Diurnal Salivary Cortisol Patterns Research Articles

Variation in diurnal cortisol patterns among the Indigenous Shuar of Amazonian Ecuador.

The hypothalamic-pituitary-adrenal (HPA) axis and its primary end product, the glucocorticoid cortisol, are major components of the evolved human stress response. However, most studies have examined these systems among populations in high-income settings, which differ from the high pathogen and limited resource contexts in which the HPA axis functioned for most of human evolution. We investigated variability in diurnal salivary cortisol patterns among 298 Indigenous Shuar from Amazonian Ecuador (147 males, 151 females; age 2-86 years), focusing on the effects of age, biological sex, and body mass index (BMI) in shaping differences in diurnal cortisol production. Saliva samples were collected three times daily (waking, 30 minutes post-waking, evening) for three consecutive days to measure key cortisol parameters: levels at waking, the cortisol awakening response, the diurnal slope, and total daily output. Age was positively associated with waking levels and total daily output, with Shuar juveniles and adolescents displaying significantly lower levels than adults (p < .05). Sex was not a significant predictor of cortisol levels (p > .05), as Shuar males and females displayed similar patterns of diurnal cortisol production across the life course. Moreover, age, sex, and BMI significantly interacted to moderate the rate of diurnal cortisol decline (p = .027). Overall, Shuar demonstrated relatively lower cortisol concentrations than high-income populations. This study expands the documented range of global variation in HPA axis activity and diurnal cortisol production and provides important insights into the plasticity of human stress physiology across diverse developmental and socioecological settings.

Imagine HEALTH: Changes in diurnal salivary cortisol patterns following a 12-week guided imagery RCT lifestyle intervention in predominantly Latino adolescents

ObjectiveAlterations in diurnal salivary cortisol patterns have been linked to adverse metabolic health outcomes. We have previously shown that stress-reduction guided imagery (GI) can reduce salivary cortisol levels acutely. We now ask whether addition of GI into a 12-week lifestyle intervention designed to improve eating and physical activity behaviors can alter diurnal salivary cortisol patterns and perceived stress. Methods232 adolescent participants (ages 14–17 years) were cluster randomized by school into one of four intervention arms: non-intervention Control (C; n = 51), Lifestyle (LS; n=61), Stress-Reduction GI (SRGI; n = 55), and Lifestyle Behavior GI (LBGI; n = 65). LS group received one nutrition and one physical activity class per week after-school for 12 weeks. SRGI and LBGI groups received same LS classes plus an additional weekly GI session. Salivary cortisol was assessed pre- and post-intervention on 3 days, 3 times daily, at awakening, 30-minutes post-awakening, and in the evening to determine Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS). Perceived Stress Scale (PSS) was administered pre- and post-intervention. Mixed effects modeling was used for intent-to-treat analysis and sensitivity analysis was used for those participants adherent to intervention protocol. ResultsAnalysis of 208 subjects with complete data showed a small between-group increase in CAR in LBGI vs C (p = 0.045, d=0.24), with no significant group differences among other intervention arms. There were no between group differences in change in DCS or change in PSS after 12-weeks. Amongst adherent participants, LBGI showed a small-moderate increase in CAR (p = 0.03, d=0.37), and moderate-large reduction in PSS (p = 0.02, d=−0.66) compared to C. There were no other between group differences in CAR, DCS, or PSS. ConclusionLBGI led to an increase in CAR, and in adherent subjects, a decrease in PSS, suggesting GI may be a mind-body intervention that can affect both objective and subjective measures of the stress response. Whether changes in cortisol patterns in this population affect measures of mental or physical health remains to be determined.

Salivary cortisol levels and stress in adults with profound intellectual and multiple disabilities participating in the Structured Water Dance Intervention: a randomised controlled crossover trial

The Structured Water Dance Intervention (SWAN) is a dance-oriented aquatic group activity directed to give opportunities for the joy of movement, relaxation, and reduced stress. This study aimed to evaluate the effects of SWAN on salivary cortisol and stress in adults with profound intellectual and multiple disabilities (PIMD). A total of 34 adults with PIMD at four habilitation centres in Sweden completed the SWAN intervention. The intervention was administered for 40 min once a week during a 12-week period. Saliva cortisol was collected in the morning and evening at baseline one week before the intervention, thrice during the intervention period, and one week after the intervention. Moreover, in connection with the SWAN sessions, the participants’ level of stress was also assessed by the accompanying assistants. The results showed that salivary cortisol and participants stress decreased significantly, directly after the SWAN sessions compared with measures directly before sessions. The study demonstrates that adults with PIMD have diurnal salivary cortisol patterns consistent with those observed in adults without disability and that the SWAN reduces salivary cortisol levels and stress in people with PIMD; this justifies that SWAN could be considered in the choice of interventions to reduce stress in adults with PIMD.Trial registration: This study is registered 09/04/2019 on ClinicalTrials.gov (ID: NCT03908801).

