Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-22T19:22:22.441Z Has data issue: false hasContentIssue false
  • English
  • Français

Exploration of possible sex bias in acute social stress research: a semi-systematic review

Published online by Cambridge University Press:  06 March 2023

Artemida Rrapaj ,
Anne M. Landau Open the ORCID record for Anne M. Landau [Opens in a new window]  and
Michael Winterdahl Open the ORCID record for Michael Winterdahl [Opens in a new window]
Artemida Rrapaj
Affiliation:
Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark
Anne M. Landau
Affiliation:
Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark Department of Nuclear Medicine and PET-Centre, Aarhus University, Aarhus, Denmark
Michael Winterdahl*
Affiliation:
Translational Neuropsychiatry Unit, Aarhus University, Aarhus, Denmark Department of Nuclear Medicine and PET-Centre, Aarhus University, Aarhus, Denmark
*
Author for correspondence: Michael Winterdahl, E-mail: michael.winterdahl@clin.au.dk
Rights & Permissions [Opens in a new window]

Abstract

Stress can have a significant impact on the daily lives of individuals and can increase vulnerability to a number of medical conditions. This study aims to estimate the ratio of male to female participants in acute social stress research in healthy individuals. We examined original research articles published over the last 20 years. Each article was screened to determine the total number of female and male participants. We extracted data from 124 articles involving a total of 9539 participants. A total of 4221 (44.2%) participants were female, 5056 (53.0%) were male and 262 (2.7%) were unreported. Articles incorporating only females were significantly underrepresented compared to articles incorporating only males. Forty articles (63.5%) which presented data from both females and males, failed to analyse and interpret the results by sex, a significant methodological limitation. In conclusion, in the literature published over the last 20 years, female participants are significantly underrepresented. In the studies where females are represented, severe methodological limitations are apparent. Researchers should be conscious of sexual dimorphism, menstrual phase and use of hormonal contraception, which may impact the interpretation of their results.

Keywords

acute stresshypothalamic–pituitary–adrenal axissex biasmenstrual phasehormonal contraceptives
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 35 , Issue 4 , August 2023 , pp. 205 - 217
Check for updates
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

Summations

  • The literature published within acute stress research over the last 20 years has an overall underrepresentation of women.

  • Articles incorporating only females were significantly underrepresented compared to articles incorporating only males.

  • More than half of the articles that included data from both females and males failed to analyse and interpret the results by sex, a significant methodological limitation.

Considerations

  • The current review included 9539 participants sourced from 124 original articles published over 20 years in recognised journals.

  • We did not consider studies on pregnant women, patient populations, post-menopausal women or older adults.

  • We did not provide additional demographic information. However, it is plausible that this information would demonstrate other biases in the field of acute social stress and warrants further investigation.

Introduction

There are notable differences between the sexes in their susceptibility and response to stress (Kirschbaum et al., Reference Kirschbaum, Kudielka, Gaab, Schommer and Hellhammer1999; Rohleder et al., Reference Rohleder, Wolf, Piel and Kirschbaum2003; Uhart et al., Reference Uhart, Chong, Oswald, Lin and Wand2006; Heck and Handa, Reference Heck and Handa2019). The coping mechanisms of men and women vary depending on the nature of the stressor (Kudielka and Kirschbaum, Reference Kudielka and Kirschbaum2005). Men show a more substantial response to stressors involving competition, whereas women react to interpersonal stressors such as social rejection (Kudielka and Kirschbaum, Reference Kudielka and Kirschbaum2005). In response to acute psychosocial stress, the differences between men and women are most pronounced when women are in the follicular phase of the menstrual cycle, characterised by low oestrogen levels (Heck and Handa, Reference Heck and Handa2019; Kudielka and Kirschbaum, Reference Kudielka and Kirschbaum2005). Women’s responses to stress are tightly connected with the gonadal hormones (Verma et al., Reference Verma, Balhara and Gupta2011) and thus vary considerably depending on menstrual phase and use of hormonal contraceptives (HCs) (Herman and Cullinan, Reference Herman and Cullinan1997; Kirschbaum et al., Reference Kirschbaum, Kudielka, Gaab, Schommer and Hellhammer1999). Furthermore, women are at a higher risk of developing stress-related diseases during adolescence and adulthood, supporting the idea that oestrogen and progesterone influence the manifestation of stress-related disorders in adult women (Heck and Handa, Reference Heck and Handa2019).

Original research should therefore be planned and powered to identify factors that may contribute to variations in psychological stress measures such as cortisol. Menstrual cycle phase and use of HCs are obvious candidates for scrutiny (Burrowes, Reference Burrowes2021). Women are underrepresented in a number of fields, such as cardiology (Kentner and Grace, Reference Kentner and Grace2017), sports medicine (Hagstrom et al., Reference Hagstrom, Yuwono, Warton and Ford2021), neuroscience (Beery and Zucker, Reference Beery and Zucker2011), autoimmune dysfunction (Lockshin, Reference Lockshin2006; Fish, Reference Fish2008), pharmacology (Beery and Zucker, Reference Beery and Zucker2011) and physiology (Beery and Zucker, Reference Beery and Zucker2011). The clinical studies focused only on males suggest the results to be applicable to both sexes. However, 80% of the drugs failing clinical trials from the US pharmaceutical market from 1997 to 2000 were due to side effects present solely in women (Burrowes, Reference Burrowes2021). In 1997, the U.S. Food and Drug Administration (FDA), implemented a rule according to which pharmaceutical companies need to ensure the safety of the manufactured drug for both genders (Verma et al., Reference Verma, Balhara and Gupta2011); stating that it is unethical to prescribe a drug to women unless they are included in the studies that aim to understand the disease mechanism. The outcome of such a policy has not gone unnoticed. It has made a difference by increasing the overall number of female participants in the clinical research funded by the US National Institutes of Health (NIH). However, the lack of funding for the medical fields focused on women, such as stress-related disorders or reproductive systems, remains a significant challenge (Burrowes, Reference Burrowes2021).

Researchers exploring the aspects of social stress commonly accept that there are physiological and psychological sex differences (Verma et al., Reference Verma, Balhara and Gupta2011). However, to the best of our knowledge, no authors have examined the number, ratio or percentage of male and female subjects participating in research in this field. Therefore, this study examines the sex of participants involved in social stress research published within the last 20 years.

Materials and methods

This is a semi-systematic review performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Moher et al., Reference Moher, Liberati, Tetzlaff and Altman2009). In total, 124 publications were included in the quantitative synthesis.

Database search

A systematic literature search was performed using the electronic database MEDLINE® via PubMed®. The search was conducted in December 2021, with the following combined set of keywords: [((cortisol) OR (HPA) OR (neuroendocrine) OR (hydrocortisone) OR (psychoneuroimmunology) OR (psychoimmunology) OR (psychoneuroendocrinology)) AND ((“stress reactivity”) OR (“acute stress”) OR (“laboratory stress”) OR (“experimental stress”) OR (“psychological stress”) OR (“mood induction”) OR (“emotion”)) Filters: Abstract, Clinical Trial, Randomized Controlled Trial, from 2000 to 2021]. This search generated 1932 results.

Study selection

One investigator selected the manuscripts based on the title and abstract, followed by a full-text assessment. See Fig. 1 for a graphical representation of the search and selection process. All selected papers met the following inclusion criteria: 1) healthy adult participants, 2) 18–50 years of age, 3) medication-free participants, 4) acute psychological stress, 5) salivary or blood cortisol and 6) at least two measurement points for cortisol. Papers were excluded if they contained at least one of the exclusion criteria such as: 1) pregnant women, 2) subjects under 18 or above 50 years of age, including menopausal women or post-menopausal women, 3) physical or psychological illnesses, 4) chronic stressor studies, 5) physical stressors, 6) physical–psychological combined stressor and 7) urinary or hair cortisol.

Figure 1. The flow chart illustrates the search and selection process of studies for this semi-systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The process includes an initial database search, followed by the screening of titles and abstracts for relevance, and then full-text screening of potentially relevant studies. The excluded studies at each stage are documented along with the reasons for their exclusion. Finally, the included studies are assessed for quality, and the relevant data is extracted for the present semi-systematic review.

Data extraction and analysis

The extracted data are number of women included, number of men included, year of publication and whether or not sex, menstrual cycle phase and HC were taken into account when analysing data. Data were analysed via Chi-square tests. p-Values < 0.05 were considered a priori as significant. Data are presented as percentages.

Results

Data were extracted from 124 articles, listed in Table 1, involving 9539 participants. A total of 4221 (44.2%) participants were female, and 5056 were male (53.0%); the sex of 262 (2.7%) individuals was not reported (Table 2). Females were significantly underrepresented (χ2 = 75.283, df = 1, p < .001). Figure 2 shows the sex of participants from 2000 to 2021.

Figure 2. Male and female participants, as well as individuals where the sex was not reported. Between 2000 and 2021, the percentage of male participants remained relatively stable, while the percentage of individuals where the sex was not reported appeared to decrease slightly, in favour of female participants.

Table 1. Description of studies (N = 124)

The number of female and male participants is listed. Publication year indicates when the manuscript was first made available, for example, online, and may vary from reference. The extent that sex, menstrual cycle phase or hormonal contractions (HC) was included in the analysis is indicated with yes or no when applicable.

