Assessment of the cortisol awakening response: Expert consensus guidelines

DisclaimerThe University of Gloucestershire has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material.The University of Gloucestershire makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited.The University of Gloucestershire makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights.The University of Gloucestershire accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT.This is a peer-reviewed, post-print (final draft post-refereeing) version of the following published document:Gallagher, Stephen and Sumner, Rachel C and Muldoon, Orla T and Creaven, AnnMarie andHannigan, Ailish (2016). Unemployment is associated with lower cortisol awakening and blunted dehydroepiandrosterone responses. Psychoneuroendocrinology, 69, 41-49. ISSN 03064530Published in Psychoneuroendocrinology, and available online at:http://www.sciencedirect.com/science/article/pii/S0306453016300725We recommend you cite the published (post-print) version.The URL for the published version is http://dx.doi.org/10.1016/j.psyneuen.2016.03.011 DisclaimerThe University of Gloucestershire has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material.The University of Gloucestershire makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited.The University of Gloucestershire makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights.The University of Gloucestershire accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT AbstractPrevious research has investigated the endocrinological consequences of unemployment as a likely pathway behind chronic stress and negative health outcomes. Despite these early attempts at delineating the neuroendocrine consequences of the chronic stress experienced by the unemployed, identifying a consistent and stable effect has remained elusive. Here we sought to strengthen existing knowledge into the effect of the stress of employment status on cortisol by improving on the methodological weaknesses of earlier studies and extend this line of enquiry by measuring the steroid hormone Dehydroepiandrosterone-Sulfate (DHEAS). Saliva samples were collected from unemployed and employe...

Section: Methodsmentioning

confidence: 99%

Section: Data Analysesmentioning

confidence: 99%

Unemployment is associated with lower cortisol awakening and blunted dehydroepiandrosterone responses

Gallagher

Sumner

Muldoon

et al. 2016

“…The CAR is considered an important biomarker in stress research as it combines features of a reactivity index with aspects tied to circadian regulation, expressed as part of normal circadian physiology (Stalder et al, 2016). Group differences in the CAR with a complete lack of a response in the most severely deprived and an attenuated pattern in the group with short duration of deprivation are consistent with the fairly uniform observation of a pattern of hypocortisolism in institutionalized and postinstitutionalized children at much younger ages.…”

Section: Discussionmentioning

confidence: 60%

“…Saliva samples were collected on two non-weekend days immediately after awakening (S1), and 30 (S2) and 45 min (S3) thereafter to assess the cortisol awakening response (CAR) (Stalder et al, 2016). Additional samples were collected at 0900 h (S4), 1200 h (S5), 1600 h (S6) and 2000 h (S7) to assess the diurnal cortisol slope (DCS) (Adam and Kumari, 2009).…”

Section: Design and Proceduresmentioning

confidence: 99%

HPA axis dysregulation in adult adoptees twenty years after severe institutional deprivation in childhood

Kumsta

Schlotz

Golm

et al. 2017

A B S T R A C THypothalamic-pituitary-adrenal (HPA) axis function is disrupted in institutionally-deprived children -reduced morning cortisol, flattened diurnal slope and blunted reactivity persist even after successful adoption into positive family environments. Here we test whether such effects persist into adulthood. Cortisol release across the day (sampled at awakening, 30 and 45 min later, and at four points across the day) was investigated in young adult adoptees who had lived in severe deprivation for up to 43 months in early childhood in Ceaușescu's Romanian orphanages and a comparison group of non-deprived UK adoptees (Total N = 57; mean age = 24 ± 0.9 years). The mediating role of cortisol levels on adult mental health was examined using data from standardized clinical assessments. Cortisol profiles were disrupted in the Romanian adoptees who experienced more than 6 months deprivation marked by a striking absence of the cortisol awakening response (CAR) and a significantly flatter cortisol curve until 1 h 15 min after awakening. Whereas institutional deprivation was associated with both cortisol secretion and emergence of emotional problems in young adulthood, path analysis revealed no evidence for a mediating role of CAR disruption in the sub-sample studied here. The results are in line with findings of HPA axis hypo-functionality following early adverse experience and provide strong evidence for long-term programming effects of HPA axis function through experience of institutional deprivation.

“…Assessment of the CAR is typically in the domestic setting, with self-collection of saliva samples on awakening and at fixed intervals up to 45 min postawakening. Given the brief time-window of the post-awakening cortisol rise, accurate sampling times relative to awakening are imperative for assessment of the CAR (Smyth et al, 2013a), an issue that has been highlighted in a recent expert consensus guidelines paper (Stalder et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Assessment of the cortisol awakening response: Real-time analysis and curvilinear effects of sample timing inaccuracy

Thorn

Hucklebridge

Clow

et al. 2016

Self Cite

 All cortisol data objectively verified for awakening and saliva sampling times  Cortisol growth curve plot against real-time not affected by protocol deviance  In healthy young adults the mean CAR was a 100% increase from awakening cortisol  Curvilinear delay effect on CAR size if protocol times wrongly assumed accurate  Electronic-monitoring vital for CAR measurement and meaningful interpretation AbstractThe cortisol awakening response (CAR) is typically measured in the domestic setting. Moderate sample timing inaccuracy has been shown to result in erroneous CAR estimates and such inaccuracy has been shown partially to explain inconsistency in the CAR literature. The need for more reliable measurement of the CAR has recently been highlighted in expert consensus guidelines where it was pointed out that less than 6% of published studies provided electronic-monitoring of saliva sampling time in the post-awakening period.Analyses of a merged data-set of published studies from our laboratory are presented. To qualify for selection, both time of awakening and collection of the first sample must have been verified by electronic-monitoring and sampling commenced within 15 min of awakening. Participants (n=128) were young (median age of 20 years) and healthy. Cortisol values were determined in the 45 min post-awakening period on 215 sampling days. On 127 days, delay between verified awakening and collection of the first sample was less than 3 minutes ('no delay' group); on 45 days there was a delay of 4-6 min ('short delay' group); on 43 days the delay was 7-15 min ('moderate delay' group).Cortisol values for verified sampling times accurately mapped on to the typical post-awakening cortisol growth curve, regardless of whether sampling deviated from desired protocol timings. This provides support for incorporating rather than excluding delayed data (up to 15 min) in CAR analyses. For this population the fitted cortisol growth curve equation predicted a mean cortisol awakening level of 6 nmols/l (+/-1 for 95% CI) and a mean CAR rise of 6nmols/l (+/-2 for 95% CI). We also modelled the relationship between real delay and CAR magnitude, when the CAR is calculated erroneously by incorrectly assuming adherence to protocol time. Findings supported a curvilinear hypothesis in relation to effects of sample delay on the CAR. Short delays of 4-6 min between awakening and commencement of saliva sampling resulted an overestimated CAR. Moderate delays of 7-15 min were associated with an underestimated CAR. Findings emphasize the need to employ electronic-monitoring of sampling accuracy when measuring the CAR in the domestic setting.