Japanese Psychological Research 2011, Volume 53, No.

2, 113120 Special issue: Psychobiological approaches to stress and health

doi: 10.1111/j.1468-5884.2011.00459.x

The relationship between perceived loneliness and cortisol awakening responses on work days and weekends1
HISAYOSHI OKAMURA*, AKIRA TSUDA, and TOYOJIRO MATSUISHI Kurume University
jpr_459 113..120

Abstract: The purpose of the present study was to investigate the relationship between the cortisol awakening response (CAR) and perceived loneliness on work days and weekends. Ninety female full-time workers (2050 years old) were recruited for this study. Loneliness was evaluated using the Revised UCLA Loneliness Scale, and participants were classied into high (average + 1 SD; n = 20) or low loneliness groups (average 1 SD; n = 20). The saliva samples were collected on work days and weekends. Participants were instructed to collect saliva on two occasions each day: immediately on awakening and 30 minutes after awakening. The CAR was higher on weekends in the high loneliness group than in the low loneliness group. There were signicant differences in the CAR in the low loneliness group between work days and weekends, but not in the high loneliness group. These results indicated that the CAR in high loneliness people was not signicantly different between work days and weekends due to a hypothalamic-pituitary-adrenal system that is always activated. Key words: loneliness, cortisol awakening response, work days/weekends. Loneliness is the feeling that emerges when social relationships are perceived to be decient, and may arise from a perceived lack of intimacy (emotional loneliness) or lack of companionship (social loneliness) (Steptoe, Owen, Kunz-Ebrecht, & Brydon, 2004). In addition, loneliness has emerged as an important contributor to physiological stress processes and physical and mental health outcomes (Cacioppo, Hawkley, & Berntson, 2003). The Revised UCLA Loneliness Scale is described and used as a unidimensional measure of loneliness, conceptualizing and assessing loneliness as a unitary, global experience (Kudoh & Nishikawa, 1983; Russell, Peplau, & Cutrona, 1980). Several studies have reported that the loneliness measured by the Revised UCLA Loneliness Scale correlated with neuroendocrine, immune, and cardiovascular responses. For example, loneliness is associated with higher blood pressure (Hawkly, Masi, Berry, & Cacippo, 2006), and impaired or underactive immune function (Pressman, Cohen, Miller, Barkin, Rabin, & Treanor, 2005). Loneliness is also associated with greater psychological stress and negative affect, and less positive affect (Pressman et al., 2005). Perceived loneliness has been studied for its adverse effects on physical and mental health, but relatively little is known about its effect on work-related stress. The allostasis and the allostatic load are relatively new concepts that have been proposed to explain the physiological responses to chronic stress (McEwen, 2003). According

*Correspondence concerning this article should be sent to: Hisayoshi Okamura, Cognitive and Molecular Institute of Brain Diseases, Kurume University, Asahi-machi, Kurume 830-0011, Japan. (E-mail: okamura_hisayoshi@med.kurume-u.ac.jp)
1

This work was supported by a Grant-in-Aid for Scientic Research (B: 22330196) from Japanese Society for the Promotion of Science to Akira Tsuda.