Salivary Cortisol Patterns in People Living With Dementia

Salivary cortisol has a well-documented circadian pattern in older adults. Yet, the pattern of salivary cortisol in persons living with dementia (PLWD) due to circadian rhythm disturbances is unknown. This study examined diurnal salivary cortisol patterns in 176 PLWD (mean age 73.6±8.8, 33.3% male, clinical dementia rating >=0.5) by collecting saliva at waking (AM1), 30 minutes after waking (AM2) and bedtime (PM) over two consecutive days. Cortisol awakening response (CAR) was calculated as the change between AM2 and AM1 cortisol levels. The mean baseline salivary cortisol levels (ug/dl) were 0.35 (SD:0.3) at AM1, 0.40 (SD:0.39) at AM2, and 0.19 (SD:0.4) at PM. On average, cortisol levels decreased from morning to evening, with 58% exhibiting a positive CAR (mean 0.05; SD:0.34). There were no significant associations between cortisol levels with age, sex, obesity, and comorbidities. The findings demonstrated that diurnal cortisol rhythms are maintained in PLWD with a flattened CAR.

MsFLASH analysis of diurnal salivary cortisol and palpitations in peri- and postmenopausal women.

To evaluate the relationship between diurnal salivary cortisol patterns and distress from heart palpitations in midlife women. We analyzed baseline data from 293 women who were eligible for a 3 × 2 factorial trial of exercise or yoga versus routine activity, and omega-3 fish oil versus placebo for vasomotor symptoms. Women self-collected salivary cortisol using swabs at four time points over 2 consecutive days and reported distress from heart racing or pounding during the past 2 weeks using a single item. Sample description and covariate data included demographics, clinical data, vasomotor symptom frequency from daily diaries, medication use, and validated questionnaires on depression, stress, and insomnia (Patient Health Questionnaire-8, Perceived Stress Scale, and Insomnia Severity index). Data were analyzed using descriptive statistics, chi-square and t tests, and repeated measure linear regression models. Participants were on average 54.6 (SD = 3.6) years old, most were White (67%) postmenopausal (84%), and 26% reported distress related to palpitations. In adjusted models, the morning (wake plus 30-min) geometric mean daily salivary cortisol concentrations were significantly more blunted in those with distress from palpitations compared with those without distress (P ≤ 0.03). When all covariates were controlled, distress from palpitations was the sole significant predictor of wake plus 30-minute cortisol (-0.25 [-0.45 to -0.04], P = 0.02). Palpitations among midlife women may be associated with blunted morning cortisol, and this relationship is not explained by demographics, clinical variables, vasomotor symptoms, medications, depression, stress, or insomnia.

Associations Among Diurnal Salivary Cortisol Patterns, Medication Use, and Behavioral Phenotype Features in a Community Sample of Rett Syndrome.

Rett syndrome (RTT) is a severe neurodevelopmental disorder resulting from mutations of the MECP2 gene. Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal stress responses have been observed in animal models of RTT, but little is known about HPA axis function among individuals with RTT. Diurnal salivary cortisol patterns from 30 females with RTT were examined in relation to mutation type, medication use, and features of the RTT behavioral phenotype. Cortisol patterns were significantly related to mutation severity, anticonvulsant medication status, and bruxism (tooth grinding). This study provides preliminary support for the hypothesis that RTT may be at risk for outcomes associated with aberrant HPA axis function, and that this risk may be mediated by mutation type.

