The cortisol awakening response (CAR), the marked increase in cortisol secretion over the first 30-45 min after morning awakening, has been related to a wide range of psychosocial, physical and mental health parameters, making it a key variable for psychoneuroendocrinological research. The CAR is typically assessed from self-collection of saliva samples within the domestic setting. While this confers ecological validity, it lacks direct researcher oversight which can be problematic as the validity of CAR measurement critically relies on participants closely following a timed sampling schedule, beginning with the moment of awakening. Researchers assessing the CAR thus need to take important steps to maximize and monitor saliva sampling accuracy as well as consider a range of other relevant methodological factors. To promote best practice of future research in this field, the International Society of Psychoneuroendocrinology initiated an expert panel charged with (i) summarizing relevant evidence and collective experience on methodological factors affecting CAR assessment and (ii) formulating clear consensus guidelines for future research. The present report summarizes the results of this undertaking. Consensus guidelines are presented on central aspects of CAR assessment, including objective control of sampling accuracy/adherence, participant instructions, covariate accounting, sampling protocols, quantification strategies as well as reporting and interpreting of CAR data. Meeting these methodological standards in future research will create more powerful research designs, thus yielding more reliable and reproducible results and helping to further advance understanding in this evolving field of research.

The notion that chewing gum may relieve stress was investigated in a controlled setting. A multi-tasking framework which reliably evokes stress and also includes performance measures was used to induce acute stress in the laboratory. Using a randomised crossover design forty participants (mean age 21.98 years) performed on the multi-tasking framework at two intensities (on separate days) both while chewing and not chewing. Order of workload intensity and chewing conditions were counterbalanced. Before and after undergoing the platform participants completed the state portion of the State-Trait Anxiety Inventory, Bond-Lader visual analogue mood scales, a single Stress Visual Analogue Scale and provided saliva samples for cortisol measurement. Baseline measures showed that both levels of the multi-tasking framework were effective in significantly reducing self-rated alertness, calmness and contentment while increasing self-rated stress and state anxiety. Cortisol levels fell during both levels of the stressor during the morning, reflecting the predominance of a.m. diurnal changes, but this effect was reversed in the afternoon which may reflect a measurable stress response. Pre-post stressor changes (Delta) for each measure at baseline were subtracted from Delta scores under chewing and no chewing conditions. During both levels of stress the chewing gum condition was associated with significantly better alertness and reduced state anxiety, stress and salivary cortisol. Overall performance on the framework was also significantly better in the chewing condition. The mechanisms underlying these effects are unknown but may involve improved cerebral blood flow and/or effects secondary to performance improvement during gum chewing.

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Background Coronavirus disease 2019 (COVID-19) is likely to exacerbate the symptoms of poor mental health in family caregivers. Aims To investigate whether rates of depressive symptomatology increased in caregivers during COVID-19 and whether the unintended consequences of health protective measures, i.e., social isolation, exacerbated this risk. Another aim was to see if caregivers accessed any online/phone psychological support during COVID. Method Data (1349 caregivers; 6178 non-caregivers) was extracted from Understanding Society, a UK population-level data-set. The General Health Questionnaire cut-off scores identified those who are likely to have depression. Results After adjustment for confounding caregivers had a higher risk of having depressive symptoms compared with non-caregivers, odds ratio (OR) = 1.22 (95% CI 1.05–1.40, P = 0.008) evidenced by higher levels of depression pre-COVID-19 (16.7% caregivers v. 12.1% non-caregivers) and during the COVID-19 pandemic (21.6% caregivers v. 17.9% non-caregivers), respectively. Further, higher levels of loneliness increased the risk of depression symptoms almost four-fold in caregivers, OR = 3.85 (95% 95% CI 3.08–4.85, P < 0.001), whereas accessing therapy attenuated the risk of depression (43%). A total of 60% of caregivers with depression symptoms reported not accessing any therapeutic support (for example online or face to face) during the COVID-19 pandemic. Conclusions COVID-19 has had a negative impact on family caregivers’ mental health with loneliness a significant contributor to depressive symptomatology. However, despite these detriments in mental health, the majority of caregivers do not access any online or phone psychiatric support. Finally, psychiatric services and healthcare professionals should aim to focus on reducing feelings of loneliness to support at-risk caregivers.

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