Salivary cortisol in psychoneuroendocrine research: Recent developments and applications

doi:10.1016/0306-4530(94)90013-2

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Salivary cortisol in psychoneuroendocrine research: Recent developments and applications

Journal Article•DOI•

Salivary cortisol in psychoneuroendocrine research: Recent developments and applications

Clemens Kirschbaum¹, Dirk H. Hellhammer¹•Institutions (1)

University of Trier¹

01 Jan 1994-Psychoneuroendocrinology (Elsevier)-Vol. 19, Iss: 4, pp 313-333

TL;DR: An up-to-date overview of recent methodological developments, novel applications as well as a discussion of possible future applications of salivary cortisol determination are provided.

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About: This article is published in Psychoneuroendocrinology.The article was published on 1994-01-01. It has received 2057 citations till now. The article focuses on the topics: Blood sampling & Dexamethasone suppression test.

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Journal Article•DOI•

Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research.

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Sally S. Dickerson¹, Margaret E. Kemeny¹•Institutions (1)

University of California, Los Angeles¹

29 Apr 2004-Psychological Bulletin

TL;DR: Motivated performance tasks elicited cortisol responses if they were uncontrollable or characterized by social-evaluative threat (task performance could be negatively judged by others), when methodological factors and other stressor characteristics were controlled for.

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Abstract: This meta-analysis reviews 208 laboratory studies of acute psychological stressors and tests a theoretical model delineating conditions capable of eliciting cortisol responses. Psychological stressors increased cortisol levels; however, effects varied widely across tasks. Consistent with the theoretical model, motivated performance tasks elicited cortisol responses if they were uncontrollable or characterized by social-evaluative threat (task performance could be negatively judged by others), when methodological factors and other stressor characteristics were controlled for. Tasks containing both uncontrollable and social-evaluative elements were associated with the largest cortisol and adrenocorticotropin hormone changes and the longest times to recovery. These findings are consistent with the animal literature on the physiological effects of uncontrollable social threat and contradict the belief that cortisol is responsive to all types of stressors.

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5,028 citations

Cites background from "Salivary cortisol in psychoneuroend..."

...In addition, the reference lists of all qualifying articles and several recent reviews (Biondi & Picardi, 1999; Kirschbaum & Hellhammer, 1994) were examined for additional studies not identified through the computer search....
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...The time of day, timing of assessment, and other methodological variables could preclude eliciting and/or capturing cortisol responses to acute laboratory stressors (e.g., Kirschbaum & Hellhammer, 1994; Lovallo & Thomas, 2000; Mason, 1968)....
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...…several narrative reviews have provided overviews of topics relevant to acute stressors and cortisol responses (e.g., Biondi & Picardi, 1999; Kirschbaum & Hellhammer, 1994; Lovallo & Thomas, 2000; Stansbury & Gunnar, 1994), in most cases, their primary purpose was not to address the…...
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...Cortisol assessments at certain time points from stressor onset could be associated with greater effect sizes, because timing of assessment could play a key role in capturing cortisol responses (Kirschbaum & Hellhammer, 1994)....
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Journal Article•DOI•

Emotion regulation: Affective, cognitive, and social consequences

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James J. Gross¹•Institutions (1)

Stanford University¹

01 May 2002-Psychophysiology

TL;DR: This review focuses on two commonly used strategies for down-regulating emotion, reappraisal and suppression, and concludes with a consideration of five important directions for future research on emotion regulation processes.

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Abstract: One of life's great challenges is successfully regulating emotions. Do some emotion regulation strategies have more to recommend them than others? According to Gross's (1998, Review of General Psychology, 2, 271-299) process model of emotion regulation, strategies that act early in the emotion-generative process should have a different profile of consequences than strategies that act later on. This review focuses on two commonly used strategies for down-regulating emotion. The first, reappraisal, comes early in the emotion-generative process. It consists of changing the way a situation is construed so as to decrease its emotional impact. The second, suppression, comes later in the emotion-generative process. It consists of inhibiting the outward signs of inner feelings. Experimental and individual-difference studies find reappraisal is often more effective than suppression. Reappraisal decreases emotion experience and behavioral expression, and has no impact on memory. By contrast, suppression decreases behavioral expression, but fails to decrease emotion experience, and actually impairs memory. Suppression also increases physiological responding for suppressors and their social partners. This review concludes with a consideration of five important directions for future research on emotion regulation processes.

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3,555 citations

Cites background from "Salivary cortisol in psychoneuroend..."