Table 2. The sex of participants from 2000 to 2021

Overall, only 15 (12.1%) of the articles incorporated only females, 41 (33.1%) included only males and 63 (50.8%) included both males and females; five articles (4.0%) did not report the sex of their participants (Table 3). Articles incorporating only females were significantly underrepresented compared to articles incorporating only males (χ2 = 29.109, df = 1, p < .001). Figure 3 shows data of the use of male-only, female-only and both sexes as participants from 2000 to 2021.

Figure 3. Articles using male-only, female-only, and both sexes as participants between 2000 and 2021. The percentage of female-only articles remained relatively stable, while those using only males appeared to decrease slightly, in favour of articles that included participants of both sexes.

Table 3. Use of male-only, female-only and both sexes as participants from 2000 to 2021

Only 22 articles (36.5%), which presented data from both females and males, included sex as an experimental variable.

Twenty-six articles (33.3%) on females-only and both females and males included the stage of the participants' oestrous or menstrual cycle phase. Of the articles reporting womens' menstrual cycle phase, 13 articles (50.0%) only included women in the luteal phase, and 4 articles (15.4%) included women in both the follicular and luteal phases. Fifty-two articles (66.7%) did not report menstrual cycle phase, nor was it an inclusion or exclusion criteria.

Forty-two articles, corresponding to 53.8% of all studies on females-only and both females and males, excluded women using HCs. Seven studies (9.0%) included women using HCs, of which only two studies (2.6%) analysed the stress response of women using HCs separately from freely cycling (FC) women; 29 (37.2%) did not mention HCs as inclusion or exclusion criteria.

Discussion

To our knowledge, this is the first study to examine the sex of participants in the acute social stress literature. Here, we present evidence that female participants are significantly underrepresented in the research from the last 20 years. In the studies where females are represented, severe methodological limitations are apparent, including lack of information of menstrual cycle phases or whether participants were HC users.

Research suggests that men and women may differ in their response to acute social stress, both in behaviour and physiology (Otte et al., Reference Otte, Hart, Neylan, Marmar, Yaffe and Mohr2005). For example, men tend to exhibit “fight or flight” responses, which is characterised by increased arousal and readiness for physical action. This response may be due to the influence of higher levels of testosterone. On the other hand, women have a greater likelihood of exhibiting the “tend and befriend” response, which is characterised by increased social behaviour and affiliation (Taylor et al., Reference Taylor, Klein, Lewis, Gruenewald, Gurung and Updegraff2000). This response is mediated by the release of oxytocin and is characterised by seeking support and protection of family and friends, nurturing and caring for others, and increased prosocial behaviour. This response may be due to the influence of higher levels of oestrogen and progesterone, which are associated with social behaviour and attachment to others (Lighthall et al., Reference Lighthall, Sakaki, Vasunilashorn, Nga, Somayajula, Chen, Samii and Mather2012). Furthermore, research suggests that there may be differences in the hypothalamic–pituitary–adrenal (HPA) axis between men and women, which may contribute to behavioural differences triggered by acute social stress. For example, studies have shown that women tend to have higher baseline cortisol levels than men, which may make them more sensitive to stressors. Additionally, women may have a more sensitive HPA axis overall, with greater responsiveness to stressors and a more rapid return to baseline cortisol levels following a stressor (Kajantie and Phillips, Reference Kajantie and Phillips2006).

Females account for 44.2% of the total number of participants in the 124 articles reviewed. Interestingly, the average percentage of female participants was relatively consistent from 2000 to 2021, although both the number of articles and the total number of participants have consistently increased over time, see Table 2 and Fig. 1. Despite the fact that 50.8% of the articles published over this period incorporated both male and female participants, women are underrepresented. This is mainly due to the greater volume of articles consisting of male-only data (33.1%), compared to female-only data (12.1%), and secondly, articles reporting data from both sexes tend to overrepresent male participants and limit the number of female participants. The proportion of female-only articles was relatively consistent from 2000 to 2021, whereas the proportion of male-only articles seems to have experienced a slight decrease in favour of articles incorporating participants of both sexes, see Table 3 and Fig. 2. Furthermore, most of the studies conducted on males do not give a thorough justification of why females were excluded. Only two of the publications stated that females were excluded from the studies due to challenges in studying all women at the same phase of the menstrual cycle (Honk et al., Reference Honk, Tuiten, van den Hout, Koppeschaar, Thijssen, Haan and Verbaten2000; Jönsson et al., Reference Jönsson, Wallergård, Österberg, Hansen, Johansson and Karlson2010). Another publication mentions that females are excluded because the menstrual cycle and birth control pills alter the level of glucocorticoids corticosterone and cortisol (CRT) (Montoya et al., Reference Montoya, Bos, Terburg, Rosenberger and van Honk2014). Only 37.1% of the articles that incorporated male and female participants over the last 20 years included sex as an experimental variable. Thus, most articles failed to recognise potential sex-related differences in susceptibility and response to acute social stress, inadvertently adding variability to their data in cases where sex-related differences exist. Although the increased inclusion of both sexes in the most recent years is encouraging, most of these studies still failed to investigate potential sex differences; they missed the opportunity to uncover how sex influences physiological parameters, for example, cortisol release.

According to Genazzini and co-workers (Genazzani et al., Reference Genazzani, Lemarchand-Béraud, Aubert, Felber, Muller, Lavanchy and Gomez1975), adrenocorticotropic hormone (ACTH) vary across the menstrual cycle phase. Women in the follicular and luteal phases do not have the same salivary-free cortisol response (Maki et al., Reference Maki, Mordecai, Rubin, Sundermann, Savarese, Eatough and Drogos2015). In order to compare the findings between men and women, it is first necessary to specify the phase of the menstrual cycle so the results can be interpreted. Progesterone has an inhibitory role in the HPA axis in women. In other words, the menstrual cycle phase impacts the response of the HPA axis to stress. However, it is still unclear how the sex hormones throughout the menstrual cycle affect the activity of the HPA axis. Consequently, there is a need for further studies to investigate the interaction between sex hormones and the HPA axis. This will facilitate the design of future stress-related experiments. Twenty-six articles (33.3%) on females-only and both females and males included the stage of the participants' oestrous or menstrual cycle phase. Fifty-two articles (66.7%) did not report menstrual cycle phase, nor was it an inclusion or exclusion criteria. Seven studies (Gold et al., Reference Gold, Zakowski, Valdimarsdottir and Bovbjerg2003; Raspopow et al., Reference Raspopow, Abizaid, Matheson and Anisman2010; Zöller et al., Reference Zöller, Maroof, Weik and Deinzer2010; Almela et al., Reference Almela, Hidalgo, Villada, van der Meij, Espín, Gómez-Amor and Salvador2011; Bostock et al., Reference Bostock, Hamer, Wawrzyniak, Mitchell and Steptoe2011; Heimgartner et al., Reference Heimgartner, Meier, Grolimund, Ponti, Arpagaus, Kappeler and Gaab2021; Kothgassner et al., Reference Kothgassner, Goreis, Glenk, Kafka, Beutl, Kryspin-Exner, Hlavacs, Palme and Felnhofer2021) conducted solely in female groups did not provide information about the phase of the menstrual cycle. On the other hand, 40 studies conducted in both sexes did not specify women’s menstrual cycle phase. It is possible for researchers to include only women in a selected phase of the menstrual cycle to compare results between sexes while minimising cost and time, such as the study by Spanakis et al. (Reference Spanakis, Wand, Ji and Golden2016) that selected women during the follicular phase where sex hormone levels are thought to be comparable between men and women. In order to detect the differences between men and women, it has been recommended to compare the male group to two or more groups of women at different menstrual cycle phases (Rich-Edwards et al., Reference Rich-Edwards, Kaiser, Chen, Manson and Goldstein2018). Of the articles reporting womens' menstrual cycle phase, 13 articles (50.0%) only included women in the luteal phase, 9 (34.6%) only included women in the follicular phase and 4 (15.4%) included women in both the follicular and luteal phases.

