Article

Burnout, Perceived Stress, and Cortisol Responses to Awakening

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Abstract

The effects of burnout and perceived stress on early morning free cortisol levels after awakening were investigated in a group of teachers. Previous studies revealed that cortisol levels show a significant increase after awakening, with high intraindividual stability. Sixty-six teachers from local public schools (42 women and 24 men, mean age 42+/-5 years) were asked to sample saliva for cortisol analysis on 3 consecutive days. On each day, cortisol levels were measured at the time of awakening and 15, 30, and 60 minutes thereafter. On the night before the third day, subjects took 0.5 mg dexamethasone orally for testing glucocorticoid feedback inhibition. Burnout and perceived stress were measured by three different questionnaires. Perceived stress correlated with increases of cortisol levels during the first hour after awakening after dexamethasone pretreatment. In addition, teachers scoring high on burnout showed lower overall cortisol secretion on all sampling days, and a higher suppression of cortisol secretion after dexamethasone administration. In the subgroup of teachers with both high levels of perceived stress and high levels of burnout, a lower overall cortisol secretion was observed on the first 2 days, with stronger increases during the first hour after awakening after dexamethasone suppression. This subgroup also showed the lowest self-esteem, the highest external locus of control, and the highest number of somatic complaints. These results demonstrate differential effects of burnout and perceived stress on hypothalamic-pituitary-adrenal axis regulation.

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... Generally, included studies indicated that self-perceived stress in teachers was associated with dysregulated cortisol across the day. Specifically, across studies, poor perception by teachers about their training [32], high job demands [39], burnout [46,56], and depersonalization and ambition [46] were associated with a blunted cortisol awakening response (CAR). In a sample of middle school teachers, perceived stress was associated with a lower sAA awakening response [46]. ...
... More acute stress and higher self-perceived stress were associated with a higher CAR [59] and greater cortisol increase following wake [63] but not associated with differences across the course of the day [59]. Within the included studies, acute stress and day-to-day perceived stress were related to greater and steeper cortisol reactivity to stressors and dysregulated diurnal cortisol patterns compared to other samples with lower stress [40,44,46,50,56,59,63]. ...
... Several studies used a dexamethasone suppression test, which measures cortisol levels in timed samples after administering a synthetic glucocorticoid [40,56,60,70]. Dexamethasone suppresses ACTH production and should decrease cortisol production more if the source of excess cortisol is stress [40,56,60,70]. ...
... The remaining four studies adopted a range of longitudinal designs. Three were prospective studies varying from three measurement points in one day (Moya-Albiol et al., 2010), three measurement points over three working days (Pruessner et al., 1999), and four measurement points over a combination of working and leisure days . The final study adopted a two-wave longitudinal design over a period of one year (Burke & Greenglass, 1995). ...
... Six studies examined cortisol (comprising five unique samples; Bellingrath et al. 2008, Katz et al. 2016, Moya-Albiol et al. 2010, Moya-Albiol et al. 2010, Pruessner et al. 1999, Wolfram et al. 2013; cortisol is an endocrine hormone which mediates the hypothalamus-pituitary-adrenal (HPA) physiological response to stress). In five of the six studies, burnout showed an association with cortisol, in some form or another. ...
... In five of the six studies, burnout showed an association with cortisol, in some form or another. This included higher cortisol at waking and less steep cortisol awakening response (Katz et al., 2016), lower cortisol at the end of the work day compared to the beginning and middle (Moya-Albiol et al., 2010), and lower cortisol across three days for a high burnout group compared to a low burnout group (Pruessner et al., 1999). It was also the case following pharmacological intervention to modulate cortisol levels including greater cortisol suppression following dexamethasone intake Pruessner et al., 1999) and higher plasma cortisol following synacthen injection (Wolfram et al., 2013). ...
Article
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Teachers are at risk of many negative physical health consequences. The high levels of burnout in the teaching profession may be one of the reasons why this is the case. We tested this idea by providing the first systematic review of the association between teacher burnout and physical health. We found 21 relevant studies including 5267 teachers. The findings showed that teacher burnout was consistently associated with somatic complaints (e.g., headaches), illnesses (e.g., gastroenteritis), voice disorders, and biomarkers of hypothalamic-pituitary-adrenal-axis dysre-gulation (cortisol) and inflammation (cytokines). Future work in this area would benefit from a greater focus on integrating and testing theory. Nevertheless, the findings suggest that burnout may be a factor underpinning the development of physical ill-health in teachers.
... Generally, included studies indicated that self-perceived stress in teachers was associated with dysregulated cortisol across the day. Specifically, across studies, poor perception by teachers about their training [32], high job demands [39], burnout [46,56], and depersonalization and ambition [46] were associated with a blunted cortisol awakening response (CAR). In a sample of middle school teachers, perceived stress was associated with a lower sAA awakening response [46]. ...
... More acute stress and higher self-perceived stress were associated with a higher CAR [59] and greater cortisol increase following wake [63] but not associated with differences across the course of the day [59]. Within the included studies, acute stress and day-to-day perceived stress were related to greater and steeper cortisol reactivity to stressors and dysregulated diurnal cortisol patterns compared to other samples with lower stress [40,44,46,50,56,59,63]. ...
... Several studies used a dexamethasone suppression test, which measures cortisol levels in timed samples after administering a synthetic glucocorticoid [40,56,60,70]. Dexamethasone suppresses ACTH production and should decrease cortisol production more if the source of excess cortisol is stress [40,56,60,70]. ...
... However, Braig et al. [45] did not observe significant correlations between self-reported psychosocial stress and hair cortisol in women. Interestingly, Pruessner et al. [46] showed that chronic stress was associated with decreased cortisol concentration. Perceived stress, particularly chronic stress, can both decrease and increase cortisol concentration [46]. ...
... Interestingly, Pruessner et al. [46] showed that chronic stress was associated with decreased cortisol concentration. Perceived stress, particularly chronic stress, can both decrease and increase cortisol concentration [46]. There are several reasons why chronic stress could be associated with elevated and decreased cortisol levels, such as cortisol depletion, lack of free cortisol, impaired cortisol secretion regulating hormones (ACTH, CRH), or modulated glucocorticoid receptor sensitivity [47]. ...
Article
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Phthalates alter the hormonal balance in humans during pregnancy, potentially affecting embryonic and fetal development. We studied the joint effect of exposure to phthalates, quantified by urinary phthalate metabolite concentration, and perceived psychological stress on the concentration of hormones in pregnant women (n = 90) from the Nitra region, Slovakia, up to the 15th week of pregnancy. We used high-performance liquid chromatography, tandem mass spectrometry (HPLC-MS/MS), and electro-chemiluminescence immunoassay to determine urinary concentrations of phthalates and serum concentrations of hormones, respectively. We used Cohen perceived stress scale (PSS) to evaluate the human perception of stressful situations. Our results showed that mono(carboxy-methyl-heptyl) phthalate (cx-MiNP) and a molar sum of di-iso-nonyl phthalate metabolites (ΣDiNP) were negatively associated with luteinizing hormone (LH) (p ≤ 0.05). Mono(hydroxy-methyl-octyl) phthalate (OH-MiNP) and the molar sum of high-molecular-weight phthalate metabolites (ΣHMWP) were positively associated with estradiol (p ≤ 0.05). PSS score was not significantly associated with hormonal concentrations. When the interaction effects of PSS score and monoethyl phthalate (MEP), cx-MiNP, ΣDiNP, and ΣHMWP on LH were analyzed, the associations were positive (p ≤ 0.05). Our cross-sectional study highlights that joint psychosocial stress and xenobiotic-induced stress caused by phthalates are associated with modulated concentrations of reproductive hormones in pregnant women.
... The crisis of physician burnout, stress, and clinical errors has been a topic of discussion and research for the past two decades 141,142 . Burnout is defined as a condition of high emotional exhaustion, depersonalization, and low personal accomplishment. ...
... Frequently, burnouts are preceded or accompanied by periods of prolonged stress 142 . ED staff are often exposed to high levels of stress due to the diverse nature of patient conditions, which include life-threatening emergencies, injuries, and chronic ailments. ...
Thesis
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Over 151 million people visit US Emergency Departments (EDs) annually. The diverse nature and overwhelming volume of patient visits make the ED one of the most complicated settings in healthcare to study. ED overcrowding is a recognized worldwide public health problem, and its negative impacts include patient safety concerns, increased patient length of stay, medical errors, patients left without being seen, ambulance diversions, and increased health system expenditure. Additionally, ED crowding has been identified as a leading contributor to patient morbidity and mortality. Furthermore, this chaotic working environment affects the well-being of all ED staff through increased frustration, workload, stress, and higher rates of burnout which has a direct impact on patient safety. This research takes a step-by-step approach to address these issues by first forecasting the daily and hourly patient arrivals, including their Emergency Severity Index (ESI) levels, to an ED utilizing time series forecasting models and machine learning models. Next, we developed an agent-based discrete event simulation model where both patients and physicians are modeled as unique agents for capturing activities representative of ED. Using this model, we develop various physician shift schedules, including restriction policies and overlapping policies, to improve patient safety and patient flow in the ED. Using the number of handoffs as the patient safety metric, which represents the number of patients transferred from one physician to another, patient time in the ED, and throughput for patient flow, we compare the new policies to the current practices. Additionally, using this model, we also compare the current patient assignment algorithm used by the partner ED to a novel approach where physicians determine patient assignment considering their workload, time remaining in their shift, etc. Further, to identify the optimal physician staffing required for the ED for any given hour of the day, we develop a Mixed Integer Linear Programming (MILP) model where the objective is to minimize the combined cost of physician staffing in the ED, patient waiting time, and handoffs. To develop operations schedules, we surveyed over 70 ED physicians and incorporated their feedback into the MILP model. After developing multiple weekly schedules, these were tested in the validated simulation model to evaluate their efficacy in improving patient safety and patient flow while accounting for the ED staffing budget. Finally, in the last phase, to comprehend the stress and burnout among attending and resident physicians working in the ED for the shift, we collected over 100 hours of physiological responses from 12 ED physicians along with subjective metrics on stress and burnout during ED shifts. We compared the physiological signals and subjective metrics to comprehend the difference between attending and resident physicians. Further, we developed machine learning models to detect the early onset of stress to assist physicians in decision-making.
... Burnout is defined as a debilitating psychological condition brought about by unrelieved work stress, which results in (a) depleted energy reserves, (b) lowered resistance to illness, (c) increased dissatisfactions and pessimism, and (d) increased absenteeism and inefficiency at work (109). Employees who experience burnout may develop a variety of symptoms, including overall job dissatisfaction, lack of energy and insomnia, tension headaches, ulcers, and dysregulated cortisol responses (107,109). ...
