SynthesisAnnals of behavioral medicine : a publication of the Society of Behavioral Medicine2016
Use of Salivary Diurnal Cortisol as an Outcome Measure in Randomised Controlled Trials: a Systematic Review.
Synthesis in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 48 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
48 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Mobile Health Interventions and RCTs: Structured Taxonomy and Research Framework.Journal of medical systems · 2022Pooled it
- Rigor and Reproducibility: A Systematic Review of Salivary Cortisol Sampling and Reporting Parameters Used in Cancer Survivorship Research.Biological research for nursing · 2019Pooled it
- Adrenal fatigue does not exist: a systematic review.BMC endocrine disorders · 2016Pooled it
- A randomized trial of prenatal cognitive behavioral stress management effects on obstetric health outcomes and infant cortisol levels.Psychoneuroendocrinology · 2026Trial
- Trial
- Effects of suvorexant on diurnal cortisol and patient-reported stress during opioid withdrawal in a randomized trial.Psychoneuroendocrinology · 2025Trial
- Characteristics of salivary cortisol and alpha-amylase as psychobiological study outcomes in palliative care research.BMC palliative care · 2022Trial
- Potential of Saliva in Stroke Patients: A Review.International journal of molecular sciences · 2026Review
- The adrenal is doing what it's supposed to do, you just don't understand it.Neurobiology of stress · 2026Article
- Methodological trends in biological assessment of children's daily stress: A scoping review.PloS one · 2026Article
- Circadian Variation of Salivary Oxytocin in Young Adult Women.Psychophysiology · 2025Article
- Dualistic Dynamics in Neuropsychiatry: From Monoaminergic Modulators to Multiscale Biomarker Maps.Biomedicines · 2025Article
- Mothers' psychopathology and their adult offspring's cortisol level in a Rwandan sample.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2025Article
- How Does Physical Activity Modulate Hormone Responses?Biomolecules · 2024Review
- The researcher's guide to selecting biomarkers in mental health studies.BioEssays : news and reviews in molecular, cellular and developmental biology · 2024Review
- Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study.Interactive journal of medical research · 2024Article
- Salivary Diurnal Cortisol Predicts Post-Traumatic Stress Symptoms in Parents of Infants With Congenital Heart Disease.Biological research for nursing · 2024Article
- Article
- When stress enhances memory encoding: The beneficial effects of changing context.Neurobiology of learning and memory · 2023Article
- For living well, behaviors and circumstances matter just as much as psychological traits.Proceedings of the National Academy of Sciences of the United States of America · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundDysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with diverse adverse health outcomes, making it an important therapeutic target. Measurement of the diurnal rhythm of cortisol secretion provides a window into this system. At present, no guidelines exist for the optimal use of this biomarker within randomised controlled trials (RCTs). PURPOSE: The aim of this study is to describe the ways in which salivary diurnal cortisol has been measured within RCTs of health or behavioural interventions in adults.
methodsSix electronic databases (up to May 21, 2015) were systematically searched for RCTs which used salivary diurnal cortisol as an outcome measure to evaluate health or behavioural interventions in adults. A narrative synthesis was undertaken of the findings in relation to salivary cortisol methodology and outcomes.
resultsFrom 78 studies that fulfilled the inclusion criteria, 30 included healthy participants (38.5 %), 27 included patients with physical disease (34.6 %) and 21 included patients with psychiatric disease (26.9 %). Psychological therapies were most commonly evaluated (n = 33, 42.3 %). There was substantial heterogeneity across studies in relation to saliva collection protocols and reported cortisol parameters. Only 39 studies (50 %) calculated a rhythm parameter such as the diurnal slope or the cortisol awakening response (CAR). Patterns of change in cortisol parameters were inconsistent both within and across studies and there was low agreement with clinical findings.
conclusionsSalivary diurnal cortisol is measured inconsistently across RCTs, which is limiting the interpretation of findings within and across studies. This indicates a need for more validation work, along with consensus guidelines.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.