The women on HCs have a significantly different cortisol rhythm than FC women. In healthy adults, the cortisol level reaches a peak in the morning, approximately 30 minutes after waking up (Boisseau et al., Reference Boisseau, Enea, Diaz, Dugué, Corcuff and Duclos2013; Roche et al., Reference Roche, King, Cohoon and Lovallo2013). On the other hand, the women on HCs have lower cortisol peaks; therefore, the cortisol level does not experience a significant drop (Boisseau et al., Reference Boisseau, Enea, Diaz, Dugué, Corcuff and Duclos2013). In addition, the daily cortisol rhythms are blunted in pill-taking women; consequently, the daily cortisol curve seems to be flatter compared to naturally cycling women (Boisseau et al., Reference Boisseau, Enea, Diaz, Dugué, Corcuff and Duclos2013). The high level of corticosteroid-binding globulins in HC users blunt the cortisol release in response to the stress (Wiegratz et al., Reference Wiegratz, Kutschera, Lee, Moore, Mellinger, Winkler and Kuhl2003; Kumsta et al., Reference Kumsta, Entringer, Hellhammer and Wüst2007). It is suggested that birth control pills hyperactivate the HPA axis, and this causes the HPA axis to shut down. In reality, the pattern of HPA axis in pill-taking women is very similar to women with chronic stress (Miller et al., Reference Miller, Chen and Zhou2007; Hertel et al., Reference Hertel, König, Homuth, van der Auwera, Wittfeld, Pietzner, Kacprowski, Pfeiffer, Kretschmer, Waldenberger, Kastenmüller, Artati, Suhre, Adamski, Langner, Völker, Völzke, Nauck, Friedrich and Grabe2017). However, this remains a hypothesis and requires research to identify the role that HCs may play and the potential reversibility of effects upon cessation of HC use. Recent studies have found that hormonal contraception may impact the oxytocin system (Garforth et al., Reference Garforth, Degnbol, Terris, Zak and Winterdahl2020); however, more research is needed to understand the nature and magnitude of these effects on acute social stress, behaviour and cognition (Byg et al., Reference Byg, Dioni and Winterdahl2023). Forty-two articles, corresponding to 53.8% of all studies on females-only and both females and males, excluded women using HCs. Four studies (Walser et al., Reference Walser, Fischer, Goschke, Kirschbaum and Plessow2013; Abelson et al., Reference Abelson, Erickson, Mayer, Crocker, Briggs, Lopez-Duran and Liberzon2014; Creswell et al., Reference Creswell, Pacilio, Lindsay and Brown2014; Meier et al., Reference Meier, Wirz, Dickinson and Pruessner2021) had HC use as an exclusion criterion for women but did not exclude men on exogenous androgens and anabolic steroids. Surprisingly, 29 studies (37.2%) did not mention HCs as inclusion or exclusion criteria. Only seven studies (9.0%) included women using HCs (Rohleder et al., Reference Rohleder, Wolf, Piel and Kirschbaum2003; Hammerfald et al., Reference Hammerfald, Eberle, Grau, Kinsperger, Zimmermann, Ehlert and Gaab2006; Kumsta et al., Reference Kumsta, Entringer, Hellhammer and Wüst2007; Pilgrim et al., Reference Pilgrim, Ellenbogen and Paquin2014; Herbison et al., Reference Herbison, Henley, Marsh, Atkinson, Newnham, Matthews, Lye and Pennell2016; Ditzen et al., Reference Ditzen, Germann, Meuwly, Bradbury, Bodenmann and Heinrichs2019; Sandner et al., Reference Sandner, Lois, Streit, Zeier, Kirsch, Wüst and Wessa2020) of which only two studies (2.6%) analysed the stress response of women using HCs (Boisseau et al., Reference Boisseau, Enea, Diaz, Dugué, Corcuff and Duclos2013; Hertel et al., Reference Hertel, König, Homuth, van der Auwera, Wittfeld, Pietzner, Kacprowski, Pfeiffer, Kretschmer, Waldenberger, Kastenmüller, Artati, Suhre, Adamski, Langner, Völker, Völzke, Nauck, Friedrich and Grabe2017) separately from FC women and concluded that HC use impacts the HPA axis response to stress.

It is difficult to provide a specific rationale for the sex bias in the acute social stress literature, and a range of physiological and methodological issues likely contribute. Women have been excluded from biomedical research over the years under the assumption that the results from studies on men apply to females or that the variation of sex hormones throughout the menstrual cycle makes the interpretation challenging. However, other studies do not justify the exclusion of women (Beery and Zucker, Reference Beery and Zucker2011). Furthermore, there is still a misconception that women are more variable than men. Both males and females have variations in gonadal steroid hormones. Testosterone has a circadian rhythm, and its level is affected by factors such as physical exercise and age (Smith et al., Reference Smith, Coward, Kovac and Lipshultz2013). In comparison, reproductive females have a fluctuation of gonadal hormones throughout the phases of the menstrual cycle (Rich-Edwards et al., Reference Rich-Edwards, Kaiser, Chen, Manson and Goldstein2018). Treating males as the norm comes with the consequence of placing women’s health at risk. It is beneficial to science to include both sexes in order to get a full insight into the mechanisms of the HPA axis. It is not possible to elucidate stress response mechanisms by studying only males. The consideration of both sexes in stress-related research will advance our knowledge and lead to the development of safer products and therapies for stress-related disorders, minimising their side effects. The very least, the presentation of the data of both sexes can improve the design of future studies. The differences in methodological design are thought to be a main reason for inconsistent results across studies (Rich-Edwards et al., Reference Rich-Edwards, Kaiser, Chen, Manson and Goldstein2018).

Original research should be planned and powered to identify factors that may contribute to variations in acute social stress measures such as cortisol, including sex, menstrual cycle and oral contraceptive use. By doing so, the findings will be more robust, generalisable and informative. Ensuring that a study has enough statistical power to distinguish different stress responses between, for example, men vs women, different phases of the menstrual cycle and hormonal contraception users vs natural cycling women, requires careful planning and consideration of several factors. Some key considerations include the following: using the correct statistical model, both analysis of variance (ANOVA) and a general linear model (GLM) can be used to model the relationship between a continuous dependent variable (such as cortisol levels or responses) and one or more independent variables (such as sex, menstrual cycle phase and hormonal contraception use). By including these variables in the model, the study would be able to test for main effects of sex, menstrual cycle phase and hormonal contraception use on the measures of choice, as well as for any interactions between these variables. The main difference between ANOVA and GLM approach is that ANOVA is used to compare the means of two or more groups and assumes normality and homogeneity of variances, while GLM can be used to model a relationship between a continuous dependent variable and one or more independent variables and assumes linearity and normality of residuals. GLM can also be extended to include other explanatory variables such as age, BMI and lifestyle factors that may influence, for example, cortisol levels and can be used to model non-normal distributions of the response variable, and it allows to include categorical and continuous variables. Furthermore, the sample size of a study is one of the most critical factors in determining statistical power. Larger sample sizes increase the likelihood of detecting significant differences between groups, so it is important to ensure that the study has a large enough sample size to detect differences in stress hormones between men and women. It is important to control for any confounding variables that may affect stress hormones such as age, lifestyle and other hormones. Finally, as multiple comparisons are made with biological samples across different groups, it may be important to adjust the significance level to take into account the increased chance of finding false positives.

Limitations and future research

A strength of the current study is the number of participants (9539) sourced from original articles published over 20 years in recognised journals. However, the current review did not consider the following in the analysis: studies involving multiple publications based on data from the same population/sample, studies on pregnant women or patient populations or studies on post-menopausal women and older adults. Finally, due to the large number of participants, we did not provide additional demographic information. It is plausible that this information would demonstrate other biases in the field of acute social stress and warrants further investigation.

Conclusion

The current study demonstrated that female participants are still underrepresented in the acute social stress literature. Absolute numbers and percentage of female participants are significantly lower than males. More importantly, the ratio of articles that included only males to articles that only included females is two-fold greater across the literature. We stress the importance of reporting menstrual cycle phase information and HC use in studies presenting female data, and we encourage the comparison of male and female data in order to uncover potential important sex differences, which may be of utmost importance for drug development and providing appropriate medical care to both sexes.

Data availability

The data that support the findings of this study are available on request from the corresponding author.

Acknowledgements

We thank Marie Vadstrup Pedersen for assistance and feedback.

Author contributions

AR and MR conceptualised the study. AR extracted data, analysed and wrote the first draft under the supervision of MW and AL. All authors have edited and approved the submitted version and take responsibility for the integrity of the findings.

Funding statement

AR’s salary was supported by the ERASMUS programme at University of Wrocław.

Conflict of interest

None.