... Individuals who believe that they personally have control over their lives are considered to have an internal locus of control. On the other hand, individuals who believe that their lives are dictated by forces outside of themselves, such as destiny, fate, or faith, have an external locus of control (107,111). These two areas of control have a major impact on health and health practices. ...
Chapter
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Chapter 13 of ACSM's Resources for the Exercise Physiologist. Health Stress Management.
... This pattern corresponds to the rest-activity cycle of the organism. Distinctly flattened diurnal cortisol levels have been linked to chronic fatigue syndrome, burnout, and insomnia [11]. Many of the body's homeostatic functions, including the immunological, metabolic, cardiovascular, reproductive, and central neurological systems, are controlled by the HPA axis. ...
... Recent evidence has shown a significant, negative relationship between the severity of psychological symptoms of dissociation and the level of stress-induced release of neuropeptide Y. Although additional research is needed to clarify this issue, the current data raise the possibility that neuropeptide Y may also play a role in certain somatic complaints (20,36). ...
... Most of them were women with little education and living in very poor financial conditions. The inverse relationship between perceived stress and hair cortisol concentration can be explained by the classical theory of learned helplessness (Seligman, 1972) or by the concept of wear-and-tear due to chronic stress (Charles et al., 2013;Pruessner et al., 1999). In a situation of long-term stress, when coping strategies turn out to be ineffective, a feeling of numbness, powerlessness, and helplessness may occur. ...
... Only a limited number of studies have employed such approaches, and not all of them have reported sex differences, as endogenous circadian melatonin and CBT rhythms often take precedence as primary circadian endpoints in these studies. The few studies that did measure CAR levels report mixed results, with some suggesting a more robust and sustained (~25 min) increase in cortisol levels after waking in females [71][72][73][74], while other studies do not observe these differences [75,76]. Crucially, studies noting sex differences in the CAR indicate minimal effect sizes, with sex accounting for only 1-3% of the observed variability [71,72,77]. ...
... Participants who thought they could control the pentagastrin infusion and who received more detailed information about expected symptoms showed significantly lower cortisol responses than participants who lacked the information or control (Abelson, Khan, Liberzon, Erickson, & Young, 2008). Another study examining the effects of perceived stress and burnout in teachers found that those reporting high stress and ▶ burnout showed a lower morning cortisol secretion (also known as the cortisol awakening response) compared to the pattern exhibited in those with low stress and low burnout (stressful life events; Pruessner, Hellhammer, & Kirschbaum, 1999). Therefore, psychological stress can impair HPA responsivity, which may prove physiologically costly when faced with an actual rather than a perceived threat. ...
... The Perceived Stress Scale was based entirely on the subjective experience of stress, as assessed via four items. Importantly, prior research has found scores on the Perceived Stress Scale do correlate with serum cortisol levels, suggesting some correspondence between Perceived Stress Scale scores, on average, and other objective measures of stress responses (Pruessner et al., 1999;Wachholtz et al., 2011). The assessments across weeks was an additional limitation of the study design, particularly given recent work (Wemm et al., 2022;Wemm and Sinha, 2019) showing within day stress to be associated with subsequent drinking on the same day (albeit mediated by craving). ...
Article
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Alcohol use has been shown to increase stress, and there is some evidence that stress predicts subsequent alcohol use during treatment for alcohol use disorder (AUD), particularly among females who are more likely to report coping-motivated drinking. Gaining a better understanding of the processes by which stress and alcohol use are linked during treatment could potentially inform AUD treatment planning. The current study aimed to characterize the association between stress and drinking during the course of AUD treatment and whether there were sex differences in these associations. Secondary data analyses of the COMBINE study (N = 1375; 69% male, 76.3% non-Hispanic and white, average age of 44.4 years) were conducted to examine self-reported perceived stress and alcohol consumption across 16 weeks of treatment for AUD using a Bayesian random-intercept cross-lagged panel model. There was stronger evidence for any alcohol use predicting greater than typical stress in subsequent weeks and less strong evidence for stress increasing the subsequent probability of alcohol use, particularly among males. For females, greater stress predicted subsequent drinking earlier in the treatment period, and a lower probability of subsequent drinking in the last week of treatment. Interventions might specifically focus on targeting reductions in stress following drinking occasions.
... Whereas elevated cortisol is a normal response to stress, repeated consistent elevation and concomitant increases in allostatic load may, in the long run, lead to HPA axis dysregulation in the form of hypocortisolism, i.e., reduced levels of cortisol and other regulatory hormones (1,9,10). Hypocortisolism has been documented in animal models (11), humans working highly stressful jobs (12,13), humans with low early-life SES (14), and among those exposed to early-life trauma or repeated traumatic experiences (15)(16)(17)(18)(19). ...
Article
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Despite significant research on the effects of stress on the hypothalamic–pituitary–adrenal (HPA) axis, questions remain regarding long-term impacts of large-scale stressors. Leveraging data on exposure to an unanticipated major natural disaster, the 2004 Indian Ocean tsunami, we provide causal evidence of its imprint on hair cortisol levels fourteen years later. Data are drawn from the Study of the Tsunami Aftermath and Recovery, a population-representative longitudinal study of tsunami survivors who were living along the coast of Aceh, Indonesia, when the tsunami hit. Annual rounds of data, collected before, the year after and 2 y after the disaster provide detailed information about tsunami exposures and self-reported symptoms of post-traumatic stress. Hair samples collected 14 y after the tsunami from a sample of adult participants provide measures of cortisol levels, integrated over several months. Hair cortisol concentrations are substantially and significantly lower among females who were living, at the time of the tsunami, in communities directly damaged by the tsunami, in comparison with similar females living in other, nearby communities. Differences among males are small and not significant. Cortisol concentrations are lowest among those females living in damaged communities who reported elevated post-traumatic stress symptoms persistently for two years after the tsunami, indicating that the negative effects of exposure were largest for them. Low cortisol is also associated with contemporaneous reports of poor self-rated general and psychosocial health. Taken together, the evidence points to dysregulation in the HPA axis and “burnout” among these females fourteen years after exposure to the disaster.
... Salivary α-amylase follows the reverse pattern as cortisol, with a decrease approximately 30 minutes after awakening (α-amylase awakening response, AAR) and a continuous increase throughout the day (diurnal α-amylase slope) [22]. HPA axis dysregulation is typically manifested by an altered CAR and an attenuated DCS [21,23], whereas ANS dysregulation is generally characterized by an attenuated AAR, indicated by a lower decrease 30 minutes after awakening and by an increased diurnal α-amylase slope [24]. Dysregulation in these diurnal secretion patterns has been associated with stress as well as poor mental and physical health outcomes [25][26][27]. ...
Article
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Teachers are among the occupational groups with the highest sick leave rates due to workplace stress and burnout symptoms. A substantial body of research has suggested social isolation and neuroticism to be related to physiological stress activity. However, the relationship between such characteristics and stress experiences has rarely been studied in conjunction with physiological stress indicators in the teachers’ natural settings. Thus, the present study examines salivary cortisol and α-amylase as physiological stress indicators on teachers’ work and leisure days and their relationship with social isolation. Furthermore, we test whether neuroticism moderates the relationship between social isolation and salivary biomarkers. Forty-two teachers completed questionnaires assessing social isolation (Trier Inventory for the Assessment of Chronic Stress) and neuroticism (Big-Five Inventory). Participants collected eight saliva samples on three days, two workdays, and one leisure day to measure the concentration of cortisol and α-amylase as biomarkers of the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), respectively. Results showed a significantly higher Cortisol Awakening Response (CAR) and diurnal cortisol slope (DCS) on workdays than on the leisure day but no significant differences regarding measures of α-amylase. We found a significant positive relationship between social isolation and the CAR on the leisure day but no association with the α-amylase measures. Furthermore, after controlling for confounders, social isolation was unrelated to neuroticism, and the latter did not moderate between social isolation and the CAR. Our findings suggest an association between social isolation and the HPA axis, i.e., the CAR, but do not support an association with the ANS, which would be indicated by the α-amylase assessments. Finally, our findings could not support an association of neuroticism with the HPA axis and ANS.
... For example, circadian patterns of urinary glucocorticoid levels are attenuated in aged chimpanzees (e.g., Emery Thompson et al., 2020), and orphaned chimpanzees in the short term (Girard-Buttoz et al., 2021). While interactions between the circadian clock and the hypothalamic-pituitary-adrenal (HPA) axis can be leveraged in studies investigating topics such as health by measuring the diurnal slope (e.g., Pruessner et al., 1999), the existence of diurnal changes in glucocorticoid secretion may require that researchers use consistent sampling times across days. To account for these rhythmic changes, samples for glucocorticoid analysis are often collected from diurnal species in the morning, when peak levels have been shown to occur (e.g., Homo sapiens and Gorilla gorilla urine (Czekala et al., 1994); H. sapiens saliva and plasma (Ljubijankić et al., 2008); Callithrix jacchus saliva (Cross & Rogers, 2004); Saimiri sciureus plasma (Coe & Levine, 1995); Macaca fascicularis feces (Stavisky et al., 2001). ...
Article
Measuring glucocorticoids is one of the most reliable and widely used techniques to monitor stress responses, however invasive techniques to collect plasma samples may not be applicable for wild populations. Monitoring excreted glucocorticoids is an effective noninvasive technique that researchers have used increasingly over the past two decades, and it has allowed the investigation of glucocorticoids in a variety of species with a range of activity patterns. Many species exhibit predictable circadian patterns of glucocorticoid secretion in accordance with their daily activity pattern. There remains a gap in our understanding of how excreted glucocorticoid metabolites vary throughout the day and across species, despite the utility of this information when developing sampling protocols and analyzing data. We investigated circadian patterns of glucocorticoid excretion in a cathemeral primate species, Eulemur rubriventer (red-bellied lemur), in Ranomafana National Park, Madagascar. We collected fecal samples from 10 individuals throughout the day and analyzed fecal glucocorticoid levels across three time points (Early, Midday, and Late), and again across two time points (Morning and Afternoon). We also investigated whether activity pattern, sex (as a control variable), and other traits associated with gut passage rate (diet, body mass) could help predict the presence and timing of circadian patterns of fecal glucocorticoid metabolites across mammal species. We found that fecal glucocorticoid metabolite levels in E. rubriventer fluctuate throughout the day, with lowest levels in the morning and peak levels in the afternoon. None of the variables that we tested predicted whether daily fecal glucocorticoid metabolites changed significantly throughout the day, nor when levels were likely to peak, across species. We stress the importance of controlling for sampling time and reporting these results as standard practice in studies of fecal glucocorticoid metabolites.
