Evidence map›Paper›PMID 28578301›Full record

SynthesisPsychoneuroendocrinology2017

Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis.

Emma K Adam, Meghan E Quinn, Royette Tavernier, Mollie T McQuillan, Katie A Dahlke, Kirsten E Gilbert

2 registry-linked trialsAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Psychoneuroendocrinology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 424 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
424citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

NCT06821035 narecruitingnot on this mapstarted 2025, after this paper: background citation

Teaching Youth & Families Self-Regulation Skills to Disrupt the Impact of Adverse Childhood Experiences: Preventing Substance Use in Adversity- Impacted Youth

TypeinterventionalSponsorUniversity of California, IrvineRan2025 to 2028Enrolled210ConditionsAdverse Childhood Experiences, Family FunctioningArmsGarnering Resilience in Traumatized youth and families (GRIT), Digital Citizenship Curriculum (DCC)
NCT07464860 narecruitingnot on this mapstarted 2026, after this paper: background citation

A Box Breathing Intervention and the Surgical Stress Response in Older Adults Undergoing Total Knee Arthroplasty: A Randomized Controlled Feasibility Trial

TypeinterventionalSponsorUniversity of ArizonaRan2026 to 2026Enrolled32ConditionsSurgical Stress Response, Stress Physiological, Stress Physiology, Stress PsychologicalArmsA 5-minute Asynchronous Breathwork Intervention, A 5-minute Asynchronous Card Game Video
3 · Its place in the literature

Who cites it

424 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  10. Trial
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  16. Article
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  18. Comparing childhood, chronic, and recent adversity on internalizing symptoms and hypothalamic-pituitary-adrenal axis functioning.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2026
    Article
  19. Review
  20. Article

364 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Emma K AdamSchool of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA. Electronic address: ek-adam@northwestern.edu.
Meghan E QuinnDepartment of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL 60208, USA; Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood St., Chicago, IL, 60612, USA. Electronic address: meghanequinn@gmail.com.
Royette TavernierDepartment of Psychology, Wesleyan University, 207 High Street, Middletown, CT, 06459, USA. Electronic address: rtavernier@wesleyan.edu.
Mollie T McQuillanSchool of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA,. Electronic address: MollieM@u.northwestern.edu.
Katie A DahlkeAmerican Institutes for Research, 1120 E. Diehl Road, Suite 200, Naperville, IL, 60563, USA. Electronic address: kdahlke@air.org.
Kirsten E GilbertDepartment of Psychiatry, Washington University in St. Louis, 4444 Forest Park Parkway, Suite 2100, St. Louis, MO, USA. Electronic address: gilbertk@wustl.edu.

Funding

Developmental Neuroscience and Child PsychopathologyT32MH100019 · NIMH · WASHINGTON UNIVERSITY · PI Deanna Barch, JOAN L. LUBY · 2013 to 2026
$4.8M
Development and Validation of a Comprehensive Stress Battery for AdolescentsR21AA021073 · NIAAA · DE PAUL UNIVERSITY · PI ADAM, EMMA K, GRANT, KATHRYN E · 2011 to 2012
$433k
NIAAA NIH HHS R21 AA021073NIMH NIH HHS T32 MH100019
6 · The paper itself

Abstract

Changes in levels of the stress-sensitive hormone cortisol from morning to evening are referred to as diurnal cortisol slopes. Flatter diurnal cortisol slopes have been proposed as a mediator between chronic psychosocial stress and poor mental and physical health outcomes in past theory and research. Surprisingly, neither a systematic nor a meta-analytic review of associations between diurnal cortisol slopes and health has been conducted to date, despite extensive literature on the topic. The current systematic review and meta-analysis examined associations between diurnal cortisol slopes and physical and mental health outcomes. Analyses were based on 179 associations from 80 studies for the time period up to January 31, 2015. Results indicated a significant association between flatter diurnal cortisol slopes and poorer health across all studies (average effect size, r=0.147). Further, flatter diurnal cortisol slopes were associated with poorer health in 10 out of 12 subtypes of emotional and physical health outcomes examined. Among these subtypes, the effect size was largest for immune/inflammation outcomes (r=0.288). Potential moderators of the associations between diurnal cortisol slopes and health outcomes were examined, including type of slope measure and study quality indices. The possible roles of flatter slopes as either a marker or a mechanism for disease etiology are discussed. We argue that flatter diurnal cortisol slopes may both reflect and contribute to stress-related dysregulation of central and peripheral circadian mechanisms, with corresponding downstream effects on multiple aspects of biology, behavior, and health.

Indexed as

Circadian RhythmEmotionsFemaleHumansHydrocortisoneHypothalamo-Hypophyseal SystemMaleMental HealthPituitary-Adrenal SystemSalivaStress, PsychologicalHydrocortisoneCircadian rhythmsDiurnal cortisol slopesHypothalamic pituitary adrenal (HPA) axisMental healthPhysical health

Identifiers

PMID28578301
PMCPMC5568897

What OpenQuestion holds

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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.