References

Abelson, JL, Erickson, TM, Mayer, SE, Crocker, J, Briggs, H, Lopez-Duran, NL and Liberzon, I (2014) Brief cognitive intervention can modulate neuroendocrine stress responses to the Trier Social Stress Test: buffering effects of a compassionate goal orientation. Psychoneuroendocrinology 44, 60–70. doi: 10.1016/J.PSYNEUEN.2014.02.016.CrossRefGoogle Scholar
Ali, N, Nitschke, JP, Cooperman, C, Baldwin, MW and Pruessner, JC (2020) Systematic manipulations of the biological stress systems result in sex-specific compensatory stress responses and negative mood outcomes. Neuropsychopharmacology 45(10), 1672–1680. doi: 10.1038/s41386-020-0726-8.CrossRefGoogle ScholarPubMed
Ali, N, Nitschke, JP, Cooperman, C and Pruessner, JC (2017) Suppressing the endocrine and autonomic stress systems does not impact the emotional stress experience after psychosocial stress. Psychoneuroendocrinology 78, 125–130. doi: 10.1016/j.psyneuen.2017.01.015.CrossRefGoogle Scholar
Almela, M, Hidalgo, V, Villada, C, van der Meij, L, Espín, L, Gómez-Amor, J and Salvador, A (2011) Salivary alpha-amylase response to acute psychosocial stress: the impact of age. Biological Psychology 87(3), 421–429. doi: 10.1016/J.BIOPSYCHO.2011.05.008.CrossRefGoogle ScholarPubMed
Appiah-Kusi, E, Petros, N, Wilson, R, Colizzi, M, Bossong, MG, Valmaggia, L, Mondelli, V, McGuire, P and Bhattacharyya, S (2020) Effects of short-term cannabidiol treatment on response to social stress in subjects at clinical high risk of developing psychosis. Psychopharmacology (Berl). 237(4), 1121–1130. doi: 10.1007/s00213-019-05442-6.CrossRefGoogle ScholarPubMed
Balodis, IM, Wynne-Edwards, KE and Olmstead, MC (2010) The other side of the curve: examining the relationship between pre-stressor physiological responses and stress reactivity. Psychoneuroendocrinology 35(9), 1363–1373. doi: 10.1016/j.psyneuen.2010.03.011.CrossRefGoogle ScholarPubMed
Bedgood, D, Boggiano, MM and Turan, B (2014) Testosterone and social evaluative stress: the moderating role of basal cortisol. Psychoneuroendocrinology 47, 107–115. doi: 10.1016/j.psyneuen.2014.05.007.CrossRefGoogle ScholarPubMed
Bellingrath, S and Kudielka, BM (2008) Effort-reward-imbalance and overcommitment are associated with hypothalamus-pituitary-adrenal (HPA) axis responses to acute psychosocial stress in healthy working schoolteachers. Psychoneuroendocrinology 33(10), 1335–1343. doi: 10.1016/J.PSYNEUEN.2008.07.008.CrossRefGoogle ScholarPubMed
Beery, AK and Zucker, I (2011) Sex bias in neuroscience and biomedical research. Neuroscience & Biobehavioral Reviews 35(3), 565–572. doi: 10.1016/J.NEUBIOREV.2010.07.002.CrossRefGoogle ScholarPubMed
Blackhart, GC, Eckel, LA and Tice, DM (2007) Salivary cortisol in response to acute social rejection and acceptance by peers. Biological Psychology 75(3), 267–276. doi: 10.1016/j.biopsycho.2007.03.005.CrossRefGoogle ScholarPubMed
Bohringer, A, Schwabe, L, Richter, S and Schachinger, H (2008) Intranasal insulin attenuates the hypothalamic-pituitary-adrenal axis response to psychosocial stress. Psychoneuroendocrinology 33(10), 1394–1400. doi: 10.1016/j.psyneuen.2008.08.002.CrossRefGoogle ScholarPubMed
Boisseau, N, Enea, C, Diaz, V, Dugué, B, Corcuff, JB and Duclos, M (2013) Oral contraception but not menstrual cycle phase is associated with increased free cortisol levels and low hypothalamo-pituitary-adrenal axis reactivity. Journal of Endocrinological Investigation 36, 955–964. doi: 10.3275/8971.Google Scholar
Bostock, S, Hamer, M, Wawrzyniak, AJ, Mitchell, ES and Steptoe, A (2011) Positive emotional style and subjective, cardiovascular and cortisol responses to acute laboratory stress. Psychoneuroendocrinology 36(8), 1175–1183. doi: 10.1016/J.PSYNEUEN.2011.02.009.CrossRefGoogle ScholarPubMed
Bottaccioli, AG, Bottaccioli, F, Carosella, A, Cofini, V, Muzi, P and Bologna, M (2020) Psychoneuroendocrinoimmunology-Based meditation (PNEIMED) training reduces salivary cortisol under basal and stressful conditions in healthy university students: Results of a randomized controlled study. Explore (NY) 16(3), 189–198. doi: 10.1016/j.explore.2019.10.006.CrossRefGoogle ScholarPubMed
Burrowes, K (2021) Gender bias in medicine and medical research is still putting women’s health at risk [WWW Document]. URL: Available at https://theconversation.com/gender-bias-in-medicine-and-medical-research-is-still-putting-womens-health-at-risk-156495, (accessed 7.28.22).Google Scholar
Burton, CL, Bonanno, GA and Hatzenbuehler, ML (2014) Familial social support predicts a reduced cortisol response to stress in sexual minority young adults. Psychoneuroendocrinology 47, 241–245. doi: 10.1016/j.psyneuen.2014.05.013.CrossRefGoogle ScholarPubMed
Busse, D, Yim, IS and Campos, B (2017) Social context matters: Ethnicity, discrimination and stress reactivity. Psychoneuroendocrinology. 83, 187–193. doi: 10.1016/j.psyneuen.2017.05.025.CrossRefGoogle ScholarPubMed
Byg, MN, Dioni, A and Winterdahl, M (2023) No decrease in perseverance and performance on cognitive tasks in Danish cohort of hormonal contraceptive users. Acta Neuropsychiatrica 1-6, 1–6. doi: 10.1017/NEU.2023.7.Google ScholarPubMed
Childs, E, O’Connor, S and de Wit, H (2011) Bidirectional interactions between acute psychosocial stress and acute intravenous alcohol in healthy men. Alcoholism: Clinical and Experimental Research 35(10), 1794–1803. doi: 10.1111/j.1530-0277.2011.01522.x.CrossRefGoogle ScholarPubMed
Childs, E, Childs, S and de Wit, H (2010) Effects of acute psychosocial stress on cigarette craving and smoking. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco 12(4), 449–453. doi: 10.1093/NTR/NTP214.CrossRefGoogle ScholarPubMed
Childs, E., Vicini, LM and De Wit, H. (2006) Responses to the Trier Social Stress Test (TSST) in single versus grouped participants. Psychophysiology, 43, 366–371. doi: 10.1111/j.1469-8986.2006.00414.x.CrossRefGoogle Scholar
Cornelisse, S, van Stegeren, AH and Joëls, M (2011) Implications of psychosocial stress on memory formation in a typical male versus female student sample. Psychoneuroendocrinology, 36(4), 569–578. doi: 10.1016/J.PSYNEUEN.2010.09.002.CrossRefGoogle Scholar
Crane, MF, Kangas, M, Karin, E, Searle, B and Chen, D (2020) Leveraging the experience of stressors: the role of adaptive systematic self-reflection. Anxiety Stress Coping 33(3), 231–247. doi: 10.1080/10615806.2020.1732359.CrossRefGoogle ScholarPubMed
Creswell, JD, Pacilio, LE, Lindsay, EK and Brown, KW (2014) Brief mindfulness meditation training alters psychological and neuroendocrine responses to social evaluative stress. Psychoneuroendocrinology 44, 1–12. doi: 10.1016/J.PSYNEUEN.2014.02.007.CrossRefGoogle ScholarPubMed
Dickerson, SS, Mycek, PJ and Zaldivar, F (2008) Negative social evaluation, but not mere social presence, elicits cortisol responses to a laboratory stressor task. Journal of Health Psychology 27(1), 116–121. doi: 10.1037/0278-6133.27.1.116.CrossRefGoogle Scholar
Ditzen, B, Germann, J, Meuwly, N, Bradbury, TN, Bodenmann, G and Heinrichs, M (2019) Intimacy as related to cortisol reactivity and recovery in couples undergoing psychosocial stress. Psychosomatic Medicine 81(1), 16–25. doi: 10.1097/PSY.0000000000000633.CrossRefGoogle ScholarPubMed
Ditzen, B, Schmidt, S, Strauss, B, Nater, UM, Ehlert, U and Heinrichs, M (2008) Adult attachment and social support interact to reduce psychological but not cortisol responses to stress. Journal of Psychosomatic Research 64(5), 479–486. doi: 10.1016/j.jpsychores.2007.11.011.CrossRefGoogle Scholar
Domes, G, Heinrichs, M, Rimmele, U, Reichwald, U and Hautzinger, M (2009) Acute stress impairs recognition for positive words--association with stress-induced cortisol secretion. Stress 7(3), 173–181. doi: 10.1080/10253890412331273213.CrossRefGoogle Scholar
Eller, NH, Netterstrøm, B, Hansen, ÅM (20006) Psychosocial factors at home and at work and levels of salivary cortisol. Biological Psychology 73(3), 280–287. doi: 10.1016/J.BIOPSYCHO.2006.05.003.CrossRefGoogle Scholar
Elzinga, BM and Roelofs, K (2005) Cortisol-induced impairments of working memory require acute sympathetic activation. doi: 10.1037/0735-7044.119.1.98.CrossRefGoogle Scholar
