| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
ORIGINAL ARTICLES |
From the Department of Experimental Psychology II (B.M.K., C.K.), University of Düsseldorf, Germany; and the Department of Psychiatry and Behavioral Science (J.E.B.), Applied Behavioral Medicine Research Institute, State University of New York at Stony Brook, Stony Brook, New York.
Address reprint requests to: Clemens Kirschbaum, PhD, Department of Experimental Psychology II, University of Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany. Email: ck{at}uni-duesseldorf.de
OBJECTIVE: Ambulatory saliva collections for subsequent analysis of free cortisol levels are now frequently applied to measure adrenocortical activity in healthy subjects and patient populations. Despite the prime importance of accurate timing of saliva collection outside the laboratory, no data are available on the compliance of study participants following a given sampling protocol. This study investigated how accurately subjects adhered to the instructions to collect six saliva samples throughout 1 day.
METHODS: Subjects were instructed to collect six saliva samples throughout 1 day (directly after awakening, 30 minutes after awakening, 11 AM, 3 PM, 8 PM, 10 PM). Objective compliance was measured using an electronic monitoring device given to the subjects either with ("informed" N = 23) or without ("noninformed" N = 24) their knowledge of the nature of the device. Data on subjective compliance were obtained by self-report.
RESULTS: Thirty-one subjects (74%) were found to comply with the sampling instructions, and 11 (26%) failed at least once to obtain the saliva sample at the correct time of day. Nine of the 11 noncompliant subjects (82%) had two or more noncompliant samples. Fifty-five percent (6 of 11) of the noncompliant subjects took sample 2 outside the sampling window. The circadian cortisol profile differed significantly between compliant and noncompliant subjects (F = 7.98, p = .007). The most important effect of compliance was seen in the rise of cortisol at awakening. Compliant subjects showed a robust increase, whereas noncompliant individuals had only minimal changes from baseline at 30 minutes after awakening (t = 2.89, p = .007). Thus the steepness of the circadian cortisol decline was greater for compliant subjects (t = 2.10, p = .043). Furthermore, the informed group adhered more closely to the sampling protocol than the noninformed subjects (p = .001). Self-reported compliance also differed significantly between study groups (p = .03). In the noninformed group, self-reported sampling accuracy was significantly higher than objectively measured compliance (p = .03); the two measures were similar in the informed group (p = NS).
CONCLUSIONS: A significant number of subjects did not obtain saliva samples reliably in an ambulatory setting. This can partially invalidate the cortisol results and mask potential differences between subject groups of interest. We therefore recommend the use of electronic monitoring devices or other suitable methods and that study participants be informed about the device when ambulatory saliva collection is performed.
Key Words: electronic monitoring, • compliance, • sampling accuracy, • salivary cortisol, • awakening cortisol response, • circadian rhythm.
Abbreviations: ANOVA = analysis of variance;; SEM = standard error of mean.