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to this model, allostasis is an extension of the concept of homeostasis, which represents the chronic adaptation process of complex physiological systems to physical, psychosocial and environmental challenges (Karlamangla, Singer, McEwen, Rowe, & Seeman, 2002; McEwen, 2002). Perceived stress initiates the persons physiological and behavioral responses, and these responses lead to subsequent allostasis in various systems, including the sympathetic-adrenal-medullary (SAM) system, the hypothalamic-pituitary-adrenal (HPA) axis, as well as cardiovascular, metabolic, neural, endocrine and immune systems. Repeated and cumulative allostasis over time causes an allostatic load (McEwen, 2006) and frequent or chronic challenges produce dysregulation of several major physiological systems, including the HPA axis, the SAM system and the immune system (Schulkin, 2004). More recently, many studies have started to investigate the effect of loneliness on the HPA axis, as indicated by the cortisol levels (Adam, 2006; Steptoe et al., 2004). Cortisol has a pronounced diurnal rhythm, with high levels in the morning and a decline in the levels during the day. In addition to this diurnal rhythm, there is a rapid increase of cortisol levels within 2060 min after awakening in the morning, typically peaking at 2040 min after waking. This phenomenon is termed the cortisol awakening response (CAR). It is thought that the CAR can serve as a reliable marker of the allostatic load. The CAR is positively associated with job stress and general life stress, and negatively associated with exhaustion, burnout and positive affect (Chida & Steptoe, 2009). Pressman et al. (2005) found that high levels of momentary or daily experiences of loneliness were associated with elevated next morning cortisol levels. Doane and Adam (2010) reported that feelings of loneliness during the previous day were associated with an increased CAR the next morning. Furthermore, a higher CAR has been reported on work days, which subjects rated as less happy and more stressful, compared to weekend days (Kunz-Ebrecht, Kirschbaum, Marmot, & Steptoe, 2004). This is an important observation
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as it means that the CAR is sensitive to the anticipation of a potentially stressful day (Clow, Thorn, Evans, & Hucklebridge, 2004). However, there are no studies that have investigated the relationship between the CAR and loneliness on work days and weekends. An examination of the relationship between loneliness and workrelated stress and the CAR on work days and weekends will provide denitive evidence that loneliness is an important factor for health and work-related stress. The aim of the present study was to investigate the relationship between the trait loneliness, the CAR on work days and weekends, and work-related stress. For the purpose of this study, loneliness was dened as a perceived lack of emotional and social support or companionship. Therefore, the trait loneliness was assessed using the Japanese version of the Revised UCLA Loneliness Scale (Kudoh & Nishikawa, 1983). In addition, work-related stress was measured using the Japanese version of the EffortReward Imbalance Questionnaire (ERIQ) (Tsutsumi, Ishitake, Peter, Siegrist, & Matoba, 2001) in order to evaluate an individuals attitude and the behavioral pattern toward work. Lonely people have been shown to have increased HPA axis activity (Doane & Adam, 2010). Lonely people also have higher levels of stress in their lives (Cacioppo et al., 2003). There is a clear weekend-weekday difference in the CAR in normal subjects. This difference is associated with chronic work overload and stress (Schlotz, Hellhammer, Schulz, & Stone, 2004). We hypothesized that the CAR in highly lonely people would show no signicant differences between work days and weekends due to a chronic state of stress as a result of their always-active HPA system. In contrast, the CAR in nonlonely people would change on work days and weekends due to adequate responsiveness in order to adapt to work and work-related stress.

Methods
Participants and study design The participants consisted of 90 healthy women (2050 years old). Loneliness was evaluated

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using the Japanese version of the Revised UCLA Loneliness Scale (Kudoh & Nishikawa, 1983) and participants were classied into high (average + 1 SD; n = 20) or low loneliness groups (average 1 SD; n = 20). Participants were healthy and free from any endocrine, eating or psychiatric disorders. In addition, all participants were free from medication or drugs such as oral contraceptives that may have affected the biological markers. To avoid any inuence of the menstrual cycle on the CAR, each participant was checked for the phase of their menstrual cycle. All participants gave spoken and written informed consent to participate in the study. The saliva samples were collected only once on each of the work days and on the weekend. Participants were instructed to collect saliva on two occasions each day: immediately on awakening and 30 minutes after awakening. Saliva samples were collected using Salisoft (SARSTEDT, Numbrecht, Germany) for a period of 2 min (without moving the jaw or stimulating saliva production in any way). Assessment of psychosocial variables Loneliness was assessed using the Japanese version of the Revised UCLA Loneliness Scale (Kudoh & Nishikawa, 1983). This consists of 20 items (e.g. I feel that no one knows me really well), and participants were asked to rate how often they felt that way on a scale from 1 = never to 4 = often. Ratings were summed to produce a total score ranging from 20 (low) to 80 (high). It was shown that the average score in women is 35.38 6.27 (mean SD). Work-related stress was measured using the Japanese version of the ERIQ (Tsutsumi et al., 2001). A Japanese version of the ERIQ has three main scales: extrinsic effort, reward, and over-commitment. Extrinsic effort refers to the demanding aspects of the work environment (subjective evaluation of the workload). Reward refers to three subscales: nancial remuneration, esteem, and career opportunities, which includes job security. The mean scores on each component were computed (range 03), with higher scores reecting

