positive psychosocial traits were negatively related to CARi and AUCw.

    “Despite not being statistically significant, the direction of the correlations revealed that job stress and anxiety/neuroticism/negative affect were positively correlated with CARi and AUCw, whereas general life stress and positive psychosocial traits were negatively correlated with CARi and AUCw.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    AUCw was positively associated with depression and negatively associated with PTSD.

    “AUCw was positively associated with depression but negatively associated with PTSD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For AUCw, the other associations were not statistically significant, but p-curves could not exclude the possibility that they have evidential value.

    “As with CARi, the other associations were not statistically significant, but p-curves could not rule out the possibility that they contain evidential value.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Findings for depression, posttraumatic stress, anxiety, and fatigue showed evidential value, and evidential value could not be ruled out for other psychosocial predictors.

    “Findings associating depression, posttraumatic stress, anxiety, and fatigue demonstrated evidential value, and evidential value could not be ruled out for other psychosical predictors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The review contained too few studies with enough sampling days to compare p-curves between sampling frames deemed theoretically insufficient and sufficient for reliability, and nearly no studies reported the empirical reliability of their CAR measure.

    “Notably, there were too few studies with a sufficient number of days to compare the p-curves of those with theoretically insufficient and sufficient sampling frames for reliability, and almost none of the studies reported the empirical reliability of their CAR measurement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the studies reviewed, the most frequent number of days on which the CAR was sampled was one, and the range across studies was one to nine days.

    “The modal number of sampling days in the studies reviewed was one (range = 1 to 9).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A possible problem for meta-analysis is the file drawer problem, in which studies with nonsignificant results remain unpublished.

    “However, a potential problem with meta-analysis is the file drawer problem, where studies are “filed away” unpublished if they fail to find statistically significant relationships.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rosenthal et al., 1979 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    This practice artificially increases Type I error and can make relationships appear to exist when they do not.

    “Over time, this practice artificially inflates Type I error and may make it appear that relationships exist when in reality they do not (Rosenthal et al., 1979).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rosenthal et al., 1979 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another study found a positive correlation between CAR measures and depression.

    “but positively correlated in another (Mommersteeg et al., 2006)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mommersteeg et al., 2006 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    P-curve analysis rests on the principle that under the null hypothesis, a p-value is equally likely to fall in any equal-sized bin.

    “p-curve analysis is based on the mathematical principle that if the null hypothesis is true, the probability of a p-value falling within a range of possible values is the same for all bins of the same size (Simonsohn, Nelson, & Simmons, 2014a, 2014b, 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Simonsohn, Nelson, & Simmons, 2014a, 2014b, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Chida and Steptoe (2009) classified psychosocial predictors into seven categories, including job stress, general life stress, depression, anxiety, fatigue or burnout, posttraumatic stress, and positive traits.

    “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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chida & Steptoe, 2009 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cortisol is a steroid hormone that helps regulate glucose and metabolism and is often called a stress hormone because stressors markedly alter its levels.

    “Cortisol is a steroid hormone involved in glucose regulation and metabolism that is frequently labeled a stress hormone because its levels change markedly in response to stressors (see Sapolsky, 2004 for a review).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sapolsky, 2004

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisereasoning

    Under the null hypothesis, a p-curve of significant p-values is flat.

    “In this case, a curve of all the significant p-values within a set of findings (i.e., a p-curve) will be flat.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Cortisol concentrations increase sharply right after waking, reach a maximum around 30 to 45 minutes later, and then gradually fall over the rest of the day.

    “Cortisol levels rise steeply immediately after awakening in the morning and peak approximately 30-45 minutes thereafter; from there, they slowly decrease throughout the day.”
    • Also stated in: § Abstract · plain
      “Cortisol levels rise immediately after awakening and peak approximately 30-45 minutes thereafter.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pruessner, 1997 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The CAR reacts to perceived stress and to anticipation of stressors during the day.

    “The CAR is responsive to stress perception and anticipation of daily stressors, making it particularly interesting to psychologists (Fries, Dettenborn, & Kirschbaum, 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fries, Dettenborn, & Kirschbaum, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Worse psychosocial functioning over time may blunt the overall output of the CAR system while keeping the dynamic component intact.

