Impact of stressors in a natural context on release of cortisol in healthy adult humans: A meta-analysis

Figures & data

Table I.  Characteristics of the studies.

			Methodological characteristics		Stressor characteristics
Type of stressor task	No. of effect sizes	Subjects	Time of day	Collection	Acute	Unpredictable	Uncontrollable	Evaluative
Occupational	112	7744	47 a.m.	65 saliva	30	22	58	29
			17 p.m.	28 blood
			16 a.m./p.m.	17 urine
			13 diurnal	2 ns
			19 ns
Social	33	2304	15 a.m.	24 saliva	3	30	32	31
			11 p.m.	8 blood
			6 diurnal	1 urine
			1 ns
Medical procedures	13	574	7 a.m.	5 saliva	13	10	13	0
			2 p.m.	7 blood	21	0	0	21
			4 ns	1 urine
Sports	23	354	11 a.m.	18 saliva
			5 p.m.	4 blood
			7 ns	1 ns
Total	181	10,976

Table II.  Methodological characteristics and average effect sizes for the studies included in the meta-analysis.

	Author/date	N	Gender*	Age	Time^†	Collection^‡	d^¶
Occupational
Academic Examination	Frankenhaeuser et al. (1978)	30	0.61	19	a.m.	Urine	1.06
	Johansson et al. (1983)	2	0.50	31	Diurnal	Urine	0.27
	Kirkeby et al. (1984)	9	1.00	26	–	Blood	0.17
	Hellhammer et al. (1985)	9	0.00	–	–	Saliva	2.14
	Lovallo et al. (1986)	28	0.00	23	a.m.	Blood	1.12
	Meyerhoff et al. (1988)	11	0.00	25	a.m.	Blood	2.33
	Herbert et al. (1986)	38	0.00	–	a.m.	Blood	1.97
	Semple et al. (1988)	9	–	21	p.m.	Blood	0.69
	Johansson et al. (1989)	27	1.00	27	a.m.	Blood	0.05
	Evans et al. (1994)	7	–	–	Diurnal	Saliva	0.87
	Glaser et al. (1994)	45	0.00	–	p.m.	Blood	0.00
	Malarkey et al. (1995)	55	0.00	22	Diurnal	Blood	0.00
	Guidi et al. (1999)	28	0.29	–	a.m.	Blood	1.19
	Song et al. (1999)	38	0.66	–	p.m.	Saliva	0.06
	Lacey et al. (2000)	15	0.50	27	a.m./p.m.	Blood	2.38
	Vedhara et al. (2000)	60	0.40	22	Diurnal	Saliva	0.20
	Ennis et al. (2001)	36	0.76	24	a.m.	Urine	0.86
	Ng et al. (2003a)	11	0.18	33	a.m.	Saliva	0.94
	Ng et al. (2003b)	31	0.32	23	a.m.	Saliva	− 4.52
	Al-Ayadhi et al. (2005)	48	1.00	20	a.m.	Blood	1.78
	Droogleever Fortuyn et al. (2004)	15	0.20	35	p.m.	Blood	0.19
	Gaab et al. (2006)	15	0.40	24	a.m.	Saliva	1.39
	Weekes et al. (2006)	67	0.51	20	p.m.	Saliva	0.28
Driving examination	Dugue et al. (2001)	7	0.00	18	–	Blood	0.21
Job Strain	Caplan et al. (1979)	85	0.00	40	Diurnal	Urine	0.49
	Rose et al. (1982)	195	0.00	–	–	Blood	0.22
	Harenstam and Theorell (1990)	1034	–	–	a.m.	Blood	0.00
	Schreinicke et al. (1990)	77	0.00	43	a.m.	Saliva	0.50
	Zeier (1994)	22	0.03	–	a.m.	Saliva	0.57
Job Strain (continued)	Zeier et al. (1996)	16	0.00	42	a.m.	Saliva	0.61
	Burton et al. (1996)	115	0.57	–	p.m.	Saliva	0.00
	Fujigaki and Mori (1997)	10	0.00	28	p.m.	Saliva	0.00
	Aronsson and Rissler (1998)	10	0.50	30	a.m.	Urine	1.10
	Schulz et al. (1998)	12	0.51	26	a.m./p.m.	Saliva	0.00 – 0.61
	Sluiter et al. (1998)	10	0.00	47	a.m.	Urine	0.18 – 1.15
	Steptoe et al. (1998)	61	0.62	35	–	Saliva	− 0.55
	Fischer et al. (2000)	139	0.81	–	Diurnal	Saliva	0.27
	Hanson et al. (2000)	77	0.44	40	a.m.	Saliva	0.00