Engert, V, Vogel, S, Efanov, SI, Duchesne, A, Corbo, V, Ali, N and Pruessner, JC (2011) Investigation into the cross-correlation of salivary cortisol and alpha-amylase responses to psychological stress. Psychoneuroendocrinology 36(9), 1294–1302. doi: 10.1016/j.psyneuen.2011.02.018.CrossRefGoogle ScholarPubMed
Fish, EN (2008) The X-files in immunity: sex-based differences predispose immune responses. Nature Reviews Immunology 8(9), 737–744. doi: 10.1038/NRI2394.CrossRefGoogle ScholarPubMed
Fries, E, Hellhammer, D, Hellhammer, J (2006) Attenuation of the hypothalamic-pituitary-adrenal axis responsivity to the Trier Social Stress Test by the benzodiazepine alprazolam. Psychoneuroendocrinology 31, 1278–1288. doi: 10.1016/j.psyneuen.2006.09.009.CrossRefGoogle Scholar
Gaab, J, Blättler, N, Menzi, T, Pabst, B, Stoyer, S and Ehlert, U (2003) Randomized controlled evaluation of the effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology 28(6), 767–779. doi: 10.1016/s0306-4530(02)00069-0.CrossRefGoogle ScholarPubMed
Gaab, J, Rohleder, N, Nater, UM and Ehlert, U (2005) Psychological determinants of the cortisol stress response: the role of anticipatory cognitive appraisal. Psychoneuroendocrinology 30(6), 599–610. doi: 10.1016/j.psyneuen.2005.02.001.CrossRefGoogle ScholarPubMed
Gallego-Gómez, JI, Balanza, S, Leal-Llopis, J, García-Méndez, JA, Oliva-Pérez, J, Doménech-Tortosa, J, Gómez-Gallego, M, Simonelli-Muñoz, AJ and Rivera-Caravaca, JM (2020) Effectiveness of music therapy and progressive muscle relaxation in reducing stress before exams and improving academic performance in Nursing students: A randomized trial. Nurse Education Today 84, 104217. doi: 10.1016/j.nedt.2019.104217.CrossRefGoogle ScholarPubMed
Garforth, B, Degnbol, H, Terris, ET, Zak, PJ and Winterdahl, M (2020) Elevated plasma oxytocin levels and higher satisfaction with life in young oral contraceptive users. Scientific Reports 10(1), 8208. doi: 10.1038/S41598-020-64528-W.CrossRefGoogle ScholarPubMed
Genazzani, AR, Lemarchand-Béraud, T, Aubert, ML, Felber, JP, Muller, A, Lavanchy, M and Gomez, J (1975) Pattern of plasma ACTH, hGH, and cortisol during menstrual cycle. The Journal of Clinical Endocrinology & Metabolism 41(3), 431–437. doi: 10.1210/JCEM-41-3-431.CrossRefGoogle ScholarPubMed
Gideon, A, Sauter, C, Fieres, J, Berger, T, Renner, B and Wirtz, PH (2020) Kinetics and interrelations of the renin aldosterone response to acute psychosocial stress: a neglected stress system. Journal of Clinical Endocrinology and Metabolism 105(3), e762–e773. doi: 10.1210/clinem/dgz190.CrossRefGoogle Scholar
Gold, SM, Zakowski, SG, Valdimarsdottir, HB and Bovbjerg, DH (2003) Stronger endocrine responses after brief psychological stress in women at familial risk of breast cancer. Psychoneuroendocrinology 28(4), 584–593. doi: 10.1016/S0306-4530(02)00046-X.CrossRefGoogle ScholarPubMed
Gruenewald, TL, Kemeny, ME, Aziz, N and Fahey, JL (2004) Acute threat to the social self: shame, social self-esteem, and cortisol activity. Psychosomatic Medicine 66(6), 915–924. doi: 10.1097/01.psy.0000143639.61693.ef.CrossRefGoogle Scholar
Hagstrom, AD, Yuwono, N, Warton, K and Ford, CE (2021) Sex bias in cohorts included in sports medicine research. Sports Medicine 51(8), 1799–1804. doi: 10.1007/S40279-020-01405-6/TABLES/1.CrossRefGoogle ScholarPubMed
Hammerfald, K, Eberle, C, Grau, M, Kinsperger, A, Zimmermann, A, Ehlert, U and Gaab, J (2006) Persistent effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects—a randomized controlled trial. Psychoneuroendocrinology 31(3), 333–339. doi: 10.1016/J.PSYNEUEN.2005.08.007.CrossRefGoogle ScholarPubMed
Hänsel, A and von Känel, R (2013) Unconscious fearful priming followed by a psychosocial stress test results in higher cortisol levels. Stress Health 29(4), 317–323. doi: 10.1002/smi.2469.Google ScholarPubMed
Heck, AL and Handa, RJ (2019) Sex differences in the hypothalamic-pituitary-adrenal axis’ response to stress: an important role for gonadal hormones. Neuropsychopharmacology 44(1), 45–58. doi: 10.1038/S41386-018-0167-9.CrossRefGoogle ScholarPubMed
Heimgartner, N, Meier, S, Grolimund, S, Ponti, S, Arpagaus, S, Kappeler, F and Gaab, J (2021) Randomized controlled evaluation of the psychophysiological effects of social support stress management in healthy women. PLoS One 16(6), e0252568. doi: 10.1371/JOURNAL.PONE.0252568.CrossRefGoogle ScholarPubMed
Hellhammer, J, Fries, E, Buss, C, Engert, V, Tuch, A, Rutenberg, D and Hellhammer, D (2004) Effects of soy lecithin phosphatidic acid and phosphatidylserine complex (PAS) on the endocrine and psychological responses to mental stress. Stress 7(2), 119–126. doi: 10.1080/10253890410001728379.CrossRefGoogle ScholarPubMed
Herbison, CE, Henley, D, Marsh, J, Atkinson, H, Newnham, JP, Matthews, SG, Lye, SJ and Pennell, CE (2016) Characterization and novel analyses of acute stress response patterns in a population-based cohort of young adults: influence of gender, smoking, and BMI. Stress - The International Journal on The Biology of Stress 19(2), 139–150. doi: 10.3109/10253890.2016.1146672.CrossRefGoogle Scholar
Herman, JP and Cullinan, WE (1997) Neurocircuitry of stress: central control of the hypothalamo-pituitary-adrenocortical axis. Trends in Neurosciences 20(2), 78–84. doi: 10.1016/S0166-2236(96)10069-2.CrossRefGoogle ScholarPubMed
Hermann, R, Schaller, A, Lay, D, Bloch, W, Albus, C and Petrowski, K (2021) Effect of acute psychosocial stress on the brain-derived neurotrophic factor in humans - a randomized cross within trial. Stress 24(4), 442–449. doi: 10.1080/10253890.2020.1854218.CrossRefGoogle ScholarPubMed
Hertel, J, König, J, Homuth, G, van der Auwera, S, Wittfeld, K, Pietzner, M, Kacprowski, T, Pfeiffer, L, Kretschmer, A, Waldenberger, M, Kastenmüller, G, Artati, A, Suhre, K, Adamski, J, Langner, S, Völker, U, Völzke, H, Nauck, M, Friedrich, N and Grabe, HJ (2017) Evidence for stress-like alterations in the HPA-axis in women taking oral contraceptives. Scientific Reports 7(1 7), 1–14. doi: 10.1038/s41598-017-13927-7.CrossRefGoogle ScholarPubMed
Het, S and Wolf, OT (2007) Mood changes in response to psychosocial stress in healthy young women: effects of pretreatment with cortisol. Behavioral Sciences 121(1), 11–20. doi: 10.1037/0735-7044.121.1.11.Google ScholarPubMed
Het, S, Schoofs, D, Rohleder, N and Wolf, OT (2012) Stress-induced cortisol level elevations are associated with reduced negative affect after stress: indications for a mood-buffering cortisol effect. Psychosomatic Medicine 74(1), 23–32. doi: 10.1097/PSY.0B013E31823A4A25.CrossRefGoogle ScholarPubMed
Honk, Jvan, Tuiten, A, van den Hout, M, Koppeschaar, H, Thijssen, J, Haan, Ede and Verbaten, R (2000) Conscious and preconscious selective attention to social threat: different neuroendocrine response patterns. Psychoneuroendocrinology 25(6), 577–591. doi: 10.1016/S0306-4530(00)00011-1.CrossRefGoogle ScholarPubMed
Huebner, DM, McGarrity, LA, Perry, NS, Spivey, LA and Smith, TW (2021) Cardiovascular and cortisol responses to experimentally-induced minority stress. Health Psychology 40(5), 316–325. doi: 10.1037/hea0001067.CrossRefGoogle ScholarPubMed
Jackson, ED, Payne, JD, Nadel, L and Jacobs, WJ (2006) Stress differentially modulates fear conditioning in healthy men and women. Biological Psychiatry 59(6), 516–522. doi: 10.1016/j.biopsych.2005.08.002.CrossRefGoogle ScholarPubMed
Jönsson, P, Wallergård, M, Österberg, K, Hansen, Å.M, Johansson, G and Karlson, B (2010) Cardiovascular and cortisol reactivity and habituation to a virtual reality version of the Trier Social Stress Test: a pilot study. Psychoneuroendocrinology 35(9), 1397–1403. doi: 10.1016/J.PSYNEUEN.2010.04.003.CrossRefGoogle ScholarPubMed
Kajantie, E and Phillips, DIW (2006) The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology 31(2), 151–178. doi: 10.1016/J.PSYNEUEN.2005.07.002.CrossRefGoogle ScholarPubMed
Kentner, AC and Grace, SL (2017) Between mind and heart: sex-based cognitive bias in cardiovascular disease treatment. Frontiers in Neuroendocrinology 45, 18–24. doi: 10.1016/J.YFRNE.2017.02.002.CrossRefGoogle ScholarPubMed
Kimura, K, Izawa, S, Sugaya, N, Ogawa, N, Yamada, KC, Shirotsuki, K, Mikami, I, Hirata, K, Nagano, Y and Hasegawa, T (2013) The biological effects of acute psychosocial stress on delay discounting. Psychoneuroendocrinology. 38(10), 2300–2308. doi: 10.1016/j.psyneuen.2013.04.019.CrossRefGoogle ScholarPubMed