... Cortisol levels are normally high in the morning and low at night. An alteration in these levels, such as abnormally high levels at night or small variation between day and night cycles points towards a time-sustained stress level situation [129], [130]. ...
Article
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The purpose of this study is to explore the measurement of human factors in the workplace that can provide critical insights into workers’ well-being. Human factors refer to physical, cognitive, and psychological states that can impact the efficiency, effectiveness, and mental health of workers. The article identifies six human factors that are particularly crucial in today’s workplaces: physical fatigue, attention, mental workload, stress, trust, and emotional state. Each of these factors alters the human physiological response in a unique way, affecting the human brain, cardiovascular, electrodermal, muscular, respiratory, and ocular reactions. This paper provides an overview of these human factors and their specific influence on psycho-physiological responses, along with suitable technologies to measure them in working environments and the currently available commercial solutions to do so. By understanding the importance of these human factors, employers can make informed decisions to create a better work environment that leads to improved worker well-being and productivity.
... Patients admitted with AMI can also develop subsequent major adverse cardiovascular events (MACE), especially when the cortisol levels in the blood are high [60]. Since cortisol increases under stress [61]- [63] in blood and in sweat [64], keeping stress levels low is vital to prevent further MACE events. Physical activity is particularly effective for this aim [65], [66]. ...
Article
Points-of-care (PoCs) augment healthcare systems by performing care whenever needed and are becoming increasingly crucial for the well-being of the worldwide population. Personalized medicine, chronic illness management, and cost reduction can be achieved thanks to the widespread adoption of PoCs. Significant incentives for PoCs deployment are nowadays given by wearable devices and, in particular, by RFID (RadioFrequency IDentification) and NFC (Near Field Communications), which are rising among the technological cornerstones of the healthcare internet of things (H-IoT). To fully exploit recent technological advancements, this paper proposes a system architecture for RFID-and NFC-based PoCs. The architecture comprises in a unitary framework both interfaces to benefit from their complementary features, and gathered data are shared with medical experts through secure and user-friendly interfaces that implement the Fast Health Interoperability Resource (FHIR) emerging healthcare standard. The selection of the optimal UHF and NFC components is discussed concerning the employable sensing techniques. The secure transmission of sensitive medical data is addressed by developing a user-friendly "PoC App" that is the first web app exploiting attribute-based encryption (ABE). An application example of the system for monitoring the pH and cortisol levels in sweat is implemented and preliminarily tested by a healthy volunteer.
... Patients admitted with AMI can also develop subsequent major adverse cardiovascular events (MACE), especially when the cortisol levels in the blood are high [60]. Since cortisol increases under stress [61]- [63] in blood and in sweat [64], keeping stress levels low is vital to prevent further MACE events. Physical activity is particularly effective for this aim [65], [66]. ...
Preprint
Full-text available
Points-of-care (PoCs) augment healthcare systems by performing care whenever needed and are becoming increasingly crucial for the well-being of the worldwide population. Personalized medicine, chronic illness management, and cost reduction can be achieved thanks to the widespread adoption of PoCs. Significant incentives for PoCs deployment are nowadays given by wearable devices and, in particular, by RFID (RadioFrequency IDentification) and NFC (Near Field Communications), which are rising among the technological cornerstones of the healthcare internet of things (H-IoT). To fully exploit recent technological advancements, this paper proposes a system architecture for RFID- and NFC-based PoCs. The architecture comprises in a unitary framework both interfaces to benefit from their complementary features, and gathered data are shared with medical experts through secure and user-friendly interfaces that implement the Fast Health Interoperability Resource (FHIR) emerging healthcare standard. The selection of the optimal UHF and NFC components is discussed concerning the employable sensing techniques. The secure transmission of sensitive medical data is addressed by developing a user-friendly "PoC App" that is the first web app exploiting attribute-based encryption (ABE). An application example of the system for monitoring the pH and cortisol levels in sweat is implemented and preliminarily tested by a healthy volunteer.
... At the same time, it may be a source of many stresses such as teaching, research, preparation of lectures, etc., and then may lead to symptoms of burnout. Many studies (Arrona-Palacios et al.; Bhui et al., 2016;Cassidy-Vu et al., 2017;Durning et al., 2013;Galindo-Dominguez et al., 2020;Garcia et al., 2008;Haghighinejad et al., 2021;Lipp, 2002;Maslach et al., 1992;McKinley, 2022;Nodoushan et al., 2021;Oginska-Bulik, 2002;Polman et al., 2010;Pruessner et al., 1999;Reddy, 2012;Seo et al., 2022;Sousa & Mendoca, 2009) indicated that continuous exposure to work stress and the absence of social and occupational support sources might lead to symptoms of occupational burnout. ...
... Third, the Trier Inventory for Assessment of Chronic Stress included 30 items that measure (via self-report) multiple aspects of long-term psychosocial stress (Schulz & Schlotz, 1999); it has been validated in concordance with other stress measures and with cortisol secretion (J. C. Pruessner et al., 1999;Schulz et al., 1998;Wust et al., 2000). ...
Article
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The stress-vulnerability model has been repeatedly highlighted in relation to the risk, onset and course of psychosis, and has been independently studied in clinical high-risk (CHR) and first-episode psychosis (FEP) populations. Notable in this literature, however, is that there are few studies directly comparing markers of stress response across progressive stages of illness. Here we examined the psychobiological response to the Trier Social Stress Test in 28 CHR (mean age 19.1) and 61 FEP (age 23.0) patients, in order to understand the stage(s) or trajectories in which differences in subjective stress or physiological response occur. The overall clinical sample had greater perceived stress and blunted cortisol (FEP + CHR, n = 89, age 21.7) compared with healthy controls (n = 45, age 22.9). Additional analyses demonstrated elevated heart rate and systolic blood pressure in FEP compared with CHR, but there were no further differences in physiological parameters (cortisol, heart rate, or blood pressure) between stage- or trajectory-based groups. Together, this suggests that individual stress response markers may differentially emerge at particular stages en route to psychosis - and demonstrates how stage-based analyses can shed light on the emergence and evolution of neurobiological changes in mental illness.
... On the other hand, impromptu public speaking-which is not only emotionally arousing but also involves a lack of control and an element of socialevaluative judgment (see below)-activates both SNS and HPA axis responses (Kirschbaum, Pirke, & Hellhammer, 1993). HPA axis hormones, in addition to responding to acute stressors, also show effects of chronic, long-term stress, such as effects of dominance hierarchies in many species (Sapolsky, 2005); and human-specific chronic stressors such as burnout (Pruessner, Hellhammer, & Kirschbaum, 1999), perceived work overload (Schlotz, Hellhammer, Schulz, & Stone, 2004), and material hardship (Ranjit, Young, & Kaplan, 2005). ...
Chapter
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Our bodies produce a rich diversity of hormones that play roles in physiological functions from blood sugar storage (insulin) to thirst and salt–water balance (angiotensin II) to inhibition of neural firing (allopregnanolone). The brain coordinates hormone production, so levels of many hormones fluctuate during emotion. Hormones also affect the brain, which gives them the potential to influence emotion, cognition, and behavior.
... The copyright holder for this preprint this version posted February 21, 2023. ; https://doi.org/10.1101/2023.02.19.526965 doi: bioRxiv preprint at 30 minutes after awakening (N3) minus the cortisol level at awakening point (N1) 265 (49), and the R30 values higher than ±3 SD were excluded from further analyses. ...
Preprint
A positive coping style is recognized as a stable disposition to promote psychological resilience and emotional wellness, enabling an adaptive process of assessing the environment and dealing with future challenges. Such adaptive process is believed to involve a nuanced interplay of the hippocampal system and the primary stress hormone cortisol activity. As a hallmark of diurnal cortisol rhythm, cortisol awakening response (CAR) is sensitive to upcoming stress and subserves preparation of the hippocampal system for rapid behavioral adaption. Yet, little is known how the hippocampal system and CAR contribute to the merit of positive coping on emotional wellness. Methods: In Study 1, we examined the effects of positive coping on children's emotional regulation skill, trait and state anxiety as well as CAR in 89 children. In Study 2, we further investigated the effects of positive coping and CAR on longitudinal changes in hippocampal-neurocortical functional organizatioon involved in emotional processing. Results: Behaviorally, positive coping predicted better emotional regulation ability, but lower anxiety and lower response caution in emotional decision-making. At a neuroendocrinal level, positive coping associated with greater CAR predictd higher hippocampal connectivity with ventrolateral prefrontal cortex (vlPFC) and stimulus-sensitive neurocortex one year later. Moreover, CAR mediated an indirect association between positive coping and longitudinal increases in hippocampal-neocortical connectivity. Positive coping and CAR together accounted for the maturity of vlPFC through longitudinal changes in hippocampal-neocortical connectivity. Conclusion: Our findings suggest a cognitive neuroendocrinal mechanism through which positive coping shapes hippocampal-neocortical maturation via stress hormone response to support emotional wellness.
... The Perceived Stress Scale is a 10-item scale 71,72 that measures how often someone feels their life is stressful, uncontrollable, or overwhelming. The PSS has been found to be correlated with higher cortisol levels [73][74][75] and has been used to assess a variety of populations including youths 76 and youth smokers, 77 Additionally, a translated Thai version demonstrated validity and reliability in estimating stress levels on a Thai population. 78 Comprised of 2 subscales, 71,76 the first PSS subscale consists of 6 questions that inquire about perceived self-efficacy (eg, "In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?"). ...
Article
Recent studies have found high levels of stress among Americans, particularly amongst young adults and ethnic minority groups. The purpose of this secondary data analysis was to explore the association between stress and social support among a sample of 276 young adult smokers of Pacific Islander ancestry, specifically Samoans and Tongans with an average age of 25.3 years. Previous research had documented the protective role of social support on stress, and thus it is hypothesized that young adult Pacific Islander smokers who perceived higher levels of social support will have less perceived stress. Social support was assessed using a 12-item scale which measured participant's perceived social support from family, friends, and significant others. Perceived stress was measured using a 10-item scale with 2 subscales - self efficacy and helplessness. Standardized parameter estimates from structural equation modeling indicated a statistically significant inverse relationship between perceived social support from family and perceived stress related to helplessness. More specifically, young adult Samoans and Tongans who report higher levels of social support from family do not feel as much stress stemming from being helpless. The results highlight the importance of family social support on stress management among this population. Most importantly, these findings add to the limited research around mental health within Pacific Islander (Samoan and Tongan) communities in the US.