    “It may be that worse psychosocial functioning over time blunts the overall output of the CAR system while keeping the dynamic component intact.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data abstraction was performed by one of the first three authors and double-checked by another.

    “Data abstraction for the articles in the current study was done by one of the first three authors (IB, CH, EH) and double-checked by another of these authors.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Small effects are impressive when the dependent variable is not expected to be easily influenced by the independent variable.

    “Prentice and Miller (1992) argue that small effects are impressive when the dependent variable is not expected to be easily influenced by the independent variable.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Prentice and Miller (1992) source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The current study was underpowered to detect true effects for the other predictors.

    “it may be that true effects exist but that the current study was underpowered to detect them.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Correlations obtained with small sample sizes are unstable and can result in Type I error.

    “On the other hand, correlations obtained with small sample sizes are unstable and can result in Type I error.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A randomly selected subset of 15 articles was independently coded by all three authors, with over 90% agreement on each variable.

    “A randomly selected subset of 15 articles were independently coded by all three authors, and there was high corroboration on the data that were extracted (>90% agreement on each variable).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Underpowered studies may fail to find significant effects when they exist, leading to lost resources and Type II error or file drawer problems.

    “On one hand, underpowered studies may fail to find significant effects when in reality they exist; in those instances, the resources spent for that study are lost and Type II error appears in the literature or, more likely, contribute to the file drawer problem.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The current study was underpowered to detect true effects for the seven predictors.

    “again leaving open the possibility that true effects exist but that the current study was underpowered to detect them.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    This point estimate can be compared with a meta-analytic point estimate to assess systematic bias in the literature.

    “This point estimate can then be compared to a meta-analytic point estimate to assess for systematic bias in the literature.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Chida and Steptoe (2009) identified seven categories of psychosocial predictors associated with the CAR: job stress, general life stress, depression, anxiety, fatigue, burnout, or exhaustion, posttraumatic stress, and positive traits.

    “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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chida and Steptoe (2009) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Heterogeneity in the literature is partly due to methodological and operationalization inconsistencies across studies and to potential measure-dependent or predictor-specific associations.

    “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).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Chida & Steptoe, 2009 source

      Not checked in the free run.

    • cites Stadler et al., 2016

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    For p-curve analyses, when multiple significant relationships came from the same or overlapping samples, the effect with the largest sample size was selected to ensure independence.

    “If more than one significant relationship was reported from the same sample, or if samples were partially overlapping (i.e., females only in one effect, and males and females in another), the effect with the largest sample size was chosen for inclusion in the p-curve.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    If CARi represents an adaptive response to stressors, this may be the most adaptive pattern for those high in psychosocial stress, allowing dynamic flexibility without chronically high cortisol output.

    “If indeed the CARi represents an adaptive response to stressors, this may be the most adaptive pattern for those high in psychosocial stress: it would allow them to maintain dynamic flexibility in the CAR system without having chronically high levels of cortisol output overall.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Some enumerative immune measures have small to moderate correlations (r's < .10) with acute and chronic stress, while immunoglobulin and cytokine levels have larger correlations (r's between .10 and .30).

    “Likewise, some enumerative measures of immune functioning like monocyte counts, T-lymphocyte counts, and granulocyte counts have small to moderate correlations (r's < .10) with acute time-limited stress and chronic stress, although correlations are larger for other measueres of immunity like immunoglobulin and cytokine levels (r's between .10 and .30; Segerstrom & Miller, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Segerstrom & Miller, 2004 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The current study used strict inclusion criteria requiring healthy participants, so its results cannot be generalized to medically compromised populations.

    “Finally, a limitation of the current study is that it used strict inclusion criteria of healthy participants and as such, results cannot generalize to medically compromised populations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The direction of that mismatch implies the published literature systematically underestimates the true effects, because the p-curve estimate is larger than the meta-analytic estimate.

    “However, the directionality of the discrepancy suggests that the published literature is systematically underestimating the true effects (i.e., the p-curve estimate is larger than the meta-analysis estimate).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The current study finds reliable evidence that psychosocial functioning influences the CAR and provides the most thorough estimate to date of effect sizes by predictor and CAR measure.

