Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis

Biol Psychol. 2009 Mar;80(3):265-78. doi: 10.1016/j.biopsycho.2008.10.004. Epub 2008 Oct 30.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Animals
  • Databases, Bibliographic / statistics & numerical data
  • Humans
  • Hydrocortisone / metabolism*
  • Meta-Analysis as Topic
  • Psychology*
  • Wakefulness / physiology*


  • Hydrocortisone