... It has been hypothesized that a higher than normal CAR can be adaptive in the short-term by helping individuals prepare to meet the demands of the day (e.g., "boost hypothesis"; Adam et al., 2006); however, when these short-term elevations are chronically experienced, a heightened CAR can confer risk for negative outcomes (e.g., major depressive disorder; Adam et al., 2010). Conversely, a lower CAR may reflect HPA axis dysregulation resulting from prior overactivation (i.e., due to exhaustion of physiological systems) and has been associated with conditions such as fatigue and burnout (Chida & Steptoe, 2009;Pruessner et al., 1999). ...
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The transition to college is a time of increased opportunity and stress spanning multiple domains. Adolescents who encounter significant stress during this transition may be vulnerable to adverse outcomes due to a "wear and tear" of the hypothalamic pituitary adrenal (HPA) axis. Latino/a students may be particularly at-risk for heightened stress exposure due to experiences of both minority-specific and general life stress. Despite this, little is known regarding the cumulative impact of multiple stressors on Latino/a students' HPA axis functioning. The present study employed a "multi-risk model" approach to examine additive, common, and cumulative effects of multiple stress forms (general, academic, social, financial, bicultural, ethnic/racial discrimination) on diurnal cortisol in a sample of first-year Latino/a college students (N = 196; 64.4% female; Mage = 18.95). Results indicated that no stress forms were additively associated with the cortisol awakening response (CAR), but general stress was associated with a flatter diurnal cortisol slope (DCS) and bicultural stress was linked with a steeper DCS. A college stress latent factor was associated with a lower CAR, whereas a latent factor of discrimination was not associated with diurnal cortisol. Cumulative risk was linked with a lower CAR. Findings highlight the physiological correlates of various stressors experienced by Latino/a college students.
... The HPG axis has been shown to interact with the hypothalamic-pituitary-adrenal (HPA) axis responsible for regulating free cortisol levels, possibly with oestradiol as a significant driver of the interplay (Høgsted et al., 2021). Additionally, OC users also show an altered cortisol awakening response with a lower morning cortisol peak and a flatter curve throughout the day (Hampson, 2018;Meulenberg et al., 1987;Pruessner et al., 1999). These decreased spikes are consistent with otherwise higher total cortisol levels in OC using women (Hertel et al., 2017), which suggests alterations in the HPA axis of women on OCs similar to that of permanent stress profiles. ...
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Cognitive consequences of Hormonal Contraceptives (HCs) are largely underexplored, despite the popularity of use. This study investigates the association between perseverance during cognitively challenging tasks and the use of HCs among Danish women. We hypothesized that women using HCs show decreased perseverance across tasks compared to their naturally cycling counterparts. We further hypothesized that HC using women would show decreased performance as a measure of accuracy (i.e., more incorrect answers) compared to naturally cycling women. The study used a cross-sectional repeated measures design, consisting of a Danish version of the Anagram Persistence Task and the Hagen Matrices Test, followed by an extensive survey documenting menstrual and HC history for each participant. The study was conducted online. Data processing was conducted on data from 129 participants. The former hypothesis was analyzed through multilevel regression with a nested random effects structure on log-transformed data. The latter hypothesis was analyzed through a multilevel generalized linear model with a nested random effects structure using the binomial family. No support was found for either of the hypotheses.
... In addition to the diurnal profile, cortisol also tends to present a marked increase within the hour after waking from nocturnal sleep. This increase in cortisol concentration, termed the cortisol awakening response (CAR), has been implicated in a range of psychopathological conditions, including depression (Adam et al. 2010;van Santen et al. 2011;Vrshek-Schallhorn et al. 2013;Dedovic and Ngiam 2015), chronic fatigue syndrome (Roberts et al. 2004;Nater et al. 2008;Heim et al. 2009;Hall et al. 2014) and burnout (Pruessner et al. 1999;Grossi et al. 2005;Oosterholt et al. 2015), as well as exercise-related conditions such as the overtraining syndrome (Anderson et al. 2021). ...
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The effects of acute exercise on the cortisol awakening response (CAR), characterized by the rapid increase in cortisol concentrations within the 30–45 min following sleep offset has yet to be fully elucidated. Thus, our study investigated the effects of late-evening acute exercise on the CAR the following morning. We hypothesized that exercise would have a significant effect on the CAR the following morning. Twelve participants (mean (SD): age = 23 (4) years; mass = 76.8 (8.7) kg; height = 175.6 (5.0) cm; V˙\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\dot{\text{V}}}$$\end{document}O2max = 48.9 (7.5) ml.kg⁻¹.min⁻¹) reported to the laboratory in the evening (1800 h) on two occasions and were randomly assigned to either exercise for one hour (70–75% of maximal power output) or rest condition. Blood and saliva samples were assayed for cortisol. Mixed-effects models determined the effect of exercise on the cortisol response post-waking in both blood and saliva. Participants demonstrated an average exercise-induced increase in circulating cortisol of 477.3%, with actual mean (SD) heart rate relative to maximum of 87.04% (6.14%). Model results demonstrated a negative effect for exercise condition when modeling the serum and salivary cortisol responses to awakening via a quadratic growth model (serum, βCondition = − 42.26 [95% CI − 64.52 to − 20.01], p < 0.001; saliva, βCondition = − 11.55 [95% CI − 15.52 to − 7.57], p < 0.001). These results suggest that cortisol concentrations in saliva and blood are significantly lower the morning following a prior evening exercise session. Therefore, the CAR may serve as a useful biomarker to monitor responses to exercise training, although the underlying mechanism for these decreases in the CAR should be investigated further.
... The measurement of cortisol as a biomarker of chronic stress and "allostatic load" (cumulative effects of allostatic responses that are chronic, excessive or poorly regulated) [180] is intended to assess and predict the cumulative biologic risks of diverse impending illnesses [181]. Its link to the pathophysiology of diverse neurologic, psychiatric, cardiovascular and metabolic diseases has been well documented [182][183][184] and investigated as a predictive factor for a broad range of study-specific endpoints [185][186][187][188]. However, its clinical use in these patients is not considered universal or routine as the extent of altered circulating cortisol does not guide therapy [189] and is not an indicator to lower or replace [190]. ...
Chapter
Cortisol, the main human glucocorticoid, is synthesized from cholesterol in the adrenal cortex and predominantly metabolized by the liver. Interpretation of quantitative results from the analysis of serum, urine and saliva is complicated by variation in circadian rhythm, response to stress as well as the presence of protein-bound and free forms. Interestingly, cortisol is the only hormone routinely measured in serum, urine, and saliva. Preanalytical and analytical challenges arise in each matrix and are further compounded by the use of various stimulation and suppression tests commonly employed in clinical practice. Although not yet included in clinical guidelines, measurement of cortisol in hair may be of interest in specific situations. Immunoassays are the most widely used methods in clinical laboratories to measure cortisol, but they are susceptible to interference from synthetic and endogenous steroids, generally producing a variable overestimation of true cortisol results, especially in urine. Analysis by mass spectrometry provides higher specificity and allows simultaneous measurement of multiple steroids including synthetic steroids, thus reducing diagnostic uncertainty. An integrated review of cortisol in various disease states is also addressed.
... Teacher turnover has largely been addressed from two main perspectives: (a) an emphasis on improving job satisfaction or (b) a focus on reducing or eliminating factors leading to job burnout (Pruessner et al., 1999;Parker et al., 2006). Instructors in Chinese higher education have gradually become one of the largest groups of teachers globally (Leiter and Maslach, 2003) and have been characterized by frequent and increasing job turnover in recent years, drawing the close attention of scholars and educational administrators (Smith and Worsfold, 2014). ...
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Introduction Teacher burnout and frequent turnover negatively affect stability and productivity in the context of higher education. Despite the fact that the relationship between burnout and turnover intention has been thoroughly studied, the role of other factors in this relationship should be evaluated in order to better clarify underlying mechanisms, particularly in the context of higher education. Methods In this study, we first aim to bridge a research gap by utilizing job satisfaction as a mediating variable for the relationship between burnout and turnover intention. Moreover, we uniquely evaluate the role of proactive personality as a moderating variable, first in terms of the relationship between burnout and job satisfaction, and then for the relationship between job satisfaction and turnover intention. Based on 296 valid questionnaires collected from university faculty members in China, proposed hypotheses were evaluated empirically. Results The results demonstrate that, as expected, burnout has a significant and positive impact on turnover intention, and job satisfaction has significantly negative impact on turnover intention, with job satisfaction partially mediating the relationship between burnout and turnover intention. Moreover, proactive personality moderated the relationship between job satisfaction and turnover intention, with this relationship being stronger for individuals with high proactive personality as compared to low proactive personality. Discussion These findings provide a better understanding of the relationship between burnout and turnover intention of university instructors. Theoretical and practical implications, limitations, and recommendations for further research are provided.
... In organizational behavior literature, it has been shown that when chronic stress lasts too long, it depletes employees' resources, eventually leading to burnout, which corresponds to a collapse of the ability to cope with stress. This collapse is evident at the psychological level but also at the physiological level (Pruessner et al. 1999). The individual therefore lacks the necessary resources to cope with stressors, which explains that burnout is even more detrimental than chronic stress. ...
Chapter
Parental burnout is a specific syndrome resulting from enduring exposure to chronic parenting stress. It encompasses three dimensions: an overwhelming exhaustion related to one’s parental role, an emotional distancing with one’s children and a sense of ineffectiveness in one’s parental role. This study aims to facilitate further identification of antecedents/risk factors for parental burnout in order to inform prevention and intervention practices. In a sample of 1723 french-speaking parents, we examined the relationship between parental burnout and 38 factors belonging to five categories: sociodemographics, particularities of the child, stable traits of the parent, parenting and family-functioning. In 862 parents, we first examined how far these theoretically relevant risk factors correlate with burnout. We then examined their relative weight in predicting burnout and the amount of total explained variance. We kept only the significant factors to draw a preliminary model of risk factors for burnout and tested this model on another sample of 861 parents. The results suggested that parental burnout is a multi-determined syndrome mainly predicted by three sets of factors: parent’s stable traits, parenting and family-functioning.KeywordsParentBurn-outExhaustionAntecedentsCauses
... Collectively, the observed fluctuations in cortisol, a return towards baseline after week 12 and an improvement in physical fitness suggest that the physiological strain experienced by recruits over BMT was largely tolerable. Furthermore, we did not observe a constant suppression of morning cortisol across BMT which can indicate chronic psychophysiological strain, 23 indicating that BMT is unlikely to impair hypothalamic-pituitary axis functioning. ...