...…be important to more precisely specify these changes by using additional measures of sympathetic activation of the cardiovascular system ~e.g., preejection time; Cacioppo, 1994! as well as other peripheral responses ~e.g., hypothalamo-pituitary-adrenocortical axis; Kirschbaum & Hellhammer, 1994!....
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Journal Article•DOI•

Sex differences in HPA axis responses to stress: a review

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Brigitte M. Kudielka¹, Clemens Kirschbaum²•Institutions (2)

University of Trier¹, Dresden University of Technology²

01 Apr 2005-Biological Psychology

1,439 citations

Cites background or methods from "Salivary cortisol in psychoneuroend..."

...More detailed information on sampling, storage and biochemical analysis are provided elsewhere (see Kirschbaum and Hellhammer, 1989, 1994, 2000)....
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...…or controlled (e.g., health status, smoking habits, female menstrual cycle phase, personality factors, time of day, habituation effects due to repeated stress exposure, social support, genetic factors, etc.; for detailed review, see Kirschbaum and Hellhammer, 1994; Kirschbaum et al., 1998)....
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Journal Article•DOI•

Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research.

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Urs M. Nater¹, Nicolas Rohleder²•Institutions (2)

University of Zurich¹, Brandeis University²

01 May 2009-Psychoneuroendocrinology

TL;DR: This review describes sAA as an emerging biomarker for stress and provides an overview of the current literature on stress-related alterations in sAA, and critically discusses how sAA might reflect changes in the autonomic nervous system.

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1,157 citations

Cites background or methods from "Salivary cortisol in psychoneuroend..."

...Whereas other stress-related factors in saliva, such as salivary cortisol (Kirschbaum and Hellhammer, 1989, 1994), received widespread scientific attention in the following decade, interest in sAA as a stress marker was not sparked again until Chatterton and colleagues published their findings of…...
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...However, apart from the analysis of hormones such as cortisol and DHEA (see, e.g. Vining and McGinley, 1987; see, e.g. Kirschbaum and Hellhammer, 1994), few other salivary components have been taken into consideration as meaningful physiological markers in psychoneuroendocrinological research....
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Journal Article•DOI•

Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival

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Sandra E. Sephton¹, Robert M. Sapolsky, Helena C. Kraemer, David Spiegel•Institutions (1)

University of Louisville¹

21 Jun 2000-Journal of the National Cancer Institute

TL;DR: Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality, and suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.

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Abstract: Background : Abnormal circadian rhythms have been observed in patients with cancer, but the prognostic value of such alterations has not been confirmed. We examined the association between diurnal variation of salivary cortisol in patients with metastatic breast cancer and subsequent survival. We explored relationships between cortisol rhythms, circulating natural killer (NK) cell counts and activity, prognostic indicators, medical treatment, and psychosocial variables. Methods Salivary cortisol levels of 104 patients with metastatic breast cancer were assessed at study entry at 0800, 1200, 1700, and 2100 hours on each of 3 consecutive days, and the slope of diurnal cortisol variation was calculated using a regression of log-transformed cortisol concentrations on sample collection time. NK cell numbers were measured by flow cytometry, and NK cell activity was measured by the chromium release assay. The survival analysis was conducted by the Cox proportional hazards regression model with two-sided statistical testing. Results Cortisol slope predicted subsequent survival up to 7 years later. Earlier mortality occurred among patients with relatively "flat" rhythms, indicating a lack of normal diurnal variation (Cox proportional hazards, P =. 0036). Patients with chest metastases, as opposed to those with visceral or bone metastases, had more rhythmic cortisol profiles. Flattened profiles were linked with low counts and suppressed activity of NK cells. After adjustment for each of these and other factors, the cortisol slope remained a statistically significant, independent predictor of survival time. NK cell count emerged as a secondary predictor of survival. Conclusions Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. Suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.

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1,028 citations

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References

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Journal Article•DOI•

The ‘Trier Social Stress Test’ – A Tool for Investigating Psychobiological Stress Responses in a Laboratory Setting

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Clemens Kirschbaum¹, Karl-Martin Pirke, Dirk H. Hellhammer•Institutions (1)

University of Trier¹

01 Jul 1993-Neuropsychobiology

TL;DR: The results suggest that gender, genetics and nicotine consumption can influence the individual's stress responsiveness to psychological stress while personality traits showed no correlation with cortisol responses to TSST stimulation.

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Abstract: This paper describes a protocol for induction of moderate psychological stress in a laboratory setting and evaluates its effects on physiological responses. The ‘Trier Social Stress Test’ (TSST) mainl

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5,207 citations

Journal Article•DOI•

A specific laboratory test for the diagnosis of melancholia. Standardization, validation, and clinical utility.

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Bernard J. Carroll¹, Michael Feinberg¹, John F. Greden², Janet Tarika¹, A. Ariav Albala¹, Roger F. Haskett¹, Norman McI. James¹, Ziad Kronfol¹, Naomi E. Lohr¹, Meir Steiner¹, Jean Paul de Vigne¹, Elizabeth A. Young¹ - Show less +8 more•Institutions (2)

University of Michigan¹, Molecular and Behavioral Neuroscience Institute²

01 Jan 1981-Archives of General Psychiatry

TL;DR: Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms.