    “Nevertheless, the current study finds reliable evidence that psychosocial functioning influence the CAR, and provides the most thorough estimate of effect sizes by predictor and CAR measure to date.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The CAR may not be the most sensitive biological marker for chronic stress, but it is still sensitive enough that continuing to study the relationships is worthwhile.

    “Thus, in the greater context of psychoneuroendocrinological research, the CAR may not be the most sensitive biological marker for chronic stress, but still sensitive enough that continuing to study the relationships is a worthwhile endeavor.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The CAR may promote adaptive physiological responses to complex social stimuli and may have implications for its evolution.

    “It suggests that the CAR may promote adaptive physiological responses to complex social stimuli, and may have implications for when, how, and why the CAR evolved”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The current study examined only linear effects, although some studies have described quadratic effects.

    “A third limitation is that the current study only examined linear effects, despite some studies describing quadratic effects (Gustafsson et al., 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gustafsson et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    This result agrees with meta-analytic findings from Chida and Steptoe (2009).

    “This corroborates meta-analytic results from Chida and Steptoe (2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chida and Steptoe, 2009 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Some of the seven categories are theoretically ambiguous and often co-occur in real life, such as depression and anxiety.

    “Some of the seven categories are theoretically ambiguous and frequently co-occur in the real world (e.g., depression and anxiety).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The current study included only articles and findings from the published literature, excluding poster abstracts, conference proceedings, and unpublished data.

    “First, the articles and findings reported in the current study were all from the published literature; poster abstracts, conference proceedings, and unpublished data were not included.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Because only published studies were included, the true CAR effects may be smaller than those reported in the current study.

    “it may be that the true CAR effects are smaller than those reported in the current study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The current study tested only bivariate correlations between psychosocial predictors and levels of CARi and AUCw, not other more dynamic CAR measures.

    “A second limitation is that the study only tested bivariate correlations among psychosocial predictors and levels of CARi and AUCw, but other more dynamic measures of the CAR are possible.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Evidence from this study indicates that the associations between psychosocial functioning and the CAR are true effects with evidential value.

    “Thus, despite the recent controversies surrounding questionable research practices in psychology and other disciplines, evidence from this study suggests that the associations of psychosocial functioning and the CAR represent true effects with evidential value.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In most cases, researchers will p-hack until the p-value falls just below .05.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Results from the current study suggest that large samples are needed to reduce the chance that Type I and II error rates enter the literature.

    “results from the current study suggest that large samples are needed to minimize the likelihood that Type I and II error rates make their way into the literature.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Recently published guidelines offer concrete and clear recommendations for researchers.

    “Recently published guidelines provide concrete and clear recommendations for researchers (Stadler et al., 2016)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Stadler et al., 2016

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The current study did not assess the time window of psychosocial predictors.

    “A fifth limitation is that the time window of psycholosocial predictors was not assessed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    CAR research has a high potential for p-hacking and other questionable research practices because many design decisions, analytical techniques, and operational-definition ambiguities can be changed after the fact.

    “This is particularly refreshing news because the potential for researchers to engage in p-hacking and other questionable research practices is high in CAR research, as there are a number of design decisions, analytical techniques, and ambiguities with operational definitions which can be modified post-hoc.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    P-curve tests against evidential value were nonsignificant in all those cases, which suggests the existing literature lacks power to detect effects if they exist.

    “However, p-curve analysis testing against evidential value were non-significant in all cases, suggesting that the extant literature is underpowered to detect effects if they exist.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    Psychosocial predictors could be conceptualized in ways other than the seven reported categories.

    “A fourth limitation is that alternate conceptualizations of psychosocial predictors besides the seven categories reported are possible.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Diurnal cortisol levels demonstrate small to moderate correlations with depression (r = .18) and chronic stress, and these relationships depend on measurement, appraisal, and contextual variables.

    “For example, diurnal cortisol levels demonstrate small to moderate correlations with depression (r = .18; Burke et al., 2005) and chronic stress (Miller, Chen, and Zhou, 2007), and these relationships depend on a number of measurement, appraisal, and contextual variables (Miller, Chen, and Zhou, 2007).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Burke et al., 2005 source

      Not checked in the free run.

    • cites Miller, Chen, and Zhou, 2007 source

      Not checked in the free run.