	Rissen et al. (2000)	31	1.00	44	–	Saliva	0.15
	Sluiter et al. (2000)	115	0.00	37	–	Urine	0.00
	Steptoe et al. (2000)	105	0.61	39	a.m.	Saliva	0.50
	Ganster et al. (2001)	198	1.00	–	–	Saliva	0.95
	Sluiter et al. (2001)	55	0.00	40	Diurnal	Urine	0.41
	Ohlson et al. (2001)	103	0.92	–	a.m.	Blood	0.00
	Yang et al. (2001)	73	–	30	a.m./p.m.	Saliva	0.75
	Lundberg and Hellstrom (2002)	82	–	–	a.m.	Urine	0.69
	Lundberg and Frankenhaeuser (1999)	60	0.50	44	a.m./p.m.	Urine	0.05 – 0.51
	Hansen et al. (2003)	101	1.00	41	a.m.	Blood	3.43
	Sluiter et al. (2003)	20	0.00	42	–	Saliva	0.19
	Weibel et al. (2003)	8	0.88	43	Diurnal	Saliva	0.50
	Fujiwara et al. (2004)	8	1.00	28	a.m./p.m.	Saliva	− 0.13
	Kunz-Ebrecht et al. (2004a)	124	0.46	52	a.m.	Saliva	0.54
	Kunz-Ebrecht et al. (2004b)	75	0.49	–	Diurnal	Saliva	0.67
	Otte et al. (2005)	76	0.13	28	–	Saliva	0.59
	Schlotz et al. (2004)	214	0.53	49	a.m.	Saliva	0.04
	Steptoe et al. (2004)	91	0.47	–	–	Saliva	0.59
	Dahlgren et al. (2005)	25	0.63	47	Diurnal	Saliva	1.68
	Ritvanen et al. (2006)
	Low vs. high stress (young)	14	1.00	31	a.m.	Blood	0.19
	Low vs. high stress (old)	14	1.00	54	a.m.	Blood	− 0.05
	Smith et al. (2006)	32			a.m.	Blood	4.00
Commuting	Evans and Wener (2006)	208	0.48		a.m.	Saliva	0.38
Burnout	Melamed et al. (1999)	89	0.04	43	a.m./p.m.	Saliva	0.81
	Pruessner et al. (1999)	66	0.64	44	a.m.	Saliva	− 0.95
	de Vente et al. (2003)	46	0.36	42	a.m.	Saliva	0.13 - 0.59
	Moch et al. (2003)	16	1.00	38	a.m.	Blood	− 2.30
	Grossi et al. (2003)	63	–	48	a.m.	Blood	0.00
	Grossi et al. (2005)	42	0.52	40	a.m.	Saliva	0.27
	Mommersteeg et al. (2006a)
	Control vs. burnout (awakening)	94	0.55	43	a.m.	Saliva	− 0.05
	Control vs. burnout (15 min after	94	0.55	43	a.m.	Saliva	0.14
	Awakening
	Mommersteeg et al. (2006b)	33	0.68	45	a.m.	Saliva	1.20
	Mommersteeg et al. (2006c)	109	0.28	43.9	a.m.	Saliva	0.07
	Langelaan et al. (2006)	88	0.00	45	a.m.	Saliva	0.00
Unemployment/socioeconomic status	Kapuku et al. (2002)	24	0.00	19	–	Blood	− 1.00
	Brenner and Levi (1987)	110	1.00	–	–	–	0.24
	Arnetz et al. (1991)	227	0.75	35	–	–	0.00
	Ockenfels et al. (1995)	60	–	–	am,pm	Saliva	0.25-0.50
	Toivanen et al. (1996)	162	–	–	a.m.	Blood	0.27
	Grossi et al. (1998)	11	0.37	42	a.m.	Saliva	0.27
	Decker (2000)	31	0.00	–	a.m./p.m.	Saliva	0.00
	Steptoe et al. (2005)	160	0.45	55	am,pm	Saliva	− 0.44–0.07
	Wright and Steptoe (2005)	139	0.49	71	a.m.	Saliva	0.07
	Maier et al. (2006)	71	0.40	42	p.m.	Blood	0.38
	Steptoe et al. (2003)
	Low vs. high grade (men)	73	0	53	Diurnal	Saliva	0.51
	Low vs. high grade (female)	63	1	52	Diurnal	Saliva	− 0.59
Noise chronic	Melamed and Bruhis (1996)	35	–	–	–	Saliva	0.27
	Evans and Johnson (2000)	38	1.00	37	–	Saliva	0.02
Public lecture	Basset et al. (1985)	29	0.24	29	Diurnal	Urine	0.19
	Bolm-Audorff et al. (1986)	10	–	–	a.m./p.m.	Blood	1.42
	Lucas et al. (2006)	11	0.73	38	–	Blood	− 0.18
Medical procedures
Surgery	Manyande et al. (1992)	40	0.45	42	p.m.	Blood	1.47
