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Cortisol Awakening Response as an Index of Mental Health and Well-Being in Adolescents

Journal of Happiness Studies volume 17, pages 2555–2568 (2016)Cite this article

Abstract

Physiological measures provide a useful complement to self-report indices of mental health and well-being. The cortisol awakening response (CAR) has been associated with mental distress, but less consistently so with positive functioning. In this study, the utility of two CAR indices as a measure of the full spectrum of mental health and well-being in a sample of healthy adolescents was explored. Forty-seven adolescents (14M, 33F; mean age 13.89, SD = .73) completed questionnaires on mental distress and positive functioning, and provided three saliva samples for cortisol analysis as well as demographic and life event information. Correlational analyses revealed that both absolute CAR (CARi) and area under the curve during awakening (CARAUC) indices correlated positively with measures of mental distress, and inversely with measures of positive functioning. When the significant life events score was controlled, moderate to strong effects were maintained with negative and positive affect, mental well-being, satisfaction with life and perceived social support from significant others. These findings provide the first data confirming that CAR is a reliable index of positive functioning in healthy adolescents.

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Notes

  1. DASS-21 scores X2 to enable comparison to DASS-42 normative ranges.

References

  • Adam, E. K. (2006). Transactions among adolescent trait and state emotion and diurnal and momentary cortisol activity in naturalistic settings. Psychoneuroendocrinology, 31, 664–679.

    Article  Google Scholar 

  • Adam, E. K., & Gunnar, M. R. (2001). Relationship functioning and home and work demands predict individual differences in diurnal cortisol patterns in women. Psychoneuroendocrinology, 26, 189–208.

    Article  Google Scholar 

  • Adam, E. K., & Kumari, M. (2009). Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology, 34, 1423–1436.

    Article  Google Scholar 

  • Baumeister, R. F. (2005). The cultural animal: Human nature, meaning, and social life. New York: Oxford University Press.

    Book  Google Scholar 

  • Block, J., & Kremen, A. M. (1996). IQ and ego-resiliency: Conceptual and empirical connections and separateness. Journal of Personality and Social Psychology, 70, 349–361.

    Article  Google Scholar 

  • Burns, J., Morey, C., & Lagelée, M. A. (2007). Reach Out! Innovation in service delivery. Medical Journal of Australia, 187(7), S31–S34.

    Google Scholar 

  • Canty-Mitchell, J., & Zimet, G. D. (2000). Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. American Journal of Community Psychology, 28, 391–400.

    Article  Google Scholar 

  • Chida, Y., & Steptoe, A. (2009). Cortisol awakening response and psychosocial factors: A systematic review and meta-analysis. Biological Psychology, 80, 265–278.

    Article  Google Scholar 

  • Chung, S., Son, G. H., & Kim, K. (2011). Circadian rhythm of adrenal glucocorticoid: Its regulation and clinical implications. Biochimica et Biophysica Acta-Molecular Basis of Disease, 1812, 581–591.

    Article  Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

    Article  Google Scholar 

  • Cohen, S., Doyle, W. J., Turner, R. B., Alper, C. M., & Skoner, D. P. (2003). Emotional Style and Susceptibility to the Common Cold. Psychosomatic Medicine, 65, 652–657.

    Article  Google Scholar 

  • Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.

    Article  Google Scholar 

  • Crawford, J. R., & Henry, J. D. (2004). The Positive and Negative Affect Schedule (PANAS): Construct validity, measurement properties and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 43, 245–265.

    Article  Google Scholar 

  • Davidson, R. J. (2004). Well-being and affective style: Neural substrates and biobehavioural correlates. Philosophical Transactions of the Royal Society London B, 359, 1395–1411.

    Article  Google Scholar 

  • Diener, E. (2000). Subjective well-being: The science of happiness and a proposal for a national index. American Psychologist, 55(1), 34–43.

    Article  Google Scholar 

  • Ditzen, B., Schmidt, S., Strauss, B., Nater, U. M., Ehlert, U., & Heinrichs, M. (2008). Adult attachment and social support interact to reduce psychological but not cortisol responses to stress. Journal of Psychosomatic Research, 64, 479–486.

    Article  Google Scholar 

  • Ellenbogen, M. A., Hodgins, S., Walker, C.-D., Couture, S., & Adam, S. (2006). Daytime cortisol and stress reactivity in the offspring of parents with bipolar disorder. Psychoneuroendocrinology, 31, 1164–1180.

    Article  Google Scholar 

  • Govindji, R., & Linley, P. A. (2007). Strengths use, self-concordance and wellbeing: Implications for strengths coaching and coaching psychologists. International Coaching Psychology Review, 2, 143–153.

    Google Scholar 

  • Greaves-Lord, K., Ferdinand, R. F., Oldehinkel, A. J., Sondeijker, F. E. P. L., Ormel, J., & Verhulst, F. C. (2007). Higher cortisol awakening response in young adolescents with persistent anxiety problems. Acta Psychiatrica Scandinavica, 116, 137–144.

