Work stress and hair cortisol levels among workers in a Bangladeshi ready-made garment factory - Results from a cross-sectional study

A cohort study on the association between changing occupational stress, hair cortisol concentration, and hypertension

OBJECTIVE

To explore the relationship between changing occupational stress levels, hair cortisol concentration (HCC), and hypertension.

METHODS

Baseline blood pressure of 2520 workers was measured in 2015. The Occupational Stress Inventory-Revised Edition (OSI-R) was used to assess changes in occupational stress. Occupational stress and blood pressure were followed up annually from January 2016 to December 2017. The final cohort numbered 1784 workers. The mean age of the cohort was 37.77±7.53 years and the percentage male was 46.52%. At baseline, 423 eligible subjects were randomly selected for hair sample collection to determine cortisol levels.

RESULTS

Increased occupational stress was a risk factor for hypertension [risk ratio (RR) = 4.200, 95% confidence interval (CI): 1.734-10.172]. The HCC of workers with elevated occupational stress was higher than that of workers with constant occupational stress [(ORQ score ≥70: geometric mean±geometric standard deviation = 5.25±3.59 ng/g hair; 60-90: 5.02±4.00; 40-59: 3.45±3.41; <40: 2.73±3.40) x2 = 5.261]. High HCC increased the risk of hypertension (RR = 5.270, 95% CI: 2.375-11.692) and high HCC was associated with higher rates of elevated diastolic and systolic blood pressure. The mediating effect of HCC was 0.51[(95% CI: 0.23-0.79, odds ratio(OR) = 1.67] and accounted for 36.83% of the total effect.

CONCLUSIONS

Increased occupational stress could lead to an increase in hypertension incidence. High HCC could increase the risk of hypertension. HCC acts as a mediator between occupational stress and hypertension.

Workplace stressors and their association with hair cortisol concentrations among ready-made garment workers in Bangladesh: A cross-sectional study

OBJECTIVES

Psychosocial working conditions of ready-made garment (RMG) workers have been associated with poorer self-reported health outcomes. However, no such research has been done with respect to physiological markers that are considered to reflect stress. We consequently aimed to investigate associations of psychosocial working conditions with such a marker, that is, hair cortisol, among RMG workers in Bangladesh.

METHODS

We conducted semi-structured face-to-face interviews in labor colonies in the Mirpur area, Dhaka, Bangladesh, in February and March 2021 with individuals identifying as garment workers. The interview inquired after various workplace stressors and resources (i.e., workplace support, workplace bullying, vertical trust, beneficial leadership, work-family conflict, and financial issues including savings, debts, financial obligations, and financial support). In addition, hair samples of 2 cm length were collected from participants. Hair cortisol concentrations (HCC) were determined based on liquid chromatography-tandem mass spectrometry (LC-MS/MS). Linear regression models were run to detect possible associations of workplace stressors and resources with HCC.

RESULTS

In total, data of 576 participants were included in the analysis (71.9% female, mean age = 25.9 years). Mean HCC was 4.4 pg/mg (standard deviation = 2.1 pg/mg). The sole variable significantly associated with increased HCC was "having to keep your job to support your children or spouse financially" (β = 0.28 [95% confidence interval 0.02-0.55]).

CONCLUSIONS

The sole workplace stressor significantly associated with increased HCC was the necessity to keep one's job to support children or spouse financially. This observation can, however, barely be disentangled from the fact that one has children/a spouse.

Association between workaholism, vital exhaustion, and hair cortisol concentrations among teachers: A longitudinal study testing the moderation effect of neuroticism

Introduction

Workaholism in teachers is characterized by the willingness to work until exhausted and may be associated with various adverse health outcomes as well as high economic costs. The present study examines the association between workaholism, vital exhaustion (VE), and hair cortisol concentration (HCC) as indicators of chronic stress. In addition, this study explores the moderating role of the personality trait neuroticism on the relationship between workaholism and chronic stress indicators, i.e., VE and HCC.

Methods

Forty-two Swiss teachers (28 females; M _age = 39.66, SD = 11.99) completed questionnaires assessing VE (Maastricht Vital Exhaustion Questionnaire), workaholism (Measure of Coping Capacity Questionnaire), and neuroticism (Big-Five Inventory). Together with VE, HCC was assessed twice, with a one year lag.