	Manyande et al. (1995)	48	0.41	45	p.m.	Blood	1.06
	Dahanukar et al. (1996)	23	–	–	–	Blood	0.65
	Smith-Hanrahan (1996)	35	1.00	–	a.m.	Saliva	0.65
	Augustin et al. (1999)	45	0.56	34	a.m.	Saliva	0.27
	Kain et al. (1999)	56	0.50	62	a.m.	Blood	4.89
	Ozarda-Ilcol et al. (2002)	16	–	–	–	Blood	9.58
	Ilcol et al. (2004)	26	1.00	49	–	Blood	1.21
	Pearson et al. (2005)	39	0.31	71	a.m.	Urine	3.15
	Nicholson et al. (2005)	–	0.25	31	–	Blood	− 3.23
Dental procedures	Benjamins et al. (1992)	13	0.46	35	a.m.	Saliva	1.87
	Miller et al. (1995)	196	0.00	35	a.m.	Saliva	2.75
	Brand (1999)	31	0.00	42	a.m.	Saliva	0.46
Severe physical injury	Offner et al. (2002)	22	0.38	35	–	Blood	4.15
Social stressors
Marital conflict	Miller et al. (1999)	–	0.50	31	a.m.	Blood	0.27
	Kiecolt-Glaser et al. (2003)	138	0.50	25	Diurnal	Saliva	0.24
Marital Conflict	Heffner et al. (2004)	85	0.50	26	a.m.	Blood	− 0.27
	Kiecolt-Glaser et al. (1996)	90	0.50	26	a.m.	Blood	0.27
Abuse	Pico-Alfonso et al. (2004)	162	1.00	46	a.m./p.m.	Saliva	0.00 - 0.61
Loneliness	Pressman et al. (2005)
	Low vs. high loneliness (morning)	83	0.55	18	a.m.	Saliva	0.54
	Low vs. high loneliness (afternoon)	“	“	“	p.m.	“	0.53
Interpersonal Stress	Hansen et al. (2006)	393	0.64	44	Diurnal	Saliva	− 0.20
Caregiving	Irwin et al. (1997)	133	0.58	70	a.m.	Blood	− 0.32
	Bauer et al. (2000)	116	0.49	72	Diurnal	Saliva	0.49
	Cacioppo et al. (2000)	27	1.00	67	a.m.	Blood	− 2.82
	Da Roza and Cowen (2001)	58	0.60	69	am,pm	Saliva	0.38 – 2.47
	Davis et al. (2004)	30	1.00	71.4	Diurnal	Saliva	1.31
	Provinciali et al. (2004)	75	0.79	54	–	Blood	0.00
	de Vugt et al. (2005)	112	0.65	60	Diurnal	Saliva	0.03
	Wilcox et al. (2005)	35	1.00	65	a.m.	Saliva	–
Caregiving (continued)
	Gallagher-Thompson et al. (2006a)	22	1.00	51	a.m.	Saliva	0.67 - 1.93
	Vedhara et al. (2002)	103	0.34	43	Diurnal	Saliva	0.92
Bereavement	Jacobs et al. (1987)	56	0.50	62	Diurnal	Urine	3.22
	Gerra et al. (2003)	14	0.57	38	a.m.	Blood	− 0.42
Sports	Urhausen and Kindermann (1987)	8	0.00	25	a.m.	Blood	4.04
	Booth et al. (1989)	6	–	–	–	Saliva	0.00
	Passelergue et al. (1995)	6	0.00	26	p.m.	Saliva	1.47
	Filaire et al. (1996)	31	1.00	19	a.m.	Saliva	0.27
	Kugler et al. (1996)	17	0.00	40	–	Saliva	3.29
	Eubank et al. (1997)	5	0.00	24	p.m.	Saliva	− 0.48–2.41
	Gonzalez-Bono et al. (1999)	16	0.00	23	p.m.	Saliva	0.00
	Salvador et al. (1999)	28	0.00	18	a.m.	Blood	0.00
	Carre et al. (2006)	17	0.00	18	p.m.	Saliva	1.03
	Suay et al. (1999)	26	0.00	18	a.m.	Blood	3.41
	Bonifazi et al. (2000)	8	0.00	–	a.m.	Blood	2.29
	Filaire et al. (2001)	12	0.00	22	–	Saliva	4.13
	Wagner et al. (2002)	8	0.00	–	–	Saliva	0.57
	Bateup et al. (2002)	17	1.00	20	–	Saliva	0.33
	Iellamo et al. (2003)	7	0.43	27	–	Saliva	1.51
	Filaire et al. (2003)	20	0.00	25	a.m.	Saliva	0.00
	Salvador et al. (2003)	17	0.00	–	a.m.	Saliva	3.11
	Kivlighan et al. (2005)	12	0.50	–	–	Saliva	1.30
	Edwards et al. (2006)	40	0.45	20	p.m.	Saliva	0.00