Kirschbaum, C, Kudielka, BM, Gaab, J, Schommer, NC and Hellhammer, DH (1999) Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis. Psychosomatic Medicine 61(2), 154–162. doi: 10.1097/00006842-199903000-00006.CrossRefGoogle ScholarPubMed
Kothgassner, OD, Goreis, A, Glenk, LM, Kafka, JX, Beutl, L, Kryspin-Exner, I, Hlavacs, H, Palme, R and Felnhofer, A (2021) Virtual and real-life ostracism and its impact on a subsequent acute stressor. Physiology & Behavior 228, 113205. doi: 10.1016/J.PHYSBEH.2020.113205.CrossRefGoogle ScholarPubMed
Kudielka, BM, Buske-Kirschbaum, A, Hellhammer, DH and Kirschbaum, C (2004) HPA axis responses to laboratory psychosocial stress in healthy elderly adults, younger adults, and children: impact of age and gender. Psychoneuroendocrinology 29(1), 83–98. doi: 10.1016/s0306-4530(02)00146-4.CrossRefGoogle ScholarPubMed
Kudielka, BM and Kirschbaum, C (2005) Sex differences in HPA axis responses to stress: a review. Biological Psychology 69(1), 113–132. doi: 10.1016/J.BIOPSYCHO.2004.11.009.CrossRefGoogle ScholarPubMed
Kudielka, BM, Schommer, NC, Hellhammer, DH and Kirschbaum, C (2004) Acute HPA axis responses, heart rate, and mood changes to psychosocial stress (TSST) in humans at different times of day. Psychoneuroendocrinology 29(8), 983–992. doi: 10.1016/j.psyneuen.2003.08.009.CrossRefGoogle ScholarPubMed
Kumsta, R, Entringer, S, Hellhammer, DH and Wüst, S (2007) Cortisol and ACTH responses to psychosocial stress are modulated by corticosteroid binding globulin levels. Psychoneuroendocrinology 32(8-10), 1153–1157. doi: 10.1016/J.PSYNEUEN.2007.08.007.CrossRefGoogle ScholarPubMed
Lamarche, L, Ozimok, B, Gammage, KL and Muir, C (2017) Men respond too: the effects of a social-evaluative body image threat on shame and cortisol in university men. American Journal of Men's Health 11(6), 1791–1803. doi: 10.1177/1557988317723406.CrossRefGoogle ScholarPubMed
Leininger, S and Skeel, R (2012) Cortisol and self-report measures of anxiety as predictors of neuropsychological performance. Archives of Clinical Neuropsychology 27(3), 318–328. doi: 10.1093/arclin/acs035.CrossRefGoogle ScholarPubMed
Lighthall, NR, Sakaki, M, Vasunilashorn, S, Nga, L, Somayajula, S, Chen, EY, Samii, N and Mather, M (2012) Gender differences in reward-related decision processing under stress. Social Cognitive and Affective Neuroscience 7(4), 476–484. doi: 10.1093/SCAN/NSR026.CrossRefGoogle ScholarPubMed
Linnen, AM, Ellenbogen, MA, Cardoso, C and Joober, R (2012) Intranasal oxytocin and salivary cortisol concentrations during social rejection in university students. Stress 15(4), 393–402. doi: 10.3109/10253890.2011.631154.CrossRefGoogle ScholarPubMed
Lockshin, MD (2006) Sex differences in autoimmune disease. Lupus 15(11), 753–756. doi: 10.1177/0961203306069353.CrossRefGoogle ScholarPubMed
Lovallo, WR, Farag, NH and Vincent, AS (2010) Use of a resting control day in measuring the cortisol response to mental stress: diurnal patterns, time of day, and gender effects. Psychoneuroendocrinology 35(8), 1253–1258. doi: 10.1016/j.psyneuen.2010.02.015.CrossRefGoogle Scholar
Maheu, FS, Collicutt, P, Kornik, R, Moszkowski, R and Lupien, SJ (2005) The perfect time to be stressed: a differential modulation of human memory by stress applied in the morning or in the afternoon. Progress in Neuro-Psychopharmacology & Biological Psychiatry 29(8), 1281–1288. doi: 10.1016/j.pnpbp.2005.08.012.CrossRefGoogle ScholarPubMed
Maki, PM, Mordecai, KL, Rubin, LH, Sundermann, E, Savarese, A, Eatough, E and Drogos, L (2015) Menstrual cycle effects on cortisol responsivity and emotional retrieval following a psychosocial stressor. Hormones and Behavior 74, 201–208. doi: 10.1016/J.YHBEH.2015.06.023.CrossRefGoogle ScholarPubMed
Manigault, AW, Zoccola, PM, Wüst, S and Yim, IS (2020) Corroborative evidence for an association between initial hypothalamic-pituitary-adrenocortical axis reactivity and subsequent habituation in humans. Psychoneuroendocrinology. 121, 104798. doi: 10.1016/j.psyneuen.2020.104798.CrossRefGoogle ScholarPubMed
Mayer, SE, Snodgrass, M, Liberzon, I, Liberzon, I, Briggs, H, Curtis, GC and Abelson, JL (2017) The psychology of HPA axis activation: Examining subjective emotional distress and control in a phobic fear exposure model. Psychoneuroendocrinology 82, 189–198. doi: 10.1016/J.PSYNEUEN.2017.02.001.CrossRefGoogle Scholar
Meier, M, Wirz, L, Dickinson, P and Pruessner, JC (2021) Laughter yoga reduces the cortisol response to acute stress in healthy individuals. Stress-the International Journal on The Biology of Stress 24(1), 44–52. doi: 10.1080/10253890.2020.1766018.CrossRefGoogle ScholarPubMed
Mikolajczak, M, Roy, E, Luminet, O, Fillée, C and de Timary, P (2007) The moderating impact of emotional intelligence on free cortisol responses to stress. Psychoneuroendocrinology 32(8-10), 1000–1012. doi: 10.1016/j.psyneuen.2007.07.009.CrossRefGoogle ScholarPubMed
Miller, GE, Chen, E and Zhou, ES (2007) If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin 133(1), 25–45. doi: 10.1037/0033-2909.133.1.25.CrossRefGoogle ScholarPubMed
Mohan, A, Sharma, R and Bijlani, RL (2011) Effect of meditation on stress-induced changes in cognitive functions. The Journal of Alternative and Complementary Medicine 17(3), 207–212. doi: 10.1089/acm.2010.0142.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J and Altman, DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339(jul21 1), 332–336. doi: 10.1136/BMJ.B2535.CrossRefGoogle ScholarPubMed
Montero-López, E, Santos-Ruiz, A, García-Ríos, MC, Rodríguez-Blázquez, M, Rogers, HL and Peralta-Ramírez, MI (2018) The relationship between the menstrual cycle and cortisol secretion: daily and stress-invoked cortisol patterns. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology 131, 67–72. doi: 10.1016/J.IJPSYCHO.2018.03.021.CrossRefGoogle ScholarPubMed
Montoya, ER, Bos, PA, Terburg, D, Rosenberger, LA and van Honk, J (2014) Cortisol administration induces global down-regulation of the brain’s reward circuitry. Psychoneuroendocrinology 47, 31–42. doi: 10.1016/J.PSYNEUEN.2014.04.022.CrossRefGoogle ScholarPubMed
Nater, UM, Moor, C, Okere, U, Stallkamp, R, Martin, M, Ehlert, U and Kliegel, M (2007) Performance on a declarative memory task is better in high than low cortisol responders to psychosocial stress. Psychoneuroendocrinology. 32(6), 758–763. doi: 10.1016/j.psyneuen.2007.05.006.CrossRefGoogle ScholarPubMed
Nater, UM, Okere, U, Stallkamp, R, Moor, C, Ehlert, U and Kliegel, M (2006) Psychosocial stress enhances time-based prospective memory in healthy young men. Neurobiology of Learning and Memory 86(3), 344–348. doi: 10.1016/j.nlm.2006.04.006.CrossRefGoogle ScholarPubMed
Nedeljkovic, M, Ausfeld-Hafter, B, Streitberger, K, Seiler, R and Wirtz, PH (2012) Taiji practice attenuates psychobiological stress reactivity--a randomized controlled trial in healthy subjects. Psychoneuroendocrinology 37(8), 1171–1180. doi: 10.1016/j.psyneuen.2011.12.007.CrossRefGoogle ScholarPubMed
Nyklíček, I, Mommersteeg, PM, Van Beugen, S, Ramakers, C and Van Boxtel, GJ (2013) Mindfulness-Based stress reduction and physiological activity during acute stress: a randomized controlled trial. Journal of Health Psychology 32(10), 1110–1113. doi: 10.1037/a0032200.CrossRefGoogle ScholarPubMed
Oei, NYL, Both, S, van Heemst, D and van der Grond, J (2014) Acute stress-induced cortisol elevations mediate reward system activity during subconscious processing of sexual stimuli. Psychoneuroendocrinology. 39, 111–120. doi: 10.1016/j.psyneuen.2013.10.005.CrossRefGoogle ScholarPubMed
Otte, C, Hart, S, Neylan, TC, Marmar, CR, Yaffe, K and Mohr, DC (2005) A meta-analysis of cortisol response to challenge in human aging: importance of gender. Psychoneuroendocrinology 30(1), 80–91. doi: 10.1016/J.PSYNEUEN.2004.06.002.CrossRefGoogle ScholarPubMed
Pabst, S, Brand, M and Wolf, OT (2013) Stress and decision making: a few minutes make all the difference. Behavioural Brain Research 250, 39–45. doi: 10.1016/j.bbr.2013.04.046.CrossRefGoogle ScholarPubMed
Pace, TW, Negi, LT, Adame, DD, Cole, SP, Sivilli, TI, Brown, TD, Issa, MJ and Raison, CL (2009) Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology 34(1), 87–98. doi: 10.1016/j.psyneuen.2008.08.011.CrossRefGoogle ScholarPubMed