greater effort and greater rewards. Overcommitment indicates a state of exhaustive coping that reects frustrated but continued efforts and associated negative feelings. The ratings were totaled so that higher scores indicated greater over-commitment (rating 015). Depression was assessed using the Japanese version of the Center for Epidemiological Studies Depression Scale (CES-D), a 20-item self-report instrument that is a valid and reliable measure for assessing the level of depressive symptoms (Shima, 1998). The CES-D score is a measure of the chronically depressed state that contrasts with the laboratory ratings of depression, which is a reection of transient, acute mood state. Based on the conventional cut-off score of 16, participants were placed into either high depression (CES-D > 16) or low depression (CES-D < 16) symptom groups. Happiness was assessed using the Japanese version of the Subjective Happiness Scale (SHS) (Shimai, Otake, Utsuki, Ikemi, & Lyubomirsky, 2004). The SHS is a 4-item scale of global subjective happiness. Two items ask respondents to characterize themselves using both absolute ratings and ratings relative to peers, whereas the other two items offer brief descriptions of happy and unhappy individuals and ask respondents the extent to which each characterization describes them. Measurement of cortisol Saliva samples were frozen at -80C until assayed. Cortisol concentrations were measured using an enzyme-linked immunosorbent assay (ELISA Kit; DRG International, Mountainside, New Jersey, USA). The limit of detection of this assay was 0.53 ng/mL, with intraand interassay coefcients of variance (CV) of 2.61% and 3.63%, respectively. The assay plates were read at 450 nm for cortisol, using a Multiskan Ascent microplate photometer (Thermo Labsystems Oy, Helsinki, Finland). Statistical analysis The data were analyzed using SPSS (Statistical Package for the Social Science) Version 11.0J.
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Table 1 Characteristics of participants

Characteristic Age (years) Marital status Married (n) Sleeping hours Work days Weekends Time of waking (h:min) Work days Weekends Loneliness scale SHS CES-D ERIQ Extrinsic effort Reward Over-commitment Overall participants (n = 90) 36.8 11.4 43 (47%) 6.13 1.0 7.42 1.2 6:15 44 min 7:28 71 min 36.4 6.4 18.7 4.6 16.8 8.6 14.3. 3.7 41.7 5.8 15.0 3.7 High-loneliness group (n = 20) 38.2 4.8 7 (35%) 6.11 1.1 7.62 1.1 6:26 52 min 7:43 56 min 47.6 6.9 16.6 4.7 22.5 8.7 16.2 5.2 39.6 6.4 17.4 3.5 Low-loneliness group (n = 20) 39.9 1.1 8 (40%) 6.15 0.8 7.27 1.3 6:07 39 min 7:15 62 min 27.1 2.8 20.5 3.8 12.0 4.9 12.1 5.1 43.8 4.6 12.9 2.6 p-level

** ** ** * ** *

Note. The average age, sleeping hours, time of awakening, and loneliness, the SHS and CES-D scores in the high-loneliness group and the low-loneliness group were expressed as the mean SD. CES-D = Center for Epidemiological Studies Depression Scale; ERIQ = Effort-Reward Imbalance Questionnaire; SHS = Subjective Happiness Scale. *p < .05, compared with the low-loneliness group. **p < .01, compared with the low-loneliness group.