Article
Introduction: Military personnel train and operate in challenging multistressor environments, which can affect hormonal levels, and subsequently compromise performance and recovery. The aims of this project were to evaluate concentrations of cortisol and testosterone and subjective perceptions of stress and recovery across basic military training (BMT). Methods: 32 male recruits undergoing BMT were tracked over a 12-week course. Saliva samples were collected weekly, on waking, 30 min postwaking and bedtime. Perceptions of stress and recovery were collected weekly. Daily physical activity (steps) were measured via wrist-mounted accelerometers across BMT. Physical fitness was assessed via the multistage fitness test and push-ups in weeks 2 and 8. Results: Concentrations of testosterone and cortisol, and the testosterone:cortisol ratio changed significantly across BMT, with variations in responses concurrent with programmatic demands. Perceptions of stress and recovery also fluctuated according to training elements. Recruits averaged 17 027 steps per day between weeks 2 and 12, with week-to-week variations. On average, recruits significantly increased predicted VO2max (3.6 (95% CI 1.0 to 6.1) mL/kg/min) and push-ups (5. 5 (95% CI 1.4 to 9.7) repetitions) between weeks 2 and 8. Conclusions: Recruit stress responses oscillated over BMT in line with programmatic demands indicating that BMT was, at a group level, well-tolerated with no signs of enduring physiological strain or overtraining. The sensitivity of cortisol, testosterone and the testosterone:cortisol ratio to the stressors of military training, suggest they may have a role in monitoring physiological strain in military personnel. Subjective measures may also have utility within a monitoring framework to help ensure adaptive, rather than maladaptive (eg, injury, attrition), outcomes in military recruits.
... In addition to the diurnal profile, cortisol also tends to present a marked increase within the hour after waking from nocturnal sleep. This increase in cortisol concentration, termed the cortisol awakening response (CAR), has been implicated in a range of psychopathological conditions, including depression (Adam et al. 2010;van Santen et al. 2011;Vrshek-Schallhorn et al. 2013;Dedovic and Ngiam 2015), chronic fatigue syndrome (Roberts et al. 2004;Nater et al. 2008;Heim et al. 2009;Hall et al. 2014) and burnout (Pruessner et al. 1999;Grossi et al. 2005;Oosterholt et al. 2015), as well as exercise-related conditions such as the overtraining syndrome (Anderson et al. 2021). ...
... PSS has been used in a plethora of studies assessing the stressfulness of the situations, the effectiveness of stress-reducing interventions, and the extent to which there are associations between psychological stress and psychiatric and physical disorders [4][5][6][7][8][9][10][11][12]. The PSS predicts both, the objective biological markers of stress and the increased risk for disease among individuals with higher perceived levels of stress [13][14][15][16][17][18][19][20][21][22][23][24]. The scale also includes a number of direct queries about current levels of experienced stress wherein the questions asked are easy to understand and the response alternatives are simple to grasp. ...
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Burnout is a growing problem in high-performance sport and has negative consequences for athletes (e.g., mental ill-health). It is therefore important to effectively monitor athlete burnout to aid intervention efforts. While self-report measures are available (e.g., athlete burnout questionnaire), the limitations associated with these measures (e.g., social desirability bias) means that objective physiological markers may also be useful. Thus, this article critically discusses potential biomarkers of athlete burnout, drawing on research inside and outside of sport to offer an overview of the current state-of-the-art in this research area. First, it outlines what athlete burnout is, its deleterious consequences, and discusses existing psychological assessments. The article then critically discusses literature on hypothalamic-pituitary-adrenal axis (e.g., salivary cortisol) and autonomic nervous system (e.g., heart rate variability) indices of burnout, highlighting some promising biomarkers for future research (e.g., salivary cortisol at bedtime, vagally-mediated heart rate variability at rest). Finally, the article concludes by highlighting key considerations and offering recommendations for future research (e.g., use of more homogenous methods in assessing burnout and physiological parameters). As a result, the intention of this article is to spark more higher quality research on the psychophysiology of athlete burnout, thereby helping tackle this prominent issue in high-performance sport.
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In healthy individuals, the majority of cortisol secretion occurs within several hours surrounding morning awakening. A highly studied component of this secretory period is the cortisol awakening response (CAR), the rapid increase in cortisol levels across the first 30 to 45 minutes after morning awakening. This strong cortisol burst at the start of the active phase has been proposed to be functional in preparing the organism for the challenges of the upcoming day. Here, we review evidence on key regulatory and functional processes of the CAR and develop an integrative model of its functional role. Specifically, we propose that, in healthy individuals, the CAR is closely regulated by an intricate dual-control system, which draws upon key circadian, environmental, and neurocognitive processes to best predict the daily need for cortisol-related action. Fine-tuned CAR expression, in turn, is then assumed to induce potent glucocorticoid action via rapid nongenomic and slower genomic pathways (eg, affecting circadian clock gene expression) to support and modulate daily activity through relevant metabolic, immunological, and neurocognitive systems. We propose that this concerted action is adaptive in mediating two main functions: a primary process to mobilize resources to meet activity-related demands and a secondary process to help the organism counterregulate adverse prior-day emotional experiences.
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Purpose. The objective is to conduct an analytical review of multidirectional studies on psychoemotional burnout of personality as a phenomenon that negatively impacts and significantly complicates its professional activity and interpersonal communication. Methods. To achieve this objective, the following scientific-theoretical methods were applied: analysis, synthesis, generalization, which allowed for the revelation of substantive and functional parameters of psychoemotional burnout. Results. A range of studies explains the cause-and-effect essence of psychoemotional burnout by the specifics of a person's professional activity. Burnout leads to the appearance of psychological and/or psychosomatic changes, adversely affects affective balance, generates increased stress, heightened anxiety, oppressive frustration, and other depressive feelings, experiences, and behavioral modalities. Monotonous and emotionally exhausting as well as physically amortizing professional activity in a specific field, along with permanent pressure from administration, may stimulate feelings of mental discomfort, increase the frequency of intra- and interpersonal conflicts, stimulate social withdrawal, loneliness, and experiences of disappointment in life values. Conclusions. Psychoemotional burnout is regarded as a complex and branching phenomenon that exerts an unfavorable influence on a person's life and complicates their communicative relationships within the family and at work. Manifestations of psychoemotional burnout and psychophysical exhaustion have been studied extensively with diverse samples (students, police officers, medical professionals, firefighters, athletes, deprived children, etc.). A common feature of the analyzed studies is the recognition of the uncomfortable and destructive pressure of psychoemotional burnout on the affective-cognitive behavioral tactics and strategies of the individual.
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O Burnout pode ser manifestada como dificuldade de concentração, baixa autoestima, pensamentos pessimistas, isolamento ou irritabilidade. Além disso, há que se preocupar com empresas que ainda tratam o Burnout como se fosse um problema individual do trabalhador. Dessa forma, tem-se por objetivo analisar aspectos teóricos e práticos da Síndrome de Burnout em Profissionais de Saúde. Estudo reflexivo, construído a partir de buscas nas bases de dados: Medical Literature Library of Medicine, Literatura Latino-Americana e do Caribe, Scientific Electronic Library e Biblioteca Virtual em Saúde, no período de maio a junho de 2023. O estudo foi guiado pelos aspectos científicos referente a comunicação. Fez-se o uso do descritores: Síndrome de Burnout; Profissionais de Saúde; Cuidado. Renuíram-se que se encontravam na linha de estudo sobre o tema, publicados nos últimos dez anos, para construir essa reflexão. Conclui-se, que o tratamento pode se dar por meio de uma abordagem multidisciplinar; compreendida por terapia psicológica, estilo de vida alternativo e até mesmo por meio de medicação.
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Recently, the cortisol awakening response (CAR) has been focused as an index of chronic stress. Chronic, accumulated stress through burnout is known to result in uncontrollable HPA axis stress responses that cause abnormal CAR. However, the effects of burnout tendency on CAR in athletes remain unclear. This study examined the effect of burnout tendency on CAR in athletes. Participants were top-level female university athletes (N=45). Among them, the results of 40 participants were analyzed after excluding five participants that experienced measurement problems. The burnout tendency was evaluated using the Athletic Burnout Inventory (ABI). The participants were classified into the High BO group (N=12) with high burnout scores and the Low BO group (N=28) with low burnout scores. They were instructed to collect saliva at home, just after waking up, as well as 15 minutes, and 30 minutes later. The concentration of cortisol in saliva was estimated using the Enzyme-Linked Immuno-Sorbent Assay (ELISA). The results revealed higher CAR and AUCG tendencies in the High BO group compared to the Low BO group. However, this possibility has not been sufficiently supported statistically in the current study. We should revalidate these findings by ensuring an adequate number of samples estimated from the effect size. These findings indicate a new physiological index for assessing burnout tendency, which could contribute to better understanding the physiological mechanisms of burnout onset.
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This study examines stress biomarkers over the process of teaching and their associations with demographics, emotions, and mental health of 56 English as Foreign Language teachers. Participating teachers were invited to complete a questionnaire packet and provide saliva samples over three‐time points (i.e., before, during, and end of teaching). Afterward, the saliva samples were assayed for cortisol and α‐amylase as stress biomarkers. The results showed a significant change in the concentrations of cortisol and α‐amylase over the teaching process. In addition, being female, younger, more educated, and having more teaching experience were significantly associated with a higher level of α‐amylase, particularly before and during class time, thereby reflecting a greater level of stress. However, emotions and general mental health were not significantly associated with cortisol and α‐amylase over time. The findings highlighted the changes of biomarkers over the process of teaching and their relationships with other variables.
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The paper deals with a robust, projection-type measure of effect size when comparing J > 1 dependent groups. The measure of effect size is scale invariant and does not assume or require that the underlying multivariate distribution is elliptically contoured. By design the measure of effect size is equal to zero when the corresponding measures of location are equal. A simple method is suggested for testing the hypothesis that this effect size is zero. The method is readily extended to comparing K-variate distributions associated with two independent groups. One of the main goal is to report simulation results on how well the method performs in terms of controlling the Type I error probability. The method, when comparing independent groups, is used to reveal new insights into the connection between depression and cortisol levels.