Petrowski, K, Wintermann, GB, Joraschky, P and Päßler, S (2014) Chewing after stress: psychosocial stress influences chewing frequency, chewing efficacy, and appetite. Psychoneuroendocrinology 48, 64–76. doi: 10.1016/j.psyneuen.2014.06.008.CrossRefGoogle ScholarPubMed
Pierrehumbert, B, Torrisi, R, Glatz, N, Dimitrova, N, Heinrichs, M and Halfon, O (2009) The influence of attachment on perceived stress and cortisol response to acute stress in women sexually abused in childhood or adolescence. Psychoneuroendocrinology 34(6), 924–938. doi: 10.1016/j.psyneuen.2009.01.006.CrossRefGoogle ScholarPubMed
Pilgrim, K, Ellenbogen, MA and Paquin, K (2014) The impact of attentional training on the salivary cortisol and alpha amylase response to psychosocial stress: importance of attentional control. Psychoneuroendocrinology 44, 88–99. doi: 10.1016/J.PSYNEUEN.2014.01.024.CrossRefGoogle ScholarPubMed
Pilgrim, K, Marin, MF and Lupien, SJ (2010) Attentional orienting toward social stress stimuli predicts increased cortisol responsivity to psychosocial stress irrespective of the early socioeconomic status. Psychoneuroendocrinology 35(4), 588–595. doi: 10.1016/j.psyneuen.2009.09.015.CrossRefGoogle ScholarPubMed
Plessow, F, Kiesel, A and Kirschbaum, C (2012) The stressed prefrontal cortex and goal-directed behaviour: acute psychosocial stress impairs the flexible implementation of task goals. Experimental Brain Research 216(3), 397–408. doi: 10.1007/s00221-011-2943-1.CrossRefGoogle ScholarPubMed
Polheber, JP, Matchock, RL (2014) The presence of a dog attenuates cortisol and heart rate in the Trier Social Stress Test compared to human friends. Journal of Behavioral Medicine 37(5), 860–867. doi: 10.1007/s10865-013-9546-1.CrossRefGoogle ScholarPubMed
Pottier, P, Dejoie, T, Hardouin, JB, Le Loupp, AG, Planchon, B, Bonnaud, A and Leblanc, VR (2013) Effect of stress on clinical reasoning during simulated ambulatory consultations. Medical Teacher 35(6), 472–480. doi: 10.3109/0142159X.2013.774336.CrossRefGoogle ScholarPubMed
Raspopow, K, Abizaid, A, Matheson, K and Anisman, H (2010) Psychosocial stressor effects on cortisol and ghrelin in emotional and non-emotional eaters: influence of anger and shame. Hormones and Behavior 58(4), 677–684. doi: 10.1016/J.YHBEH.2010.06.003.CrossRefGoogle ScholarPubMed
Rich-Edwards, JW, Kaiser, UB, Chen, GL, Manson, JAE and Goldstein, JM (2018) Sex and gender differences research design for basic, clinical, and population studies: essentials for investigators. Endocrine Reviews 39(4), 424–439. doi: 10.1210/ER.2017-00246.CrossRefGoogle ScholarPubMed
Roche, DJO, King, AC, Cohoon, AJ and Lovallo, WR (2013) Hormonal contraceptive use diminishes salivary cortisol response to psychosocial stress and naltrexone in healthy women. Pharmacology Biochemistry and Behavior 109, 84–90. doi: 10.1016/J.PBB.2013.05.007.CrossRefGoogle ScholarPubMed
Rohleder, N, Wolf, JM, Piel, M and Kirschbaum, C (2003) Impact of oral contraceptive use on glucocorticoid sensitivity of pro-inflammatory cytokine production after psychosocial stress. Psychoneuroendocrinology 28(3), 261–273. doi: 10.1016/S0306-4530(02)00019-7.CrossRefGoogle ScholarPubMed
Roy, MP (2004) Patterns of cortisol reactivity to laboratory stress. Hormones and Behavior 46(5), 618–627. doi: 10.1016/j.yhbeh.2004.06.015.CrossRefGoogle ScholarPubMed
Sandner, M, Lois, G, Streit, F, Zeier, P, Kirsch, P, Wüst, S and Wessa, M (2020) Investigating individual stress reactivity: high hair cortisol predicts lower acute stress responses. Psychoneuroendocrinology 118, 104660. doi: 10.1016/J.PSYNEUEN.2020.104660.CrossRefGoogle ScholarPubMed
Scarpa, A, Self-Esteem, Luscher KA (2002) Cortisol reactivity, and depressed mood mediated by perceptions of control. Biological Psychology 59(2), 93–103. doi: 10.1016/s0301-0511(01)00130-2.CrossRefGoogle ScholarPubMed
Scheuringer, A, Lundin, C, Derntl, B, Pletzer, B and Sundström Poromaa, I (2020) Use of an estradiol-based combined oral contraceptives has no influence on attentional bias or depressive symptoms in healthy women. Psychoneuroendocrinology. 113, 104544. doi: 10.1016/j.psyneuen.2019.104544.CrossRefGoogle ScholarPubMed
Scholey, A, Haskell, C, Robertson, B, Kennedy, D, Milne, A and Wetherell, M (2009) Chewing gum alleviates negative mood and reduces cortisol during acute laboratory psychological stress. Physiology & Behavior 97(3–4), 304–312. doi: 10.1016/j.physbeh.2009.02.028.CrossRefGoogle ScholarPubMed
Scholz, U, La Marca, R, Nater, UM, Aberle, I, Ehlert, U, Hornung, R, Martin, M and Kliegel, M (2009) Go no-go performance under psychosocial stress: beneficial effects of implementation intentions. Neurobiology of Learning and Memory 91(1), 89–92. doi: 10.1016/j.nlm.2008.09.002.CrossRefGoogle ScholarPubMed
Schoofs, D, Preuss, D and Wolf, OT (2008) Psychosocial stress induces working memory impairments in an n-back paradigm. Psychoneuroendocrinology 33(5), 643–653. doi: 10.1016/j.psyneuen.2008.02.004.CrossRefGoogle Scholar
Seeman, TE, Singer, B, Wilkinson, CW and McEwen, B. (2001) Gender differences in age-related changes in HPA axis reactivity. Psychoneuroendocrinology 26(3), 225–240. doi: 10.1016/s0306-4530(00)00043-3.CrossRefGoogle Scholar
Sep, MSC, van Ast, VA, Gorter, R, Joëls, M and Geuze, E (2019) Time-Dependent effects of psychosocial stress on the contextualization of neutral memories. Psychoneuroendocrinology 108, 140–149. doi: 10.1016/j.psyneuen.2019.06.021.CrossRefGoogle ScholarPubMed
Sheppard, LD, Cuttler, C, Shin, E and McLaughlin, RJ (2021) Differences in cortisol following cooperative and competitive work-related tasks with same-sex versus opposite-sex partners. Psychoneuroendocrinology 124, 105063. doi: 10.1016/j.psyneuen.2020.105063.CrossRefGoogle ScholarPubMed
Singer, N, Sommer, M, Döhnel, K, Zänkert, S, Wüst, S and Kudielka, BM (2017) Acute psychosocial stress and everyday moral decision-making in young healthy men: The impact of cortisol. Hormones and Behavior 93, 72–81. doi: 10.1016/j.yhbeh.2017.05.002.CrossRefGoogle ScholarPubMed
Skosnik, PD, Chatterton, RT Jr, Swisher, T and Park, S (2000) Modulation of attentional inhibition by norepinephrine and cortisol after psychological stress. International Journal of Psychophysiology 36(1), 59–68. doi: 10.1016/s0167-8760(99)00100-2.CrossRefGoogle ScholarPubMed
Sladek, MR, Doane, LD, Luecken, LJ, Gonzales, NA and Grimm, KJ (2020) Reducing cultural mismatch: Latino students' neuroendocrine and affective stress responses following cultural diversity and inclusion reminder. Hormones and Behavior 120, 104681. doi: 10.1016/j.yhbeh.2020.104681.CrossRefGoogle ScholarPubMed
Smith, A (2010) Effects of chewing gum on cognitive function, mood and physiology in stressed and non-stressed volunteers. Nutritional Neuroscience 13(1), 7–16. doi: 10.1179/147683010X12611460763526.CrossRefGoogle ScholarPubMed
Smith, RP, Coward, RM, Kovac, JR and Lipshultz, LI (2013) The evidence for seasonal variations of testosterone in men. Maturitas 74(3), 208–212. doi: 10.1016/J.MATURITAS.2012.12.003.CrossRefGoogle ScholarPubMed
Söderpalm, A, Nikolayev, L and de Wit, H (2003) Effects of stress on responses to methamphetamine in humans. Psychopharmacology (Berl). 170(2), 188–199. doi: 10.1007/s00213-003-1536-5.CrossRefGoogle ScholarPubMed
Sollberger, S, Bernauer, T and Ehlert, U (2016a) Salivary testosterone and cortisol are jointly related to pro-environmental behavior in men. Social Neuroscience 11(5), 553–566. doi: 10.1080/17470919.2015.1117987.CrossRefGoogle ScholarPubMed
Sollberger, S, Bernauer, T and Ehlert, U (2016b) Stress influences environmental donation behavior in men. Psychoneuroendocrinology 63, 311–319. doi: 10.1016/j.psyneuen.2015.10.017.CrossRefGoogle ScholarPubMed
Sommer, M, Braumann, M, Althoff, T, Backhaus, J, Kordon, A, Junghanns, K, Ehrenthal, D, Bartmann, U, Hohagen, F and Broocks, A (2011) Psychological and neuroendocrine responses to social stress and to the administration of the alpha-2-receptor antagonist, yohimbine, in highly trained endurance athletes in comparison to untrained healthy controls. Pharmacopsychiatry 44(4), 129–134. doi: 10.1055/s-0031-1277166.CrossRefGoogle Scholar
Spanakis, EK, Wand, GS, Ji, N and Golden, SH (2016) Association of HPA axis hormones with copeptin after psychological stress differs by sex. Psychoneuroendocrinology 63, 254–261. doi: 10.1016/J.PSYNEUEN.2015.10.009.CrossRefGoogle ScholarPubMed