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Abstract: • Four hundred thirty-eight subjects underwent an overnight dexamethasone suppression test (DST) to standardize the test for the diagnosis of melancholia (endogenous depression). Abnormal plasma cortisol concentrations within 24 hours after dexamethasone administration occurred almost exclusively in melancholic patients. The best plasma cortisol criterion concentration, above which a DST result may be considered abnormal, was 5 ug/dL. The optimal dose of dexamethasone was 1 rather than 2 mg. Two blood samples obtained at 4 and 11 PM after dexamethasone administration detected 98% of the abnormal test results. This version of the DST identified melancholic patients with a sensitivity of 67% and a specificity of 96%. Baseline nocturnal plasma cortisol concentrations were not useful. Abnormal DST results were found with similar frequency among outpatients and inpatients with melancholia; but they were not related to age, sex, recent use of psychotropic drugs, or severity of depressive symptoms. Extensive evidence validates this practical test for the diagnosis of melancholia.

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2,006 citations

"Salivary cortisol in psychoneuroend..." refers result in this paper

...In contrast to its diagnostic value in the diagnosis of Cushing's syndrome, the usefulness of the DST as a biological marker for melancholic depression (Carroll et al., 1981) is discussed controversially....
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Journal Article•DOI•

Salivary cortisol in psychobiological research: an overview.

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Clemens Kirschbaum¹, Dirk H. Hellhammer•Institutions (1)

University of Trier¹

01 Jan 1989-Neuropsychobiology

TL;DR: This overview intends to give a comprehensive introduction to the method of salivary cortisol assessment and to briefly discuss its application in different scientific disciplines.

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Abstract: The measurement of cortisol in saliva provides the basic scientist as well as the clinician with a reliable tool for investigations of hypothalamus-pituitary-adrenal axis activity. Since saliva samples can be obtained stress-free and independent from medically trained personnel this method may be well suited for use in psychobiological studies. This overview intends to give a comprehensive introduction to the method of salivary cortisol assessment and to briefly discuss its application in different scientific disciplines.

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1,512 citations

Journal Article•DOI•

The Free Hormone Hypothesis: A Physiologically Based Mathematical Model*

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Carl M. Mendel

01 Aug 1989-Endocrine Reviews

TL;DR: It is shown that whether or not this hypothesis is likely to be valid for any given hormone will depend largely on which step in the tissue uptake process (plasma flow, dissociation from plasma binding proteins, influx, or intracellular elimination) is rate-limiting to the net tissue uptake of that hormone.

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Abstract: The free hormone hypothesis states that the biological activity of a given hormone is affected by its unbound (free) rather than protein-bound concentration in the plasma. The fundamental mathematical and physiological principles relating to this hypothesis are reviewed, along with experimental data that shed light on its validity. It is shown that whether or not this hypothesis is likely to be valid for any given hormone will depend largely on which step in the tissue uptake process (plasma flow, dissociation from plasma binding proteins, influx, or intracellular elimination) is rate-limiting to the net tissue uptake of that hormone. It is further shown that the free hormone hypothesis could hold even if tissue uptake of hormone occurred by a mechanism that acted directly on one or more circulating protein-bound pools of hormone. Indeed, many of the data previously interpreted as being inconsistent with the free hormone hypothesis are in fact readily consistent with it when its predictions are fully understood. Nevertheless, the free hormone hypothesis is not likely to be valid for all hormones with respect to all tissues. It is likely to be valid with respect to all tissues for the thyroid hormones, for cortisol, and for the hydroxylated metabolites of vitamin D. For many of the other steroid hormones, however, it is likely to be valid with respect to some tissues, but not with respect to others (in particular, the liver). And for some of the steroid hormones (in particular, progesterone) it may not hold at all.

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908 citations

Journal Article•DOI•

Synthesis of a cortisol-biotin conjugate and evaluation as a tracer in an immunoassay for salivary cortisol measurement

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Regina A. Dressendörfer¹, Clemens Kirschbaum², W. Rohde³, F. Stahl³, Christian J. Strasburger¹ - Show less +1 more•Institutions (3)

Ludwig Maximilian University of Munich¹, University of Trier², Humboldt University of Berlin³

01 Dec 1992-The Journal of Steroid Biochemistry and Molecular Biology

TL;DR: A simple-to-perform synthesis yielded a conjugate suitable for use as a tracer in immunoassays for cortisol measurement and showed excellent correlation with a commercially available radioimmunoassay adapted for salivary cortisol measurement.

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837 citations