Results

Both workaholism and neuroticism were positively associated with VE at both time points but not with HCC. Moderation analyses revealed a positive relationship between workaholism and VE in teachers with high neuroticism, while no such association was observed in teachers with low neuroticism. No associations were found between self-reports and HCC.

Discussion

These findings emphasize the importance of considering individual characteristics when investigating VE. Further research is necessary to investigate the applicability of HCC as a biomarker of chronic stress in the context of work.

Experiences of Conducting Research With Vulnerable and Disempowered Participants in a Developing Country: Perspectives From a Novice Researcher

Sensitive, emotionally laden research requires mental strength, emotional fortitude, and logistic supports for novice researchers. Little is known about the challenges that the novice researcher faces while conducting sensitive, emotionally laden research. This is exacerbated where participants of such studies have little/no idea about expressing the value of a particular research study (i.e., where the first question to arise from the participants is "what would be my benefit if I participate in your research?"). Based on the student researcher's self-reflections, this article focuses on the inherent challenges that a researcher faced while conducting in-depth interviews among a group of emotionally vulnerable people-survivors of the disastrous Rana Plaza collapse in Bangladesh. It suggests how the challenges can be reduced or mitigated, and the researcher's self-care can be ensured. It also raises important methodological questions, including whether in-depth narrative interviews are appropriate in relation to those living with significantly different cultural norms.

Effects of a work-related stress model based mental health promotion program on job stress, stress reactions and coping profiles of women workers: a control groups study

BACKGROUND

Work-related stress and its detrimental effects on human health have rapidly increased during the past several years. It causes many different stress reactions, related diseases and unhealthy behavior among workers, but especially women workers. Thus, the aim of this study was to examine the effects of the work-related stress model based Workplace Mental Health Promotion Programme on the job stress, social support, reactions, salivary immunoglobulin A and Cortisol levels, work absenteeism, job performance and coping profiles of women workers.

METHODS

This study had a "pre-test post-test non-equivalent control groups" design and included 70 women workers (35 in each study group) selected by randomized sampling from two factories. The programme was delivered as an intervention including 12 weeks of follow-up. Reminder messages, videos, and WhatsApp texts were used at the follow-up stage. The research measurements were; the assessment form, the Brief Job Stress Questionnaire, the Brief Coping Profile Scale, salivary ELISA kits, and a self-reported check-list.

RESULTS

There were no differences in sociodemographic characteristics, general health or working conditions between the Intervention and control groups(p > .05). Three months after the intervention, there was a significant decrease in job stress(p ≤ .001), physical and mental reactions' scores(p ≤ .001) and work absenteeism(p < .05), and there was an increase in job performance(p < .05), social support(p ≤ .001) among the intervention group. The programme showed positive effects on coping profiles(p < .05). After the intervention salivary-cortisol and IgA levels showed a statistically significant decrease(p < .05). A majority of effect sizes were very large (ηp2 > .14).

CONCLUSIONS

Work-ProMentH was found to be effective and useful in job stress management and promotion of effective coping profiles. It enables its users to holistically assess worker stress and to plan and examine intervention programmes via a systematic approach. There is a need for more empirical studies that may support the data of the present study, but it is thought that the intervention can be maintained for the long-term. We recommend that occupational health professionals at workplaces should consider using this model-based cost-effective intervention, which seems easy and practical to apply in real-life situations.

TRIAL REGISTRATION

ISRCTN registration ID: ISRCTN14333710 (2020/10/03, retrospective registration).

Urinary symptoms and infections among female garment factory workers in Bangladesh

BACKGROUND

The prevalence of urinary symptoms and infections among female garment factory workers in Bangladesh - a large developing country - is largely unknown. Garment sector is this country's main economic growth engine.

OBJECTIVES

This paper focuses on garment industry workers and compares the findings with another group of low socioeconomic status working women.

METHODS

Urinary tract symptoms (UTS) were determined by self-reported survey including International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and urinary tract infection (UTI) was determined among a subset population by urine dipstick tests.