Evening salivary cortisol as a single stress marker in women with metastatic breast cancer

BackgroundFlattened diurnal salivary cortisol patterns predict shorter subsequent survival with breast, lung, and renal cell carcinomas. The underlying cause of this flattened slope is undetermined, though it has been hypothesized to be secondary to a deficit in the amplitude of the circadian clock. To gain greater insight into the portions of the diurnal salivary curve that are associated with cancer survival, we examined (1) which points in the diurnal curve are predictive of the slope of the curve and (2) whether elevated evening cortisol levels alone are associated with reduced HPA-axis feedback inhibition (i.e., decreased sensitivity to the dexamethasone suppression test). MethodWe examined study hypotheses on adult women with advanced breast cancer (age = 54.3 ± 9.58 years; n = 99) using non-parametric Wilcoxon’s rank-sum tests, Spearman correlation coefficients and an accuracy formula based on a confusion matrix. Cortisol was sampled five times per day for three consecutive days, with dexamethasone administered late on the second day. ResultsSalivary cortisol concentrations did not vary between those with flat and steep slopes during the morning (p’s > .05), but did vary in the evening (p’s < 0.05). Furthermore, the concentration of the 2100h alone was 86% accurate in discriminating between individuals classified as having “flat” or “steep” slopes. Dexamethasone suppression was only associated with diurnal salivary cortisol slope (p = .0042). ConclusionsEvening cortisol levels are a sensitive indicator flattened diurnal cortisol slope, suggesting evening cortisol may also be a useful predictor of breast cancer survival. Future research should focus on determining the causes of abnormally increased evening cortisol.

Challenges to Identity Integration Indirectly Link Experiences of Heterosexist and Racist Discrimination to Lower Waking Salivary Cortisol in Sexually Diverse Latinx Emerging Adults.

Heterosexist and racist discrimination may adversely impact neurobiological processes implicated in the physical and psychosocial well-being of sexually diverse Latinx people. Yet, little is known about how experiences of both heterosexist and racist discrimination are associated with adrenocortical and psychological functioning in groups of people with multiply marginalized social group identities. Through the application of the intersectionality, minority stress, and allostatic load frameworks, it was hypothesized that experiences of heterosexist and racist discrimination would be associated with disruptions to diurnal salivary cortisol patterns and challenges to identity integration. A group of sexually diverse (self-identified lesbian, gay, bisexual, and queer) Latinx emerging adults (N = 51; ages 18–29, M = 24.06 years; SD = 2.73) provided saliva samples and completed a series of questionnaires during a four-day testing protocol. Heterosexist and racist discrimination were both positively associated with challenges to identity integration. Challenges to identity integration, in turn, were associated with lower intercepts of diurnal cortisol slopes, and heterosexist and racist discrimination were indirectly associated with lower cortisol intercepts via challenges to identity integration. These findings suggest that experiences of heterosexist and racist discrimination may interconnect by challenging sexual and ethnic/racial identity integration and disrupting adaptive adrenocortical regulation among sexually diverse Latinx emerging adults.

Latino adolescents’ cultural values associated with diurnal cortisol activity

Hypothalamic-pituitary-adrenal (HPA) axis activity has been identified as a mechanism through which daily life stress contributes to health problems and racial/ethnic health disparities. Stress-related changes in neuroendocrine function are evident as early as adolescence, but the ways in which promotive cultural factors may also contribute to variation in diurnal HPA activity have received little empirical attention. Grounded in cultural models of resilience, dual dimensions of Latino adolescents’ cultural values (ethnic heritage and U.S. mainstream) were examined as promotive and protective factors in relation to their diurnal salivary cortisol patterns using ecological momentary assessment (N = 209; Mage = 18.10; 64.4% female). Participants provided 5 daily saliva samples for 3 days while completing corresponding electronic diary reports and using time-sensitive compliance devices (track caps, actigraphs). Results from 3-level growth curve models indicated that higher U.S. mainstream cultural values (e.g., self-reliance, competition, material success) were associated with higher average waking cortisol levels and a more rapid rate of diurnal cortisol decline (i.e., “steeper” slope). Regarding situational deviations from the diurnal rhythm (within-person differences), cortisol levels were higher in relation to diary-reported ongoing stress (vs. completed). Accounting for these situational differences in stress timing, a cross-level interaction (i.e., between-person difference in within-person process) indicated that higher perceived stress than usual was associated with lower cortisol levels for adolescents with stronger alignment to Latino ethnic heritage values (e.g., familism, respect, religiosity), compared to relatively higher cortisol levels for those with less alignment to these values. Results were consistent adjusting for participants’ sex, immigrant generation, parents’ education level, depressive symptoms, medication use, sleep duration, and other self-reported health behaviors. These findings join the growing science of cultural neurobiology by demonstrating the promotive and potentially regulating influence of cultural values in the daily HPA functioning of Latino adolescents.