The c2 test was used to analyze differences in the group and marital status. Students t-tests were used to detect the differences in age, waking time, sleeping time, and the scores of loneliness, ERIQ, CES-D and SHS between two groups. The levels of cortisol and CAR (increase of cortisol levels between waking and 30 min after waking) were analyzed using repeated-measures analyses of variance (ANOVA), in which the independent variables were group (high loneliness group and low loneliness group), time (waking, 30 min after awakening) and day (work day, weekend) for the within-subject repeated measure. We also performed a series of linear regression analyses that contained all 90 participants to examine the impact of loneliness levels (using the UCLA score as a continuous independent variable) on the CAR (as the dependent variable), making adjustments for the ERIQ, CES-D and SHS scores. The data are presented as the means SD.
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Results
Group characteristics The group characteristics are summarized in Table 1. The level of loneliness on the revised UCLA Loneliness Scale in the high loneliness group was signicantly higher than that of the low loneliness group, t(38) = -12.38, p < .01. The score of positive affect measured by the SHS was lower, and the negative affect measured using the CES-D was higher in the high loneliness group than in the low loneliness group, t(38) = 3.02, p < .01; t(38) = -5.02, p < .01, respectively. However, there were no group differences in terms of age, marital status, waking time, and sleeping time. Work-related stress The score for extrinsic effort and overcommitment on the ERIQ was signicantly higher and the reward was lower in the high loneliness group than in the low loneliness

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group, t(38) = -2.22, p < .05; t(38) = -4.76, p < .01; t(38) = 2.52, p < .05, respectively. Cortisol awakening response A linear regression analysis revealed that the revised UCLA Loneliness Scale predicted the CAR on weekends, b = .30, p < .05, after

adjustment for covariates, although it did not predict the CAR on workdays. Figures 1 and 2 show the changes in cortisol levels. The analyses of the CAR on work days and weekends revealed that there were signicant effects of the day, F(1,76) = 6.41, p < .05, time, F(1,76) = 12.15, p < .01, and a signicant three-way

Salivary cortisol (nmol/L)

Salivary cortisol (nmol/L)

25
20

High loneliness group

25
20

Low loneliness group #*

15
10

15
10

Work days 5 0
Weekends

Work days 5 0
Weekends

Wake

Wake + 30 min

Wake

Wake + 30 min

Figure 1 Comparison of the cortisol awakening response on work days and weekends in the high- and low-loneliness groups. #p < .05 compared with on awakening, *p < .05 compared with weekends.

Salivary cortisol (nmol/L)

20
#

Salivary cortisol (nmol/L)

25

Work days

25
20

Weekends #*

15
10

15
10 High loneliness group

High loneliness group 5 0 Low loneliness group

5 0

Low loneliness group

Wake

Wake + 30 min

Wake

Wake + 30 min

Figure 2 Comparison of the cortisol awakening response in the high- and low-loneliness groups on work days and weekends. #p < .05 compared with on awakening, *p < .05 compared with the low loneliness group.
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interaction between the day, time and group, F(1,76) = 5.19, p < .05. There were also signicant differences in the CAR in the low loneliness group between work days and weekends, p < .05, but not in the high loneliness group. In addition, the CAR was higher on weekends in the high loneliness group than in the low loneliness group, p < .05. However, there were no signicant differences in the CAR on work days between subjects with a higher loneliness level and those with a lower one. There was no signicant group difference in terms of their menstrual cycles.