    Article  Google Scholar 

  • Grolnick, W. S., Deci, E. L., & Ryan, R. M. (1997). Internalization within the family: The self-determination theory perspective. In J. E. Grusec & L. Kuczynski (Eds.), Parenting and children’s internalization of values: A handbook of contemporary theory (pp. 135–161). New York: Wiley.

    Google Scholar 

  • Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54, 1389–1398.

    Article  Google Scholar 

  • Huebner, E. S. (1991). Initial development of the Students’ Life Satisfaction Scale. School Psychology International, 12, 231–243.

    Article  Google Scholar 

  • Huppert, F. A., & Johnson, D. M. (2010). A controlled trial of mindfulness training in schools: The importance of practice for an impact on well-being. The Journal of Positive Psychology, 5, 264–274.

    Article  Google Scholar 

  • Kallen, V. L., Tulen, J. H. M., Utens, E. M. W. J., Treffers, P. D. A., de Jong, F. H., & Ferdinand, R. F. (2008). Associations between HPA axis functioning and level of anxiety in children and adolescents with an anxiety disorder. Depression and Anxiety, 25, 131–141.

    Article  Google Scholar 

  • Kern, M. L., Benson, L., Steinberg, E. A., & Steinberg, L. (2015). The EPOCH measure of adolescent well-being. Psychological Assessment. doi:10.1037/pas0000201.

  • Kessler, R. C., Angermeyer, M., Anthony, J. C., de Graaf, R., Demyttenaere, K., et al. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey initiative. World Psychiatry, 6, 168–176.

    Google Scholar 

  • Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548.

    Article  Google Scholar 

  • Kirschbaum, C., & Hellhammer, D. H. (1994). Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19, 313–333.

    Article  Google Scholar 

  • Lai, J. C. L., Evans, P. D., Hung Ng, S., Chong, A. M. L., Siu, O. T., Chan, C. L. W., et al. (2005). Optimism, positive affectivity, and salivary cortisol. British Journal of Health Psychology, 10, 467–484.

  • Laurent, J., Catanzaro, S. J., Joiner, T. E, Jr, Rudolph, K. D., Potter, K. I., Lambert, S., et al. (1999). A measure of positive and negative affect for children: Scale development and preliminary validation. Psychological Assessment, 11, 326–338.

    Article  Google Scholar 

  • Lindfors, P., & Lundberg, U. (2002). Is low cortisol release an indicator of positive health? Stress and Health, 18, 153–160.

    Article  Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation.

    Google Scholar 

  • Niemiec, C. P., Lynch, M. F., Vansteenkiste, M., Bernstein, J., Deci, E. L., & Ryan, R. M. (2006). The antecedents and consequences of autonomous self-regulation for college: A self-determination theory perspective on socialization. Journal of Adolescence, 29, 761–775.

    Article  Google Scholar 

  • O’Donnell, K., Badrick, E., Kumari, M., & Steptoe, A. (2008). Psychological coping styles and cortisol over the day in healthy older adults. Psychoneuroendocrinology, 33, 601–611.

    Article  Google Scholar 

  • Polk, D. E., Cohen, S., Doyle, W. J., Skoner, D. P., & Kirschbaum, C. (2005). State and trait affect as predictors of of salivary cortisol in healthy adults. Psychoneuroendocrinology, 30, 261–272.

    Article  Google Scholar 

  • Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health? Psychological Bulletin, 131, 925–971.

    Article  Google Scholar 

  • Proctor, C., Maltby, J., & Linley, P. A. (2011). Strengths use as a predictor of well-being and health-related quality of life. Journal of Happiness Studies, 12, 153–169.

    Article  Google Scholar 

  • Pruessner, J. C., Hellhammer, D. H., & Kirschbaum, C. (1999). Burnout, perceived stress, and cortisol responses to awakening. Psychosomatic Medicine, 61, 197–204.

    Article  Google Scholar 

  • Pruessner, M., Hellhammer, D. H., Pruessner, J. C., & Lupien, S. J. (2003). Self-reported depressive symptoms and stress levels in healthy young men: Associations with the cortisol response to awakening. Psychosomatic Medicine, 65, 92–99.

    Article  Google Scholar 

  • Ptacek, J., Smith, R. E., Espe, K., & Raffety, B. (1994). Limited correspondence between daily coping reports and restrospective coping recall. Psychological Assessment, 6, 41–49.

    Article  Google Scholar 

  • Rickard, N. S., & Vella-Brodrick, D. A. (2014). Changes in well-being: Complementing a psychosocial approach with neurobiological insights. Social Indicators Research, 117(2), 437–457.

    Article  Google Scholar 

  • Rosal, M. C., King, J., May, Y., & Reed, G. W. (2004). Stress, social support, and cortisol: Inverse associations? Behavioral Medicine, 30, 11–21.