L-Thyroxine intake as a potential risk factor for the development of fatigue in breast cancer patients undergoing chemotherapy.

L-Thyroxine is one of the most commonly prescribed drugs and accordingly used by many breast cancer patients with thyroid disorders. Hence, potential interactions of chemotherapy with L-thyroxine, possibly contributing to fatigue, would be of high clinical relevance. Therefore, we investigated fatigue and underlying pathways in L-thyroxine-using breast cancer patients during chemotherapy. Thyroid-stimulating hormone (TSH), L-triiodothyronine (T3), and diurnal salivary cortisol patterns were analyzed in breast cancer patients in the beginning and at the end of adjuvant chemotherapy within the control group (n = 41) of a randomized exercise intervention trial. Additionally, relationships in the exercising group (n = 45) as well as in healthy women (n = 25) were explored. Regression and mediation analyses were performed. L-Thyroxine use was significantly associated with lower TSH (median = 0.33mU/l, interquartile range = (0.15-0.48)), whereas patients not using L-thyroxine had TSH comparable to healthy women (0.51mU/l (0.37-0.74)). T3 significantly declined during chemotherapy in L-thyroxine users but not in non-users. However, the group difference failed statistical significance. L-Thyroxine treatment was significantly associated with increased physical fatigue during chemotherapy (p = 0.004) in the non-exercising group. This association appeared to be partly mediated by TSH. Further, TSH appeared to affect fatigue partly via increased cortisol levels. In the exercise group, there was no significant association between L-thyroxine and fatigue. L-Thyroxine treatment during chemotherapy might result in hormonal dysregulations that can contribute to increased physical fatigue. Therefore, breast cancer patients on L-thyroxine treatment may need special monitoring of their thyroid levels and of fatigue during chemotherapy and should be encouraged to exercise. ClinicalTrials.gov NCT01106820.

Long-term stability of diurnal salivary cortisol and alpha-amylase secretion patterns

This study aimed to investigate long-term stability and variability of diurnal cortisol and alpha-amylase patterns. Diurnal cortisol and alpha-amylase secretion patterns were assessed on a single workday with three waves of measurement across a total time period of 24months in 189 participants. Separate hierarchical linear models were analyzed, with and without a number of potential predictor variables (age, BMI, smoking, chronic stress, stress reactivity). While low long-term stability was found in diurnal cortisol, the stability of diurnal alpha-amylase was moderate across the time period of 24months. Several predictor variables had a positive impact on diurnal cortisol and alpha-amylase secretion patterns averaged across waves. Our findings underpin the notion that long-term stability is not necessarily warranted in longitudinal studies. It is important to choose an appropriate study design when attempting to disentangle clinically and biologically relevant changes from naturally occurring variations in diurnal cortisol and alpha-amylase.

Diurnal Cortisol Patterns and Dexamethasone Suppression Test Responses in Healthy Young Adults Born Preterm at Very Low Birth Weight.

BackgroundEarly life stress, such as painful and stressful procedures during neonatal intensive care after preterm birth, can permanently affect physiological, hormonal and neurobiological systems. This may contribute to altered programming of the hypothalamic-pituitary-adrenal axis (HPAA) and provoke changes in HPAA function with long-term health impacts. Previous studies suggest a lower HPAA response to stress in young adults born preterm compared with controls born at term. We assessed whether these differences in HPAA stress responsiveness are reflected in everyday life HPAA functioning, i.e. in diurnal salivary cortisol patterns, and reactivity to a low-dose dexamethasone suppression test (DST), in unimpaired young adults born preterm at very low birth weight (VLBW; <1500 g).MethodsThe participants were recruited from the Helsinki Study of Very Low Birth Weight Adults cohort study. At mean age 23.3 years (2.1 SD), 49 VLBW and 36 controls born at term participated in the study. For cortisol analyzes, saliva samples were collected on two consecutive days at 0, 15, 30 and 60 min after wake-up, at 12:00 h, 17:00 h and 22:00 h. After the last salivary sample of the first study day the participants were instructed to take a 0.5 mg dexamethasone tablet.ResultsWith mixed-effects model no difference was seen in overall diurnal salivary cortisol between VLBW and control groups [13.9% (95% CI: -11.6, 47.0), P = 0.31]. Salivary cortisol increased similarly after awakening in both VLBW and control participants [mean difference -2.9% (29.2, 33.0), P = 0.85]. Also reactivity to the low-dose DST (awakening cortisol ratio day2/day1) was similar between VLBW and control groups [-1.1% (-53.5, 103.8), P = 0.97)].ConclusionsDiurnal cortisol patterns and reactivity to a low-dose DST in young adulthood were not associated with preterm birth.