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Perseverative cognitions, defined as "the repeated or chronic activation of the cognitive representation of one or more psychological stressors" (Brosschot et al., 2006, p. 114), are studied primarily in the context of their relationship with physiological activity to clarify the relationship between chronic stress and health. Their influence on the cardio-vascular, autonomic, and endocrine systems has been established (Ottaviani et al., 2016). The report presents data from a study of the relationship between different types of perseverative cognition and perceived daily stress. The moderate and strong positive correlations between the predisposition to repeated thinking about negative events in the past and the future and the perceived stress in the last month allow the role of perseverative cognition as a stressor in itself, maintaining cognitive representations of negative events after the stressor has stopped, or as an unsuccessful attempt to cope with stress. These results suggest that perseverative cognition may play a significantly more important role in the development of chronic stress and its accompanying mental and physiological effects than the immediate effects of stressors.
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Cortisol awakening response (CAR) refers to the dynamic change of cortisol concentration within 1 h after awakening. Trait anxiety is a general risk marker of anxiety disorders. The present study aimed to investigate the effect of trait anxiety on CAR using R30 (change in cortisol level at 30 min after awakening) and AUCi (the area under the curve with respect to the increase) as indicators. 133 college students were divided into high trait anxiety (HTA) and low trait anxiety (LTA) group according to the median score of the trait version of State-Trait Anxiety Inventory. Saliva samples were collected immediately upon awakening, 30 min, 45 and 60 min on two consecutive mornings. The results showed that, (1) decreased CAR was found for the male than female participants. (2) Compared to the LTA group, the HTA group showed decreased R30 and AUCi. (3) Both R30 and AUCi were negatively correlated with trait anxiety scores. These results demonstrated that trait anxiety might weaken the CAR, and both R30 and AUCi can be used as CAR indicators in detecting trait anxiety. Future research on CAR should consider the moderating effect of trait anxiety.
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The current pandemic has generated changes in work and lifestyles, thereby promoting psychological disorders such as burnout. This study aimed to contribute to the understanding of its antecedents: perceived stress and preparation for return to work. For this, a questionnaire was applied to 193 people from Ciudad Victoria, México, workers in commerce, services and industry. The results were analyzed through a multiple regression that showed a good significance of the model and a partial effect of independent variables on burnout, determining the need to consider other complementary variables in future research.
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A burnout kialakulásáért elsősorban munkahelyi tényezők tehetők felelőssé, de az egyén tulajdonságai (személyiségjegyek) is fontos szerepet játszanak benne. A kezdeti kutatások a munkahelyi tényezők szerepére koncentráltak, csak később került fókuszba az egyéni tulajdonságok szerepe. Ma már egyértelmű, hogy a munkahelyi és személyes jellemzőket együttesen kell tanulmányozni.
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Empathy is a fundamental component of our social-emotional experience. Over the last decade, there has been increased interest in understanding the effects of acute stress on empathy. We provide a first comprehensive—and systematic—overview identifying emerging patterns and gaps in this literature. Regarding affective empathy, there is abundant evidence for stress contagion—the ‘spillover’ of stress from a stressed target to an unstressed perceiver. We highlight contextual factors that can facilitate and/or undermine these effects. Fewer studies have investigated the effects of acute stress on affective empathy, revealing a nuanced picture, some evidence suggests acute stress can block contagion of other’s emotions; but again contextual differences need to be considered. Regarding cognitive empathy, most studies find no conclusive effects for simplistic measures of emotion recognition; however, studies using more complex empathy tasks find that acute stress might affect cognitive empathy differentially for men and women. This review provides an important first step towards understanding how acute stress can impact social-togetherness, and aims to aid future research by highlighting (in)congruencies and outstanding questions.
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Developed a 21-item Likert scale to measure burnout among public school teachers. The validity of the Teacher Burnout Scale is supported by the results of a factor analysis of data from 365 teachers in which the 4 factors that emerged are consistent with the theoretical constructs believed to underlie burnout. The factor analysis determined the subscales of the instrument: (1) Career Satisfaction, (2) Perceived Administrative Support, (3) Coping with Job-Related Stress, and (4) Attitudes towards Students. Additional analyses with 490 teachers indicated that the Teacher Burnout Scale has good internal consistency, test–retest reliability, and construct and predictive validity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A scale designed to assess various aspects of the burnout syndrome was administered to a wide range of human services professionals. Three subscales emerged from the data analysis: emotional exhaustion, depersonalization, and personal accomplishment. Various psychometric analyses showed that the scale has both high reliability and validity as a measure of burnout. Since the publication of this article in 1981, more extensive research was done on the MBI, which resulted in some modifications of the original measure. The present article has been re-edited to reflect those modifications. However, it does not include other new additions (which are contained in the MBI Manual distributed by the publisher, Mind Garden).
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Chronic fatigue syndrome is characterized by persistent or relapsing debilitating fatigue for at least 6 months in the absence of a medical diagnosis that would explain the clinical presentation. Because primary glucocorticoid deficiency states and affective disorders putatively associated with a deficiency of the arousal-producing neuropeptide CRH can be associated with similar symptoms, we report here a study of the functional integrity of the various components of the hypothalamic-pituitary-adrenal axis in patients meeting research case criteria for chronic fatigue syndrome. Thirty patients and 72 normal volunteers were studied. Basal activity of the hypothalamic-pituitary-adrenal axis was estimated by determinations of 24-h urinary free cortisol-excretion, evening basal plasma total and free cortisol concentrations, and the cortisol binding globulin-binding capacity. The adrenal cortex was evaluated indirectly by cortisol responses during ovine CRH (oCRH) stimulation testing and directly by cortisol responses to graded submaximal doses of ACTH. Plasma ACTH and cortisol responses to oCRH were employed as a direct measure of the functional integrity of the pituitary corticotroph cell. Central CRH secretion was assessed by measuring its level in cerebrospinal fluid. Compared to normal subjects, patients demonstrated significantly reduced basal evening glucocorticoid levels (89.0 +/- 8.7 vs. 148.4 +/- 20.3 nmol/L; P less than 0.01) and low 24-h urinary free cortisol excretion (122.7 +/- 8.9 vs. 203.1 +/- 10.7 nmol/24 h; P less than 0.0002), but elevated basal evening ACTH concentrations. There was increased adrenocortical sensitivity to ACTH, but a reduced maximal response [F(3.26, 65.16) = 5.50; P = 0.0015). Patients showed attenuated net integrated ACTH responses to oCRH (128.0 +/- 26.4 vs. 225.4 +/- 34.5 pmol/L.min, P less than 0.04). Cerebrospinal fluid CRH levels in patients were no different from control values (8.4 +/- 0.6 vs. 7.7 +/- 0.5 pmol/L; P = NS). Although we cannot definitively account for the etiology of the mild glucocorticoid deficiency seen in chronic fatigue syndrome patients, the enhanced adrenocortical sensitivity to exogenous ACTH and blunted ACTH responses to oCRH are incompatible with a primary adrenal insufficiency. A pituitary source is also unlikely, since basal evening plasma ACTH concentrations were elevated. Hence, the data are most compatible with a mild central adrenal insufficiency secondary to either a deficiency of CRH or some other central stimulus to the pituitary-adrenal axis. Whether a mild glucocorticoid deficiency or a putative deficiency of an arousal-producing neuropeptide such as CRH is related to the clinical symptomatology of the chronic fatigue syndrome remains to be determined.
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Patients (n = 47) presenting to a neurological centre with unexplained chronic "postviral" fatigue (CFS) were studied prospectively. Controls were patients with peripheral fatiguing neuromuscular diseases and inpatients with major depression in a psychiatric hospital. Seventy-two percent of the CFS patients were cases of psychiatric disorder, using criteria that excluded fatigue as a symptom, compared with 36% of the neuromuscular group. There was no difference in subjective complaints of physical fatigue between all groups. Mental fatigue and fatigability was equally common in CFS and affective patients, but only occurred in those neuromuscular patients who were also cases of psychiatric disorder. Overall, the CFS patients more closely resembled the affective than the neuromuscular patients. Attribution of symptoms to physical rather than psychological causes was the principal difference between matched CFS and psychiatric controls. The symptoms of "postviral" fatigue had little ability to discriminate between CFS and affective disorder. The fatigue in CFS appeared central in origin, suggesting it is not primarily a neuromuscular illness. The implications for research and treatment of chronic fatigue are discussed.
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This study examined the effect of chronic stress associated with unemployment on the magnitude of salivary cortisol excretion, on the diurnal rhythm of cortisol, and on cortisol reactivity to acute naturalistic stressors using Experience Sampling Methodology (ESM). Employed (N = 60) and unemployed (N = 60) subjects were studied for 2 days. Subjects were beeped 6 times per day by a preprogrammed wristwatch to assess acute stressors; 25 minutes after each ESM-beep, subjects were beeped a second time for saliva samples. The groups did not differ in their overall cortisol excretion or in cortisol reactivity to acute daily stressors. Compared to employed subjects, unemployed subjects had a diurnal pattern of cortisol excretion with relatively higher morning and lower evening levels. Subjects' daily activities and their locations were associated with diurnal rhythm differences.
Article
Neuroendocrine studies examining the hypothalamic-pituitar3'-adrenal (HPA) axis under baseline conditions and in response to neuroendocrine challenges have supported the hypothesis of altered HPA functioning in posttraumatic stress disorder (PTSD). However, to date, there is much debate concerning the nature of HPA changes in PTSD. Furthermore , in studies showing parallel findings in PTSD and major depressive disorder there is controversy regarding whether the HPA alterations suggest a specific pathophysiolog'y of PTSD, or, rather, reflect comorbid major depressive disorder. This review summarizes findings of HPA axis dysfunction in both PTSD and major depressive disorder, and shows distinct patterns of HPA changes, which are probably due to db~'erent mechanisms of action for cortisol and its regulatory factors.
Chapter
This chapter discusses the research that has considered endocrinological responses to chronic stress experienced by people living near the damaged Three Mile Island Nuclear Station (TMI) near Middletown, Pennsylvania. Stress is a process that links environmental events with psychological analysis and interpretation of them, and a whole-body response to those events interpreted as threatening, challenging, or harmful. It may involve a single powerful event, such as a change of jobs or a natural disaster that is encountered against an otherwise benign background. Stress may involve a summation of several sources of threat or harm experienced on a day-to-day basis. The duration of the event, its power, suddenness, predictability, and the number of people affected by it may influence interpretation of, and response to, these events. Adrenocortical activity during stress requires some central appraisal of stimuli. Higher brain centers transmit signals to the hypothalamus, which secretes corticotropin-releasing factor (CRF). This stimulates pituitary activity and secretion of adrenocorticotropic hormone (ACTH), which results in releases of corticosteroids, including cortisol, increasing the availability of energy in cells and heightening overall metabolism. Studies of stress have examined all of the levels of response, allowing evaluation of the degree of interdependence among them.