This article has been cited by other articles:
 |
|
 |
|
  M. Kumari, E. Badrick, T. Chandola, N. E. Adler, E. Epel, T. Seeman, C. Kirschbaum, and M. G. Marmot Measures of Social Position and Cortisol Secretion in an Aging Population: Findings From the Whitehall II Study Psychosom Med, January 1, 2010; 72(1): 27 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kumari, E. Badrick, J. Ferrie, A. Perski, M. Marmot, and T. Chandola Self-Reported Sleep Duration and Sleep Disturbance Are Independently Associated with Cortisol Secretion in the Whitehall II Study J. Clin. Endocrinol. Metab., December 1, 2009; 94(12): 4801 - 4809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. H. J. Dekker, J. W. Koper, M. O. van Aken, H. A. P. Pols, A. Hofman, F. H. de Jong, C. Kirschbaum, J. C. M. Witteman, S. W. J. Lamberts, and H. Tiemeier Salivary Cortisol Is Related to Atherosclerosis of Carotid Arteries J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3741 - 3747. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ditzen, C. Hoppmann, and P. Klumb Positive Couple Interactions and Daily Cortisol: On the Stress-Protecting Role of Intimacy Psychosom Med, October 1, 2008; 70(8): 883 - 889. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Wichers, I. Myin-Germeys, N. Jacobs, G. Kenis, C. Derom, R. Vlietinck, P. Delespaul, R. Mengelers, F. Peeters, N. Nicolson, et al. Susceptibility to Depression Expressed as Alterations in Cortisol Day Curve: A Cross-Twin, Cross-Trait Study Psychosom Med, April 1, 2008; 70(3): 314 - 318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Badrick, M. Bobak, A. Britton, C. Kirschbaum, M. Marmot, and M. Kumari The Relationship between Alcohol Consumption and Cortisol Secretion in an Aging Cohort J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 750 - 757. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. M. Nater, E. Maloney, R. S. Boneva, B. M. Gurbaxani, J.-M. Lin, J. F. Jones, W. C. Reeves, and C. Heim Attenuated Morning Salivary Cortisol Concentrations in a Population-Based Study of Persons with Chronic Fatigue Syndrome and Well Controls J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 703 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Wichers, I. Myin-Germeys, N. Jacobs, F. Peeters, G. Kenis, C. Derom, R. Vlietinck, P. Delespaul, and J. Van Os Genetic risk of depression and stress-induced negative affect in daily life The British Journal of Psychiatry, September 1, 2007; 191(3): 218 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Bosch, C. G. Engeland, J. T. Cacioppo, and P. T. Marucha Depressive Symptoms Predict Mucosal Wound Healing Psychosom Med, September 1, 2007; 69(7): 597 - 605. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Pendry and E. K. Adam Associations between parents' marital functioning, maternal parenting quality, maternal emotion and child cortisol levels International Journal of Behavioral Development, May 1, 2007; 31(3): 218 - 231. [Abstract] [PDF]
|
|
|
|
|
|
E. Badrick, C. Kirschbaum, and M. Kumari The Relationship between Smoking Status and Cortisol Secretion J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 819 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Rohleder, S. E. Beulen, E. Chen, J. M. Wolf, and C. Kirschbaum Stress on the Dance Floor: The Cortisol Stress Response to Social-Evaluative Threat in Competitive Ballroom Dancers Pers Soc Psychol Bull, January 1, 2007; 33(1): 69 - 84. [Abstract] [PDF]
|
|
|
|
 |
|
 E. K. Adam, L. C. Hawkley, B. M. Kudielka, and J. T. Cacioppo Day-to-day dynamics of experience-cortisol associations in a population-based sample of older adults PNAS, November 7, 2006; 103(45): 17058 - 17063. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. C. Mommersteeg, C. J. Heijnen, A. Kavelaars, and L. J. P. van Doornen Immune and Endocrine Function in Burnout Syndrome Psychosom Med, November 1, 2006; 68(6): 879 - 886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Steptoe, L. Brydon, and S. Kunz-Ebrecht Changes in Financial Strain Over Three Years, Ambulatory Blood Pressure, and Cortisol Responses to Awakening Psychosom Med, March 1, 2005; 67(2): 281 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Steptoe, J. Siegrist, C. Kirschbaum, and M. Marmot Effort--Reward Imbalance, Overcommitment, and Measures of Cortisol and Blood Pressure Over the Working Day Psychosom Med, May 1, 2004; 66(3): 323 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Schlotz, J. Hellhammer, P. Schulz, and A. A. Stone Perceived Work Overload and Chronic Worrying Predict Weekend-Weekday Differences in the Cortisol Awakening Response Psychosom Med, March 1, 2004; 66(2): 207 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Steptoe, S. Kunz-Ebrecht, N. Owen, P. J. Feldman, G. Willemsen, C. Kirschbaum, and M. Marmot Socioeconomic Status and Stress-Related Biological Responses Over the Working Day Psychosom Med, May 1, 2003; 65(3): 461 - 470. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