Shiftwork and Diurnal Salivary Cortisol Patterns Among Police Officers.

To investigate associations between shiftwork and diurnal salivary cortisol among 319 police officers (77.7% men). Information on shiftwork was obtained from the City of Buffalo, NY electronic payroll records. Saliva was collected using Salivettes at seven time points and analyzed for free cortisol concentrations (nmol/L) using a chemiluminescence immunoassay. Mean slopes and areas under the curve were compared across shift schedule using analysis of variance (ANOVA)/analysis of covariance (ANCOVA). Officers working primarily on the night shift had a significantly shallower slope. Mean slope (nmol/L/minutes) of the cortisol curve varied significantly across shifts (day: -0.00332 ± 0.00017, afternoon: -0.00313 ± 0.00018, night: -0.00257 ± 0.0002); adjusted P = 0.023. Our results suggest that night shiftwork is a workplace factor that may alter the response of the hypothalamic-pituitary-adrenal (HPA) axis to the circadian cues responsible for the pattern of the diurnal cortisol curve.

Salivary Cortisol Profiles of Children with Hearing Loss.

It has long been speculated that effortful listening places children with hearing loss at risk for fatigue. School-age children with hearing loss experiencing cumulative stress and listening fatigue on a daily basis might undergo dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity resulting in elevated or flattened cortisol profiles. The purpose of this study was to examine whether school-age children with hearing loss show different diurnal salivary cortisol patterns than children with normal hearing. Participants included 32 children with mild to moderate hearing loss (14 males; 18 females) and 28 children with normal hearing (19 males; 9 females) ranging in age from 6 to 12 years. Saliva samples were obtained six times per day on two separate school days. Cortisol levels were measured by mass spectrometric detection after liquid-liquid extraction. Salivary cortisol levels between children with hearing loss and children with no hearing loss over the course of the day were examined with hierarchical linear modeling using mixed model statistical analysis. Between-group comparisons were also computed for the area under the curve, an analytical approach for calculating overall cortisol secretion throughout the day. Significant differences in the cortisol awakening response (CAR) were observed between children with hearing loss and children with normal hearing; however, no differences were observed between the two groups subsequent to the cortisol awakening response (60-min postawakening, 10:00 A.M., 2:00 P.M., and 8:00 P.M.). Compared with children with normal hearing, children with hearing loss displayed elevated cortisol levels at awakening and a reduced growth in cortisol secretion from awakening to 30-min postawakening. No significant differences in overall cortisol secretion throughout the day were found between groups (area under the curve). Finally, cortisol levels increased with increasing age for children with hearing loss but not for children with normal hearing. Results of this preliminary study indicate a possible dysregulation in HPA axis activity in children with hearing loss characterized by elevated salivary cortisol levels at awakening and a diminished increase in cortisol from awakening to 30-min postawakening. The pattern of elevated cortisol levels at awakening is consistent with some studies on adults with burnout, a condition characterized by fatigue, loss of energy, and poor coping skills. These findings support the idea that children with hearing loss may experience increased vigilance and need to mobilize energy promptly in preparation for the new day.