Starcke, K, Polzer, C, Wolf, OT and Brand, M (2011) Does stress alter everyday moral decision-making? Psychoneuroendocrinology, 36(2), 210–219. doi: 10.1016/J.PSYNEUEN.2010.07.010.CrossRefGoogle ScholarPubMed
Stephens, MA, Mahon, PB, McCaul, ME and Wand, GS (2016) Hypothalamic-pituitary-adrenal axis response to acute psychosocial stress: Effects of biological sex and circulating sex hormones. Psychoneuroendocrinology 66, 47–55. doi: 10.1016/j.psyneuen.2015.12.021.CrossRefGoogle ScholarPubMed
Storch, M, Gaab, J, Küttel, Y, Stüssi, A-C, and Fend, H (2007) Psychoneuroendocrine effects of resource-activating stress management training. Health Psychology 26(4), 456–463. doi: 10.1037/0278-6133.26.4.456.CrossRefGoogle ScholarPubMed
Stroud, LR, Salovey, P and Epel, ES (2002) Sex differences in stress responses: social rejection versus achievement stress. Biological Psychiatry 52(4), 318–327. doi: 10.1016/s0006-3223(02)01333-1.CrossRefGoogle ScholarPubMed
Tahara, Y, Sakurai, K and Ando, T (2007) Influence of chewing and clenching on salivary cortisol levels as an indicator of stress. J Prosthodont 16(2), 129–135. doi: 10.1111/j.1532-849X.2007.00178.x.CrossRefGoogle ScholarPubMed
Taylor, SE, Klein, LC, Lewis, BP, Gruenewald, TL, Gurung, RAR and Updegraff, JA (2000) Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychological Review 107(3), 411–429. doi: 10.1037/0033-295X.107.3.411.CrossRefGoogle Scholar
Uhart, M, Chong, RY, Oswald, L, Lin, PI and Wand, GS (2006) Gender differences in hypothalamic-pituitary–adrenal (HPA) axis reactivity. Psychoneuroendocrinology 31(5), 642–652. doi: 10.1016/J.PSYNEUEN.2006.02.003.CrossRefGoogle ScholarPubMed
van Dulmen, S, Tromp, F, Grosfeld, F, ten Cate, O and Bensing, J (2007) The impact of assessing simulated bad news consultations on medical students’ stress response and communication performance. Psychoneuroendocrinology. 32(8–10), 943–950. doi: 10.1016/j.psyneuen.2007.06.016.CrossRefGoogle ScholarPubMed
Verma, R, Balhara, YPS and Gupta, CS (2011) Gender differences in stress response: role of developmental and biological determinants. Industrial Psychiatry Journal 20(1), 4. doi: 10.4103/0972-6748.98407.Google ScholarPubMed
von Dawans, B, Kirschbaum, C and Heinrichs, M (2011) The Trier Social Stress Test for Groups (TSST-G): A new research tool for controlled simultaneous social stress exposure in a group format. Psychoneuroendocrinology 36(4), 514–522. doi: 10.1016/J.PSYNEUEN.2010.08.004.CrossRefGoogle Scholar
von Känel, R, Kudielka, BM, Preckel, D, Hanebuth, D and Fischer, JE (2006) Delayed response and lack of habituation in plasma interleukin-6 to acute mental stress in men. Brain Behavior and Immunity 20(1), 40–48. doi: 10.1016/j.bbi.2005.03.013.CrossRefGoogle ScholarPubMed
Walser, M, Fischer, R, Goschke, T, Kirschbaum, C and Plessow, F (2013) Intention retrieval and deactivation following an acute psychosocial stressor. PLoS One 8(12), 85685. doi: 10.1371/JOURNAL.PONE.0085685.CrossRefGoogle ScholarPubMed
Weik, U, Maroof, P, Zöller, C and Deinzer, R (2010) Pre-Experience of social exclusion suppresses cortisol response to psychosocial stress in women but not in men. Hormones and Behavior 58(5), 891–897. doi: 10.1016/j.yhbeh.2010.08.018.CrossRefGoogle Scholar
Wiegratz, I, Kutschera, E, Lee, JH, Moore, C, Mellinger, U, Winkler, UH and Kuhl, H (2003) Effect of four different oral contraceptives on various sex hormones and serum-binding globulins. Contraception 67(1), 25–32. doi: 10.1016/S0010-7824(02)00436-5.CrossRefGoogle ScholarPubMed
Wiemers, US, Sauvage, MM, Schoofs, D, Hamacher-Dang, TC and Wolf, OT (2013) What we remember from a stressful episode. Psychoneuroendocrinology 38(10), 2268–2277. doi: 10.1016/j.psyneuen.2013.04.015.CrossRefGoogle ScholarPubMed
Wirtz, PH, Ehlert, U, Emini, L and Suter, T (2008) Higher body mass index (BMI) is associated with reduced glucocorticoid inhibition of inflammatory cytokine production following acute psychosocial stress in men. Psychoneuroendocrinology 33(8), 1102–1110. doi: 10.1016/j.psyneuen.2008.05.002.CrossRefGoogle ScholarPubMed
Wolf, OT, Bauser, DS and Daum, I (2012) Eyeblink conditional discrimination learning in healthy young men is impaired after stress exposure. Psychophysiology 49(2), 164–171. doi: 10.1111/j.1469-8986.2011.01294.x.CrossRefGoogle ScholarPubMed
Wolf, OT, Schommer, NC, Hellhammer, DH, McEwen, BS and Kirschbaum, C (2001) The relationship between stress induced cortisol levels and memory differs between men and women. Psychoneuroendocrinology 26(7), 711–720. doi: 10.1016/s0306-4530(01)00025-7.CrossRefGoogle ScholarPubMed
Wolf, OT, Schommer, NC, Hellhammer, DH, Reischies, FM Kirschbaum, C (2002) Moderate psychosocial stress appears not to impair recall of words learned 4 weeks prior to stress exposure. Stress (Amsterdam, Netherlands) 5(1), 59–64. doi: 10.1080/102538902900012332.CrossRefGoogle Scholar
Wüst, S, Entringer, S, Federenko, IS, Schlotz, W and Hellhammer, DH (2005) Birth weight is associated with salivary cortisol responses to psychosocial stress in adult life. Psychoneuroendocrinology 30(6), 591–598. doi: 10.1016/J.PSYNEUEN.2005.01.008.CrossRefGoogle ScholarPubMed
Young, EA, Abelson, JL and Cameron, OG (2005) Interaction of brain noradrenergic system and the hypothalamic-pituitary-adrenal (HPA) axis in man. Psychoneuroendocrinology 30(8), 807–814. doi: 10.1016/j.psyneuen.2005.03.009.CrossRefGoogle ScholarPubMed
Young, EA, Lopez, JF, Murphy-Weinberg, V, Watson, SJ and Akil, H (2000) Hormonal evidence for altered responsiveness to social stress in major depression. Neuropsychopharmacology 23(4), 411–418. doi: 10.1016/S0893-133X(00)00129-9.CrossRefGoogle ScholarPubMed
Young, EA and Nolen-Hoeksema, S. (2001) Effect of ruminations on the saliva cortisol response to a social stressor. Psychoneuroendocrinology 26(3), 319–329. doi: 10.1016/s0306-4530(00)00059-7.CrossRefGoogle ScholarPubMed
Young Kuchenbecker, S, Pressman, SD, Celniker, J, Grewen, KM, Sumida, KD, Jonathan, N, Everett, B and Slavich, GM (2021) Oxytocin, cortisol, and cognitive control during acute and naturalistic stress. Stress 24(4), 370–383. doi: 10.1080/10253890.2021.1876658.CrossRefGoogle ScholarPubMed
Youssef, FF, Dookeeram, K, Basdeo, V, Francis, E, Doman, M, Mamed, D, Maloo, S, Degannes, J, Dobo, L, Ditshotlo, P and Legall, G (2012) Stress alters personal moral decision making. Psychoneuroendocrinology 37(4), 491–498. doi: 10.1016/j.psyneuen.2011.07.017.CrossRefGoogle ScholarPubMed
Zoccola, PM, Dickerson, SS and Zaldivar, FP (2008) Rumination and cortisol responses to laboratory stressors. Psychosomatic Medicine 70(6), 661–667. doi: 10.1097/PSY.0b013e31817bbc77.CrossRefGoogle ScholarPubMed
Zöller, C, Maroof, P, Weik, U and Deinzer, R (2010) No effect of social exclusion on salivary cortisol secretion in women in a randomized controlled study. Psychoneuroendocrinology 35(9), 1294–1298. doi: 10.1016/J.PSYNEUEN.2010.02.019.CrossRefGoogle Scholar
Figure 0

Figure 1. The flow chart illustrates the search and selection process of studies for this semi-systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The process includes an initial database search, followed by the screening of titles and abstracts for relevance, and then full-text screening of potentially relevant studies. The excluded studies at each stage are documented along with the reasons for their exclusion. Finally, the included studies are assessed for quality, and the relevant data is extracted for the present semi-systematic review.

Figure 1

Figure 2. Male and female participants, as well as individuals where the sex was not reported. Between 2000 and 2021, the percentage of male participants remained relatively stable, while the percentage of individuals where the sex was not reported appeared to decrease slightly, in favour of female participants.

Figure 2

Table 1. Description of studies (N = 124)

Figure 3

Table 2. The sex of participants from 2000 to 2021

Figure 4

Figure 3. Articles using male-only, female-only, and both sexes as participants between 2000 and 2021. The percentage of female-only articles remained relatively stable, while those using only males appeared to decrease slightly, in favour of articles that included participants of both sexes.

Figure 5

Table 3. Use of male-only, female-only and both sexes as participants from 2000 to 2021