* Denotes % female

^† a.m. = morning; p.m. = afternoon; a.m./p.m. = during the day

^‡ Medium of cortisol collection

^¶ Effect size estimate.

Table III.  Effect sizes of different stressor types.

Type of stressor task	No. of effect sizes	Subjects	d	Confidence interval (95%)
Occupational	112	7744	0.33**	0.12–0.56
Social Stressors	33	2304	0.63**	0.20–1.06
Medical Procedures	13	574	1.42*	0.16–2.68
Sports	23	354	1.29***	0.72–1.86
Total	181	10,976	0.58***	0.39–0.77

t-Tests indicated that effect sizes were significantly different from 0 at *p < 0.05; **p < 0.01; ***p < 0.001.

Table IV.  Effect sizes of stressor characteristics across stressor types.

Stressor characteristic	Mean d ± SD
Chronicity**
Acute	0.76 ± 0.40
Chronic	0.22 ± 0.35
Predictability
No	0.42 ± 0.47
Yes	0.60 ± 0.32
Controllability
No	0.57 ± 0.30
Yes	0.36 ± 0.65
Evaluative threat
No	0.68 ± 0.27
Yes	0.21 ± 0.61

**p < 0.01.

Table V.  Effect sizes of stressor characteristics without medical and sports stressors.

Stressor characteristic	Mean d ± SD
Chronicity
Acute	0.53 ± 0.46
Chronic	0.22 ± 0.32
Predictability
No	0.41 ± 0.46
Yes	0.33 ± 0.32
Controllability
No	0.38 ± 0.32
Yes	0.36 ± 0.59
Evaluative threat
No	0.53 ± 0.30
Yes	0.11 ± 0.55

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