Daily salivary cortisol patterns in midlife women with hot flashes

Diurnal salivary cortisol patterns in healthy adults are well established but have not been studied in midlife women with hot flashes. We hypothesized that frequent hot flashes areassociated with aberrant cortisol patterns similar to sleep-deficient individuals. Cross-sectional. A total of 306 women, ages 40-62, randomized to a behavioural intervention for hot flashes. Baseline comparisons of cortisol geometric means (nmol/l) from four daily time points averaged over two consecutive days plus other calculated cortisol measures were made between groups defined by baseline: (i) mean daily hot flash frequency tertile (≤5·5, N=103; >5·5-8·8, N=103; >8·8, N=100) and (ii) selected characteristics. Repeated-measures linear regression models of log-transformed cortisol evaluated group differences, adjusting for covariates. Women were 67% White and 24% African American, with 7·6 (SD 3·9) hot flashes per day. Salivary cortisol geometric means (nmol/l) among all women were as follows: 75·0 (SD 44·8) total, 8·6 (SD 5·6) wake, 10·0 (SD 7·5) wake +30min, 3·7 (SD 3·3) early afternoon and 1·6 (SD 1·8) bedtime. Wake+30-minute values showed an 18% median rise from wake values (interquartile range -24 to 96%), and means varied by hot flash frequency tertile, from lowest to highest: 11·4(SD 7·3), 10·3 (SD 6·5) and 8·6 (SD 7·8), respectively, P=0·003. Beside the early afternoon value (P=0·02), cortisol values did not vary by hot flash frequency. Taken together, these findings suggest that high frequency of moderate-to-severe hot flashes may be associated with subtle abnormalities in cortisol concentrations - a pattern consistent with chronic sleep disturbance.

Diurnal salivary cortisol patterns prior to pregnancy predict infant birth weight.

Elevated maternal psychosocial stress during pregnancy and accompanying changes in stress hormones may contribute to risk of adverse birth outcomes such as low birth weight and preterm birth. Relatedly, research on fetal programming demonstrates intriguing associations between maternal stress processes during pregnancy and outcomes in offspring that extend into adulthood. The purpose of this study was to test whether hypothalamic-pituitary-adrenal (HPA) patterns in mothers during the period between 2 pregnancies (i.e., the interpregnancy interval) and during the subsequent pregnancy predict infant birth weight, a key birth outcome. This study sampled salivary cortisol before and during pregnancy in a diverse community sample of 142 women enrolled in the Community Child Health Network study. Using multilevel modeling, we found that flatter diurnal cortisol slopes in mothers during the interval between one birth and a subsequent pregnancy predicted lower infant birth weight of the subsequent child. This interpregnancy cortisol pattern in mothers also correlated with significantly shorter interpregnancy intervals, such that women with flatter cortisol slopes had more closely spaced pregnancies. After adding demographic covariates of household income, cohabitation with partner, and maternal race to the model, these results were unchanged. For participants who provided both interpregnancy and pregnancy cortisol data (n = 73), we found that interpregnancy cortisol slopes predicted infant birth weight independent of pregnancy cortisol slopes. These novel findings on interpregnancy HPA axis function and subsequent pregnancy outcomes strongly support life course health approaches and underscore the importance of maternal stress physiology between pregnancies. (PsycINFO Database Record

Investigating within-day and longitudinal effects of maternal stress on children's physical activity, dietary intake, and body composition: Protocol for the MATCH study

Parental stress is an understudied factor that may compromise parenting practices related to children's dietary intake, physical activity, and obesity. However, studies examining these associations have been subject to methodological limitations, including cross-sectional designs, retrospective measures, a lack of stress biomarkers, and the tendency to overlook momentary etiologic processes occurring within each day. This paper describes the recruitment, data collection, and data analytic protocols for the MATCH (Mothers And Their Children's Health) study, a longitudinal investigation using novel real-time data capture strategies to examine within-day associations of maternal stress with children's physical activity and dietary intake, and how these effects contribute to children's obesity risk. In the MATCH study, 200 mothers and their 8 to 12year-old children are participating in 6 semi-annual assessment waves across 3years. At each wave, measures for mother–child dyads include: (a) real-time Ecological Momentary Assessment (EMA) of self-reported daily psychosocial stressors (e.g., work at a job, family demands), feeling stressed, perceived stress, parenting practices, dietary intake, and physical activity with time and location stamps; (b) diurnal salivary cortisol patterns, accelerometer-monitored physical activity, and 24-hour dietary recalls; (c) retrospective questionnaires of sociodemographic, cultural, family, and neighborhood covariates; and (d) height, weight, and waist circumference. Putative within-day and longitudinal effects of maternal stress on children's dietary intake, physical activity, and body composition will be tested through multilevel modeling and latent growth curve models, respectively. The results will inform interventions that help mothers reduce the negative effects of stress on weight-related parenting practices and children's obesity risk.