61 of 61

  • The paper relies on this without support.

    There are no norms for the CAR.

    “because there are no norms for the CAR”

  • The paper relies on this without support.

    Small sample sizes, often under 100 participants, are typical of the CAR literature.

    “small sample sizes (N < 100) that are characteristic of the literature.”

  • The paper relies on this without support.

    The psychosocial-functioning and CAR literature has more than doubled in the past six years.

    “The literature on psychosocial functioning and the cortisol awakening response (CAR) has more than doubled in the last six years”

  • The paper relies on this without support.

    Meta-analyses can be biased by Type 1 error.

    “but meta-analyses can be biased by Type 1 error.”

  • The paper relies on this without support.

    The p-curve-derived estimate can be considered a less biased measure for gauging effect size.

    “To the extent that the p-curve-derived estimate can be considered a less biased measure for gauging effect size”

  • The paper relies on this without support.

    Psychosocial predictors influence the CAR.

    “Psychosocial predictors are thought to influence the CAR”

  • The paper relies on this without support.

    There are not enough findings in the extant literature to detect moderation effects.

    “there are not enough findings in the extant literature”

  • The paper relies on this without support.

    There is no theoretical framework for making predictions about moderation.

    “nor is there a theoretical framework for making predictions about moderation”

  • The paper relies on this without support.

    In most cases, researchers will p-hack until the p-value falls just below .05.

    “In most cases, researchers will p-hack until the p-value falls to just under .05.”

  • The paper relies on this without support.

    A solid theoretical framework exists for the seven psychosocial predictor categories.

    “Nevertheless, solid theoretical scaffolding exists for the seven categories”
10 of 10

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?

  • Trait psychosocial tendencies can predict trait-like allostatic responses to a small extent, such as accounting for variance (less than 5%) in the cortisol awaking response.

    “Trait psychosocial tendencies can predict trait like allostatic responses to a small extent, such as accounting for variance (less than 5%) in the cortisol awaking response (Boggero et al., 2017), serving as a piece of the foundation for understanding how stress becomes embedded in long term health.”

    From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Boggero et al., 2017

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: F (3,203) = 0.25, p = .83

    Minor

    The paper reports p = .83 here; recomputing from the test statistic and its degrees of freedom gives p = .861. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .83 · recomputed p = .861

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(3, 203) = 0.25reported p = .83 · recomputed p = .861

    “F (3,203) = 0.25, p = .83”

  • ConsistentF(6, 693) = 0.87reported p = .52 · recomputed p = .516

    “F (6, 693) = 0.87, p = .52”

2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Lower-CARi p-curve effect size changes from .09 to .11

    Minor

    The results give the p-curve-derived effect size for lower CARi as r = .09, but the discussion calls it r = .11.

1 of 1

Cites

Flagged first, then by citations

1 of the 252 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Boggero, I. A., Hostinar, C. E., Haak, E. A., Murphy, M. L. M., & Segerstrom, S. C.
Affiliations
  • University of Kentucky (US)
  • University of California, Davis (US)
  • Carnegie Mellon University (US)
Corresponding author
Boggero, Ian A.
ORCID
Venue
Biological Psychology
Publisher
Elsevier BV
Published
2017-10
Volume
129
Pages
207-230
ISSN
0301-0511 (ISSN-L)
DOI
10.1016/j.biopsycho.2017.08.058
PMC
PMC5673546
OpenAlex
W2754000831
Semantic Scholar
e07eb5c5d22ab346723510f19f1edf0ceb96d3ca
Cited by
97
References
252
Citations by year
2026: 3 · 2025: 11 · 2024: 10 · 2023: 11 · 2022: 18 · 2021: 13 · 2020: 6 · 2019: 16 · 2018: 8
FWCI
0.72
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • UKnowledge (University of Kentucky) (submittedVersion, cc-by-nc-nd)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute on Aging of the National Institutes of Health (F31-AG048692, K02-AG033629)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
cortisol awakening response, psychosocial functioning, depression, post-traumatic stress, circadian rhythm, evidentiary value, p-curve, sample size determination, effect size
MeSH terms
Circadian Rhythm, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Saliva, Social Adjustment, Stress, Psychological, Wakefulness

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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.

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