    Article  Google Scholar 

  • Ryff, C. D., & Singer, B. H. (2008). Know thyself and become what you are: A eudaimonic approach to psychological well-being. Journal of Happiness Studies, 9, 13–39.

    Article  Google Scholar 

  • Ryff, C. D., Singer, B. H., & Dienberg Love, G. (2004). Positive health: Connecting well-being with biology. Philosophical Transactions of the Royal Society London B, 359, 1383–1394.

    Article  Google Scholar 

  • Schulz, P., Kirschbaum, C., Pruessner, J., & Hellhammer, D. (1998). Increased free cortisol secretion after awakening in chronically stressed individuals due to work overload. Stress Medicine, 14, 91–97.

    Article  Google Scholar 

  • Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology practice: Empirical validation of interventions. American Psychologist, 60, 410–421.

    Article  Google Scholar 

  • Steptoe, A., Gibson, E. L., Hamer, M., & Wardle, J. (2007). Neuroendocrine and cardiovascular correlates of positive affect measured by ecological momentary assessment and by questionnaire. Psychoneuroendocrinology, 32, 56–64.

    Article  Google Scholar 

  • Steptoe, A., Wardle, J., & Marmot, M. (2005). Positive affect and health-related neuroendocrine, cardiovascular, and inflammatory processes. Proceedings of the National Academy of Sciences, 102(18), 6508–6512.

    Article  Google Scholar 

  • Stone, A. A., Schwartz, J. E., Neale, J. M., Shiffman, S., Marco, C. A., Hickcox, M., et al. (1998). A comparison of coping assessed by ecological momentary assessment and retrospective recall. Journal of Personality and Social Psychology, 74, 1670–1680.

    Article  Google Scholar 

  • Suldo, S. M., & Huebner, E. S. (2004). Does life satisfaction moderate the effects of stressful life events on psychopathological behavior during adolescence? School Psychology Quarterly, 19, 93–105.

    Article  Google Scholar 

  • Suldo, S. M., & Shaffer, E. J. (2008). Looking beyond psychopathology: The dual factor model of mental health in youth. School Psychology Review, 37, 52–68.

    Google Scholar 

  • Szabó, M. (2010). The short version of the Depression Anxiety Stress Scales (DASS-21): Factor structure in a young adolescent sample. Journal of Adolescence, 33, 1–8.

    Article  Google Scholar 

  • Taylor, S. E. (2011). Social support: A review. In M. S. Friedman (Ed.), The handbook of health psychology (pp. 189–214). New York, NY: Oxford University Press.

    Google Scholar 

  • Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., et al. (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Development and UK validation. Health and Quality of Life Outcomes, 5, 63.

    Article  Google Scholar 

  • Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119, 488–531.

    Article  Google Scholar 

  • Vella-Brodrick, D. A., Park, N., & Peterson, C. (2009). Three ways to be happy: Pleasure, engagement, and meaning: Findings from Australian and US samples. Social Indicators Research, 90, 165–179.

    Article  Google Scholar 

  • Waterman, A. S. (2008). Reconsidering happiness: A eudaimonist’s perspective. The Journal Positive Psychology, 3(4), 234–252.

    Article  Google Scholar 

  • Westerhof, G. J., & Keyes, C. L. M. (2010). Mental illness and mental health: The two continua model across the lifespan. Journal of Adult Development, 17, 110–119.

    Article  Google Scholar 

  • World Health Organization. (2011). World Health Statistics 2011. Retrieved from: http://www.who.int/whosis/whostat/2011/en/.

  • Yeaworth, R. C., York, J., Hussey, M. A., Ingle, M. E., & Goodwin, T. (1980). The development of an adolescent life change event scale. Adolescence, 15(57), 91–97.

    Google Scholar 

  • Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G.K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

    Article  Google Scholar 

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Acknowledgments

We gratefully acknowledge the financial support and recruitment opportunities provided by The Reach Foundation, Melbourne Australia.

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Authors and Affiliations

  1. School of Psychological Sciences, Monash University, Clayton, VIC, 3800, Australia

    Nikki S. Rickard

  2. Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC, Australia

    Tan-Chyuan Chin & Dianne A. Vella-Brodrick

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  1. Nikki S. Rickard
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  2. Tan-Chyuan Chin
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  3. Dianne A. Vella-Brodrick
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Correspondence to Nikki S. Rickard.

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Rickard, N.S., Chin, TC. & Vella-Brodrick, D.A. Cortisol Awakening Response as an Index of Mental Health and Well-Being in Adolescents. J Happiness Stud 17, 2555–2568 (2016). https://doi.org/10.1007/s10902-015-9706-9

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Keywords

  • Cortisol
  • Mental health
  • Adolescents
  • Physiological
  • Social support
  • Hedonic well-being
  • Psychological well-being