Diurnal patterns of salivary cortisol and DHEA using a novel collection device: Electronic monitoring confirms accurate recording of collection time using this device

The accurate indication of saliva collection time is important for defining the diurnal decline in salivary cortisol as well as characterizing the cortisol awakening response. We tested a convenient and novel collection device for collecting saliva on strips of filter paper in a specially constructed booklet for determination of both cortisol and DHEA. In the present study, 31 healthy adults (mean age 43.5 years) collected saliva samples four times a day on three consecutive days using filter paper collection devices (Saliva Procurement and Integrated Testing (SPIT) booklet) which were maintained during the collection period in a large plastic bottle with an electronic monitoring cap. Subjects were asked to collect saliva samples at awakening, 30 min after awakening, before lunch and 600 min after awakening. The time of awakening and the time of collection before lunch were allowed to vary by each subjects' schedule. A reliable relationship was observed between the time recorded by the subject directly on the booklet and the time recorded by electronic collection device (n=286 observations; r(2)=0.98). However, subjects did not consistently collect the saliva samples at the two specific times requested, 30 and 600 min after awakening. Both cortisol and DHEA revealed diurnal declines. In spite of variance in collection times at 30 min and 600 min after awakening, the slope of the diurnal decline in both salivary cortisol and DHEA was similar when we compared collection tolerances of ±7.5 and ±15 min for each steroid. These unique collection booklets proved to be a reliable method for recording collection times by subjects as well as for estimating diurnal salivary cortisol and DHEA patterns.

Too Much of a Good Thing?: Positive Religious Coping Predicts Worse Diurnal Salivary Cortisol Patterns for Overwhelmed African American Female Dementia Family Caregivers

Religious coping arguably prevents negative health outcomes for stressed persons. This study examined the moderating role of religious coping (positive, negative, and combined) in the connection of care recipient functional status with diurnal salivary cortisol patterns among dementia family caregivers. Thirty African American (AA) female dementia caregivers and 48 AA noncaregivers completed the Religious Coping (RCOPE) scale, the Activities of Daily Living scale, and the Revised Memory and Behavior Problem Checklist (RMBPC) and collected five saliva samples daily (at awakening, 9 A.M., 12 P.M., 5 P.M., and 9 P.M.) for 2 straight days. Hierarchical regression tests with mean diurnal cortisol slope as the outcome illustrated surprisingly that higher combined and positive (but not negative) RCOPE scores were associated with increasingly flatter or worse cortisol slope scores for caregivers (but not noncaregivers). Of note, the RCOPE by RMBPC interaction was significant. Among caregivers who reported higher RMBPC scores, higher combined and positive (but not negative) RCOPE scores were unexpectedly associated with increasingly flatter cortisol slopes. These results extend current findings by showing that being AA, a caregiver, and high in positive religious coping may predict increased daily stress responses, mainly for those with higher patient behavioral problems. Because religious coping is a central coping strategy for AA caregivers, it is vital that epidemiologic assessments of religious coping in health and aging as well as tailored interventions focus on the unique reasons for this disparity.

Depressive Symptoms and Diurnal Salivary Cortisol Patterns Among Female Caregivers of Stroke Survivors

Informal caregivers of stroke survivors experience elevated chronic stress and are at risk of developing depressive symptoms. The cumulative effects of chronic stress can increase allostatic load and dysregulate biological processes, thus increasing risk of stress-related disease. Stress-induced alterations in the pattern of cortisol secretion vary with respect to stressor onset, intensity, and chronicity. Little is known about the psychoendocrine response to stress in female caregivers of stroke survivors. The purpose of this study was to examine perceived stress, caregiver burden, and the association between caregiver depressive symptoms and diurnal cortisol in 45 females caring for a significant other who experienced a stroke within the past year. Women completed the Center for Epidemiologic Studies Depression Scale (CES-D) and collected saliva for cortisol upon awakening, 30 min postawakening, noon, and bedtime for 2 consecutive days. Results revealed that women had high levels of perceived stress and caregiver burden. In women with CES-D scores ≥ 16, salivary cortisol levels were significantly lower across the day relative to women with CES-D scores < 16. This difference persisted after adjusting for age, number of caregiving hours per week, perceived social support, and quality of sleep. Younger age was associated with more depressive symptoms as well as lower levels of cortisol at awakening and 30 min postawakening. Results demonstrate that the burden of caregiving increases risk of depressive symptoms and hypocortisolism across the day. Hypocortisolism may contribute to increased risk of depressive symptoms as a result of the loss of glucocorticoid attenuation of stress-induced inflammation.