Discussion
The present study was designed to assess the relationship between perceived loneliness, the CAR on work days and weekends, and workrelated stress. To our knowledge, this is the rst study to comprehensively evaluate perceived loneliness, the CAR on work days and weekends, and work-related stress, at the same time. The main nding of this study was that loneliness was associated with higher work-related stress. A heightened CAR on weekends was also associated with high loneliness. In addition, there were signicant differences in the CAR in low-loneliness subjects between work days and weekends, but not in high-loneliness subjects. There have been many reports showing perceived loneliness to be associated with greater psychological stress and negative affect, less positive affect. Witvliet, Brendgen, van Lier, Koot, and Vitaro (2010) have shown that loneliness is associated with higher depressive symptoms. Furthermore, loneliness is consistently negatively related to positive affect and life satisfaction (Lee & Ishii-Kuntz, 1987; Pressman et al., 2005). In this study, the score on the CES-D was higher, and that on the SHS was lower, in the high-loneliness group than in the low-loneliness group. The results of this study conrmed the ndings of previous studies showing that perceived loneliness measured using the Revised UCLA Loneliness Scale is associated with greater negative affect and less positive affect (Pressman et al., 2005).
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Together, our current ndings and those of previous studies have demonstrated that perceived loneliness is related to a decreased sense of well-being. In addition, these results provide evidence that group allocation according to the scores of the Revised UCLA Loneliness Scale in this study was appropriate. Psychosocial factors in the work environment are among the most important predictors of employee well-being (Buapetch, Lagampan, Faucett, & Kalampakorn, 2008). Perceived loneliness is one of the psychosocial factors associated with psychological distress and daily stress (Prince, Harwood, Blizard, Thomas, & Mann, 1997), but relatively little is known about its effect on work-related stress. In this study, the score of extrinsic effort and overcommitment on the ERIQ was signicantly higher and the reward was lower in the high loneliness group than in the low loneliness group. Loneliness was associated with limited social networks and low emotional social support (Steptoe et al., 2004). In addition, social support reduced the strain and moderated the stressor-strain relationship in the workplace (Viswesvaran, Sanchez, & Fisher, 1999). These ndings suggested that lonely people are not satised with their work, and that their workrelated stress was always high due to their lack of emotional and social support or companionship in the workplace. Loneliness therefore seems to be an important factor for workers. A growing body of literature suggests that the CAR may reect both work stress and general life stress. For example, Schlotz et al. (2004) found that the CAR was positively related to chronic worrying. Job strain or work overload has also been positively associated with the CAR in working adults (Steptoe, Cropley, Grifth, & Kirschbaum, 2000). KunzEbrecht, Kirschbaum, and Steptoe (2004) found that the CAR was greater on work days than on nonwork days. The results of the present study showed that the CAR was higher on weekends in the high-loneliness group than in the low-loneliness group. However, there were no signicant differences in the CAR on work days between subjects with higher and

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lower loneliness levels. In addition, there were signicant differences in the CAR in the low loneliness group between work days and weekends, but not in the high loneliness group. Our ndings and those of previous studies demonstrated that loneliness is a marker of psychological distress that also stimulates increased CAR. In addition, our results indicated that the CAR in lonely people showed no signicant differences between work days and weekends, because the loneliness felt on weekends continues to provide a source of stress. Their elevated CAR reects the fact that they do not look forward to spending the weekends by themselves without any social contact. In contrast, the CAR of low loneliness people changes on work days and weekends due to adequate responsiveness in order to adapt to work and work-related stress. Steptoe et al. (2004) reported that the CAR was higher in highloneliness people than in low-loneliness people. However, there was only a signicant difference in the CAR on the weekends in the present study. The inconsistencies between our results and the previous study may be explained by the difference in the participants. The participants in this study were all women, while the previous study included men and women. The CAR has previously been shown to be higher on work days in women than in men. In addition, the differences in the CAR in men between work days and weekends were greater than in women (Lundberg & Frankenhaeuser, 1999;Wright & Steptoe, 2005).These factors are reected in the results of the present study. In order to clarify whether the results of the present study can be generalized to all Japanese workers, further studies will be needed with regard to sex differences, employment grades, and lifestyle. In conclusion, the results of the present study provide evidence that lonely people have a perception of higher work-related stress due to their lack of social support. This might lead to a chronic state of stress that is not resolved even on weekends, because they are particularly lonely on the weekends. Therefore, the CAR in lonely people showed no signicant differences between work days and weekends. Further-

more, the CAR can be a useful indicator of loneliness and work-related stress by comparing work days with weekends. There were some limitations in this study. First, the waking time and sampling time were measured by self-report, which might not accurately reect objective waking times and sampling time. Further studies will be needed that use electronic devices to record waking time and the time of saliva sampling, such as an Actigraph. Second, we collected only single data for each work day and weekend day. Hellhammer, Fries, Schweisthal, Schlotz, Stone, and Hagemann (2007) have argued that several days of monitoring may be required to assess the trait aspects of the CAR. Third, we collected data on health behaviors; however, unfortunately, we do not have enough data to compare the difference, because some participants within both the low- and high-loneliness groups did not answer the health behavior questionnaire. In order to investigate the relations between loneliness, CAR, and health behaviors such as smoking, physical activity, and alcohol, it will be necessary to take health behavior into consideration in the next study.

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