Article
EVALUATION of the role of the adrenal cortex in the response of man to stressful situations has long been a problem of major interest to investigators. Early the effects of relatively well defined and isolated environmental events were studied. These included studies of auto race drivers,1 college 0arsmen,2 medical students taking final exams,3 and patients prior to cardiac and pulmonary surgery.4 Initially the stress of the event itself was regarded as the only significant variable against which the subjects physiological response was measured. The degree of stress which such events provided for the subjects under study was based entirely on subjective estimates by the investigators. Subsequent studies, especially those of Wolff,5 Fox,6 and Sachar,7 modified this approach by suggesting the importance of individual difference in the psychological and physiological handling of threatening events in the environment
Article
This study examined the effect of chronic stress associated with unemployment on the magnitude of salivary cortisol excretion, on the diurnal rhythm of cortisol, and on cortisol reactivity to acute naturalistic stressors using Experience Sampling Methodology (ESM).Employed (N = 60) and unemployed (N = 60) subjects were studied for 2 days. Subjects were beeped 6 times per day by a preprogrammed wristwatch to assess acute stressors; 25 minutes after each ESM-beep, subjects were beeped a second time for saliva samples. The groups did not differ in their overall cortisol excretion or in cortisol reactivity to acute daily stressors. Compared to employed subjects, unemployed subjects had a diurnal pattern of cortisol excretion with relatively higher morning and lower evening levels. Subjects' daily activities and their locations were associated with diurnal rhythm differences.
Article
The present study tested the hypothesis that some subjects may not readily show habituation of adrenocortical stress responses to repeated psychological stress. Twenty healthy male subjects were each exposed five times to the same, brief psychosocial stressor (public speaking and mental arithmetic in front of an audience) with one stress session per day. Salivary cortisol levels were assessed as an index of adrenocortical stress responses. For the total group, cortisol levels were significantly elevated on each of the 5 days. The mean response decreased from day 1 to day 2; however, no further attenuation could be observed on the remaining days. Cluster analysis revealed two groups of subjects who showed completely different response kinetics. In the first group (N = 13), termed "low responders," cortisol levels were elevated on day 1 only. Day 2 to 5 cortisol levels were unaltered. In contrast, subjects in the second group ("high responders") displayed large increases to each of the five experimental treatments. This group had no significant response decrement from day 1 to day 2 to 4 and only a marginal response difference between day 1 and day 5. Discriminant analysis revealed that a combination of five personality scales plus the scores on a symptoms checklist significantly discriminated between high and low responders. With this discriminant function, all 20 subjects were correctly classified to the two groups. These results are discussed with a focus on the possible impact of adrenocortical response types on health and disease.
Article
We evaluated the efficacy of two programs designed to reduce stress among nurses by increasing their coping resources. The interventions were based on principles of Stress Inoculation Training and Conservation of Reources stress theory. A dual resource intervention targeted the enhancement of both social support and mastery resources. A single resource intervention targeted the enhancement of only mastery resources. Both interventions were contrasted to a no intervention control condition. Participants in the dual resource intervention experienced significant enhancements in social support and mastery compared to the no intervention control. The social support enhancement persisted through a five-week follow-up. Participants in the dual resource intervention with low initial levels of social support or mastery experienced significant reductions in psychological distress. Participants in the single resource intervention experienced a slight enhancement in mastery compared to the no intervention control. Implications for stress theory and the design of stress reduction programs are discussed.
Article
The present study investigated the association between chronic stress and cortisol changes during the first hour after awakening in the morning. According to results of a pilot study, it was hypothesized that chronically stressed subjects would show a more enhanced and prolonged increase of cortisol level after awakening compared to non-stressed subjects. In 100 subjects, chronic stress was assessed twice with a 1-week interval between measures and cortisol was repeatedly measured during the first hour of awakening on 3 consecutive days. Results showed that chronically stressed subjects had a significantly larger increase in cortisol (+15.5 nmol/l) compared to unstressed subjects (+9.1 nmol/l). Further analysis indicated a significant sex difference with larger increases in chronically stressed women (+16.5 nmol/l) compared to stressed men (+11.8 nmol/l). From these data we conclude that a repeated measurement of free cortisol in response to awakening should be considered a possible biological correlate of chronic stress. Possible causes, consequences and clinical relevance of this hypercortisolism in chronically stressed subjects are briefly discussed. © 1998 John Wiley & Sons, Ltd.
Article
Conducted regression analyses to investigate which work stressors, attitudinal and demographic variables predicted the reported emotional distress (anxiety, depression, and physical symptoms) and burnout (emotional exhaustion, use of depersonalization, and feelings of personal accomplishment) of music and math teachers working in secondary schools. 107 secondary school teachers completed a 4-part questionnaire that obtained biographical data, assessed work stressors, general health, and behaviors and attitudes of teachers. Results showed that music teachers gave significantly more problematic responses defining the variables which predicted emotional distress and burnout than math teachers. Also, music teachers were substantially more distressed and burnt out than math teachers. These and other results are discussed in terms of their implications for well-being of teachers who may feel marginalized within the teaching system. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Neuroendocrine studies examining the hypothalamic-pituitary-adrenal (HPA) axis under baseline conditions and in response to neuroendocrine challenges have supported the hypothesis of altered HPA functioning in posttraumatic stress disorder (PTSD). However, to date, there is much debate concerning the nature of HPA changes in PTSD. Furthermore, in studies showing parallel findings in PTSD and major depressive disorder there is controversy regarding whether the HPA alterations suggest a specific pathophysiology of PTSD, or, rather, reflect comorbid major depressive disorder. This review summarizes findings of HPA axis dysfunction in both PTSD and major depressive disorder, and shows distinct patterns of HPA changes, which are probably due to different mechanisms of action for cortisol and its regulatory factors.
Article
Perceived white collar work load was studied as a determinant of cortisol, an adrenal hormone with a pronounced circadian rhythm. Two hundred male NASA employees in administration, engineering and science, mean age 40, completed self-report questionnaires and gave blood samples. Respondents were grouped according to the time of day when their blood was sampled and were grouped into high, medium and low tertiles on an index of subjective quantitative work load. There was no main effect of work load on mean cortisol. There was a significant effect of level of work load on the relationship between time of day sampled and cortisol. High work load employees showed lower than normal morning cortisol values and did not show the expected decrease in cortisol from morning to afternoon. Low work load employees showed the expected circadian rhythm. We test two hypotheses which may further explain the results—(1) job satisfaction mediates the effect of work load on circadian rhythm and (2) personality traits produce self-selection into high work load environments—and discuss other interpretations.
Article
Responses to Rahe and job stress questionnaires and urinary concentrations of cortisols and catecholamines served to indicate work related stress in 56 fire fighters and 67 paramedics. Although the average Rahe test scores, indicative of stress arising from life events, were comparable, those of the job stress test were statistically significantly higher for the paramedics. The paramedics felt their jobs more exhausting, less satisfying and requiring too much responsibility. For the paramedics, statistically significant higher levels of epinephrine and elevated levels of norepinephrine were found for the work as compared to the off day. For fire fighters, higher levels of cortisol and norepinephrine evident on the off day rather than the work day apparently reflect the relatively light work load experienced during the span of urine collections.
Article
It is still discussed controversially to what extent the nocturnal activity of the hypothalamus-pituitary-adrenocortical system depends on sleep and awakening in the morning. Therefore, we investigated the association of plasma ACTH and cortisol levels with undisturbed nocturnal sleep and spontaneous awakening in 14 healthy male subjects (between 2300 h and 1100 h). Between sleep onset and 476.9 min after sleep onset mean plasma cortisol level was significantly (P < 0.01) higher (210 +/- 15 vs. 155 +/- 9 nmol/L) in the group with a shorter (476.9 +/- 15.0 min; n = 7; mean +/- SEM) than in the group with a longer total sleep time (596.9 +/- 14.4 min; n = 7). Spontaneous awakening in the morning was not linked to the presence of any specific sleep stage or to rising plasma ACTH and cortisol levels. However, spontaneous awakening was followed by a brief rise in plasma ACTH and cortisol in both groups. Thereafter, during wakefulness plasma ACTH and cortisol abruptly declined in all subjects irrespective of the time of awakening. The slope of the plasma ACTH and cortisol curves differed significantly (ACTH: P < 0.001; cortisol: P < 0.002, for all subjects) comparing the time after awakening (until 1100 h) with a time interval of identical length before awakening. We conclude that the duration of sleep and nocturnal ACTH and cortisol secretion are interrelated. Furthermore, the data suggest that the endogenous early morning activation of the hypothalamus-pituitary-adrenocortical system is terminated by mechanisms closely associated with awakening.
Article
Cortisol 3-(o-carboxymethyl)oxime (C3-CMO) and a commercially available biotin-hydrazide derivative were used to synthesize a C3-CMO-biotin conjugate. C3-CMO was converted into a N-hydroxysuccinimide ester derivative which in a second reaction step was allowed to interact with the hydrazide derivative of biotin. This simple-to-perform synthesis yielded a conjugate suitable for use as a tracer in immunoassays for cortisol measurement. Employing biotin as the primary probe in a competitive solid phase immunoassay allows for variable end point determination by means of commercially available labeled avidin or streptavidin derivatives. Streptavidin-Europium was used in conjunction with the DELFIA-system for time-resolved fluorometric end point measurement (TR-FIA) throughout the study. In addition, colorimetric end point determination (ELISA) using streptavidin-alkaline phosphatase as a secondary probe was established and evaluated. Both forms of this non-isotopic assay showed excellent correlation with a commercially available radioimmunoassay adapted for salivary cortisol measurement. The lower detection limit was 0.43 nM for a 50 microliters salivary sample. The intra-assay coefficient of variation was 6.7, 4.7 and 4.0% at cortisol concentrations of 2.2, 5.5 and 13.2 nM, respectively (n = 37), and the corresponding inter-assay coefficients of variation were 9.0, 8.6 and 7.1% (n = 50). The competitive immunoassay requires 1.5 h incubation time and shows robust and reproducible performance. The C3-CMO-biotin conjugate allows for sensitive and flexible end point determination of salivary cortisol levels in immunoassays.
Article
33 teachers from one institutional school setting and 59 teachers from three north central school districts volunteered to complete and return Beck's Depression Scale, the Coopersmith Self-esteem Inventory--Adult Form, Stress Profile for Teachers, and the Staff Burnout Scale for Mental Health Professionals. Analysis of variance (2 x 2) for teaching level (grade and high school) by sex showed those teaching regular classrooms is grade school experienced less burnout and stress than did high school teachers. There was no sex difference. In the institutional setting there was a significant difference on burnout scores between men and women who taught high school; their scores were higher than those of the male grade school teachers. Burnout lie scores were also significantly higher for female high school teachers than for both male and female grade school teachers. Scores on stress were significantly higher for male high school teachers than for both female high school teachers and male grade school teachers.
Article
The effects of acute stress during a parachute jump on hormonal responses were studied in 12 experienced and 11 inexperienced military parachutists. Each subject performed two jumps. Prior to and immediately after each jump blood samples were drawn and analysed for plasma levels of cortisol, prolactin, thyrotropin (TSH), somatotropin (STH), and luteinizing hormone (LH). While there was a significant increase in cortisol, prolactin and TSH levels after both jumps, no alterations could be observed in STH and LH levels. Stress-induced hormonal responses were not affected by jump experience. There was also no association between the endocrine variables and anxiety scores.
Article
Recent studies have provided evidence that nocturnal cortisol secretion is coupled to ultradian rhythms of sleep. The present study was designed to specify how exogenous and sleep-related endogenous factors influence nocturnal adrenocorticotropin (ACTH) and cortisol secretion. We compared the influences of (1) temporary sleep deprivation, (2) arousals continuously induced during sleep and, (3) undisturbed sleep (baseline) on pituitary-adrenocortical activity in 10 healthy men. Sleep deprivation (DS) and continuous arousals during sleep (AS) were introduced at the beginning of the second rapid eye movement (REM) sleep period which is an epoch close to the first significant nocturnal rise in plasma cortisol. Compared with the baseline nights, plasma cortisol significantly increased immediately after continuous arousals were started or the subject was awakened and remained awake. Despite this exogenously provoked first cortisol peak, average cortisol release during DS and AS was no higher than during undisturbed sleep. The arousal-induced cortisol burst was followed by a temporary inhibition of cortisol secretion, suggesting that once the subject is aroused (i.e., in stage 1 sleep or awake), the hypothalamus-pituitary-adrenal (HPA) system becomes highly sensitive to negative feedback inhibition. Spontaneously occurring endogenous cortisol peaks of comparable size during undisturbed sleep did not exhibit such a temporary inhibition of cortisol secretion. We hypothesize that sleep attenuates negative feedback inhibition within the HPA system, whereas wakefulness (or stage 1 sleep) reflects increased feedback sensitivity of this system.
Article
The effects of a psychological stressor and nicotine upon corticosteroid release were investigated using a full factorial, repeated-measures design in eight moderate smokers. Sessions involved the presentation of either competitive mental arithmetic or reading aloud and either smoking a usual cigarette or sham smoking. Self-reported anxiety increased after exposure to competitive mental arithmetic, confirming the stressfulness of the procedure. Cortisol levels increased significantly in response to psychological stress and showed a trend towards a significant elevation over time in response to nicotine self-administration. The two manipulations in combination produced additive effects upon plasma cortisol. These findings underscore the usefulness of the corticosteroid response as a marker of the impact of different procedures and suggest that it may provide an indicator for exploring the mechanisms by which nicotine-stress interactions are mediated. Systematic research that varies temporal and other parameters involving nicotine and various stressors will be needed to resolve inconsistencies in the literature on smoking and anxiety in the context of stress.
Article
This article is based on research carried out in the author's laboratory during the past decades. The central theme is the study of how environmental factors influence health and behavior. The approach is multidisciplinary, focusing on the dynamics of stressful person-environment interactions, viewed from social, psychological, and biomedical perspectives. A biopsychosocial framework for the study of stress and coping at the workplace is outlined. Key notions in the biopsychosocial approach are that endocrine responses to the psychosocial environment reflect its impact on the individual and serve as early warnings of long-term risks. Research on the release of the adrenal hormones, catecholamines and cortisol, in response to different work demands is interpreted in terms of the author's "effort and affect" model. The significance of personal control for achieving a state of effort and positive affect is underscored. Finally, a plea is made for dialogue between researchers in the biopsychosocial field and the employees, their organizations, and management. The dialogue is seen as a tool for translating research results into practical measures.
Article
The adrenocortical response to increasing periods of exposure to a novel cage, as well as the effects of returning hamsters to their familiar home cages, were examined. We found that a five min exposure to a novel cage was insufficient to activate the pituitary-adrenal system, but that cortisol levels increased significantly as duration of exposure increased from 15 to 30 min. In contrast, returning hamsters to their home cages for at least 15 min following the 15 min novel cage exposure produced a significant drop in plasma levels of cortisol. Finally we found that males exhibit a greater cortisol response to novelty than females, indicating a sexual dimorphism which is the reverse of that reported in other rodents.
Article
Among 56 persons who were acutely bereaved or threatened with a loss, a group with worsening separation anxiety over a period of a month early after the event had higher urinary free cortisol output than a group experiencing improvement in grief. Although not tested in this study, both these psychological and physiological measures may have potential for serving as early predictors of poor outcome in bereavement for the 15%-20% of exposed persons who are at risk for unresolved grief or persistent depressive syndromes.
Article
This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
Article
This review analyses the recent literature devoted to two related fatigue syndromes: chronic fatigue syndrome (CFS) and acute onset postviral fatigue syndrome (PVFS). The articles are grouped into five pathogenic tracks: infectious agents, immune system, skeletic muscle, hypothalamo-pituitary-adrenal (HPA) axis and psychiatric factors. Although a particular infectious agent is unlikely to be responsible for all CFS cases, evidence is shown that host-parasite relationships are modified in a large proportion of patients with chronic fatigue. Antibody titres against infectious agents are often elevated and replication of several viruses could be increased. Chronic activation of the immune system is also observed and could be due to the reactivation of persistent or latent infectious agents such as herpes viruses (i.e. HHV-6) or enteroviruses. It could also be favorised by an impaired negative feedback of the HPA axis on the immune system. A model is proposed where the abnormalities of the HPA axis are primary events and are mainly responsible for a chronic activation of the immune system which in turn induces an increased replication of several viruses under the control of cellular transcription factors. These replicating viruses together with cytokines such as TNF-alpha would secondarily induce functional disorders of muscle and several aspects of asthenia itself.
Article
Repeated exposures to a stressor in our rat model of a chronic stress state cause elevated plasma corticosterone levels in the morning for several days after the last stressor. However, plasma corticosterone levels are normally characterized by a circadian rhythm with low levels for much of the morning and higher levels near the onset of darkness. The current experiment examined the question of whether the elevated morning levels after stressor exposures were accompanied by other changes in this circadian rhythm. Male rats were given restraint-shock stressor sessions for 0, 1, or 3 days, after which plasma samples were collected for 3 days at 0900 h and at three other times around the circadian peak (1400, 1800, and 2200 h). Plasma corticosterone levels at 0900 h were elevated for the first 2 days after three stressor exposures and for 1 day after a single stressor exposure compared to those in nonstressed controls. However, levels at 1400, 1800, and 2200 h were not different in stressed and control rats on the first 2 days after stressor exposures. In addition, the amplitude of the corticosterone rhythm was suppressed after three stressor exposures, but not after one. This decrease in amplitude was mostly due to increased morning levels, inasmuch as the evening levels were similar in stressed rats and controls. Because the hypothalamic-pituitary-adrenal axis is more sensitive to glucocorticoid feedback in the morning, our data suggest that the mechanisms mediating feedback at this time of day may be disrupted by repeated stressor exposures.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
This study examined a research model developed to understand psychological burnout among school-based educators. Data were collected from 833 school-based educators using questionnaires completed anonymously. Four groups of predictor variables identified in previous research were considered: individual demographic and situational variables, work stressors, role conflict, and social support. Some support for the model was found. Work stressors were strong predictors of psychological burnout. Individual demographic characteristics, role conflict, and social support had little effect on psychological burnout.
Article
The biological consequences of stress have been studied for over half a decade, however, little is known about persistent biological alterations after extreme stress in humans. Posttraumatic stress disorder (PTSD) is a syndrome that occurs in some individuals after exposure to extreme stress. In this review, we summarize some of our studies of hypothalamic-pituitary-adrenal axis alterations in PTSD and compare and contrast these findings with knowledge concerning biological changes following stress.
Article
1. Studies in our laboratory have used the psychoendocrine strategy to explore differences in basal hormone levels between patients with posttraumatic stress disorder (PTSD) and other groups. This approach has allowed us to explore the relationship between hormone levels and specific psychological and biological processes which appear to develop following exposure to extreme trauma. 2. The concurrent assessment of several hormonal systems provides an opportunity to explore differences in hormonal patterns in various psychiatric disorders. PTSD appears to be characterized by a specific profile of hormonal changes that is distinct from that of other diagnostic groups and normal controls. These findings raise the possibility that the psychoendocrine approach may be useful in further exploring the pathophysiology and diagnosis of PTSD. 3. This paper reviews psychoendocrine changes in PTSD and describes updated multivariate methods that further elucidate psychological and neurochemical correlates of hormonal alterations in this disorder.
Article
To determine whether genetic factors control the expression of human circadian rhythmicity, we analyzed the 24-h profile of plasma cortisol in 11 monozygotic and 10 dizygotic pairs of normal male twins. Blood was sampled every 15 min, and sleep was monitored. Circadian rhythmicity was characterized by measures of amplitude, phase, and overall waveshape. Pulsatility was quantified by pulse frequency, pulse amplitude, and relative contribution of pulsatile vs. circadian variations. Data were analyzed by a procedure specifically developed for twin studies. Genetic control was demonstrated for the timing of the nocturnal nadir and for the proportion of overall temporal variability associated with pulsatility. Environmental effects were detected for the 24-h mean and the timing of the morning acrophase. The timing of the cortisol nadir is a robust marker of human circadian phase and is dependent, under entrained conditions, on the length of the endogenous period. Animal studies have shown that the endogenous period and the pattern of entrainment to exogenous 24-h periodicities are genetically controlled. Our results indicate that, despite the increased impact of social inputs, genetic factors also control human circadian rhythmicity.
Article
The present study tested the hypothesis that some subjects may not readily show habituation of adrenocortical stress responses to repeated psychological stress. Twenty healthy male subjects were each exposed five times to the same,