RESULTS

Data were collected from 310 garment workers and 297 comparison workers. About one third of garment workers (31.94%) and comparison workers (29.97%) could take up to 3 toilet breaks in a day. Garment workers reported to be more sexually active and menstruation was more common among them compared to comparison workers. They reported a significantly higher prevalence of malodorous urine and vaginal discharge. Garment workers were found to have a significantly higher ICIQ-FLUTS score of voiding than comparison workers (0.44 vs. 0.27; p-value = 0.0167).Among the study respondents, 148 garment workers and 134 other workers provided urine samples and 21 (7.45%) were found to have UTI. After considering all the risk factors in multivariate model, garment work had a significant impact on the probability of having UTI with Odds Ratio of 5.46 (p-value = 0.0374; 95% CI = 1.10, 26.97) compared to other workers.

CONCLUSIONS

This study highlights the prevalence and burden of urinary symptoms and infections among female worker populations in Bangladesh.

Effort-reward imbalance at work is associated with hair cortisol concentrations: Prospective evidence from the Dresden Burnout Study

Chronic stress experienced at work is considered a major health challenge for modern societies. In fact there is ample evidence that deleterious work environments, based on high efforts in relation to few rewards, substantially augment the risk for a number of highly prevalent diseases (e.g. ischemic heart disease, stroke). One potential pathway mediating these associations involves the stress-related activation of the hypothalamus-pituitary-adrenocortical (HPA) axis with proceeding alterations in the secretion of its main effector hormone cortisol. In this study we assessed a prospective, two-year effect of effort-reward imbalance (ERI) on cortisol secretion, based on a sub sample (N = 150; mean ± SD age: 42.4 ± 11.1; 84.0% female) of the ongoing Dresden Burnout Study (DBS). The provided ERI measures were collected as part of the online baseline and first follow up assessment. Further, cortisol secretion patterns over prolonged periods of time were evaluated in three consecutive years of laboratory baseline and follow up visits. Our findings suggest prospective associations between ERI and cortisol, indicating a blunted cortisol secretion in response to long-term work stress (p < 0.001). Given the regulatory properties of cortisol on various central and peripheral target tissues (e.g. cardiovascular system, liver, adipose tissue), a long-term decrease of cortisol availability can be hypothesized to cause multiple health-challenging consequences. Based on our findings, providing work environments where high efforts are always linked with high rewards have to be considered an important issue for employees health.

Mediating effects of hair cortisol on the mutual association of job burnout and insomnia: A retrospective exploratory study

BACKGROUNDS

The present study was designed to clarify the mutual association of job burnout and insomnia and to detect the mediating effects of hair cortisol on that association.

METHODS

In all, 68 female employees were recruited for the study from one secondary and one tertiary hospital between October 2018 and November 2018 in Beijing. Participants completed a questionnaire for the collection of demographic data and standardized measures for burnout and insomnia. Hair sample collection and anthropometric measurements were performed at the same time.

RESULTS

Median hair cortisol concentration (HCC) was 5.89 ng/g hair (interquartile range = 2.20-10.74). And ages are between 22 and 51 years old (32.50 ± 6.13), among which 22 were below 30 years, 20 were between 30 and 35 years, and 26 were over 35 years. A majority of Pearson's coefficients were significant, with the exception of that for the correlation between personal accomplishment and HCC or depersonalization. Significant mutual correlations were shown between burnout dimensions and insomnia directly. HCC acted as a mediator in the pathway from emotional exhaustion, depersonalization to insomnia; and no significant mediating effect of HCC in the pathway from insomnia to burnout was found.

CONCLUSIONS

Job burnout may directly or indirectly (through chronically elevated cortisol) increase insomnia risk, whereas insomnia probably promotes burnout. Prospective studies involving different body systems and a larger sample size should be performed to further identify the mechanisms underlying the associations between burnout and insomnia among the working population.

The association of potential stressors with hair steroids in parents with small children: The Ulm SPATZ health study

Previous studies have reported weak associations between questionnaire-based stress measurements and hair steroids. A stronger relationship may exist in highly stressed subpopulations or with stress brought up by novel or unpredictable situations. In the Ulm SPATZ Health Study, conducted in Ulm, Germany, baseline recruitment 04/2012 to 05/2013, we analyzed data of families enrolled shortly after childbirth. Mothers completed standardized questionnaires assessing sociodemographic, health- and family-life-related factors, and the Screening Scale of the Trier Inventory of Chronic Stress (TICS) at 6 months (T2) and 12 months postpartum (T3). Their current partners completed SSCS-TICS and an Effort-Reward Imbalance (ERI) Questionnaire obtained at 6 weeks postpartum (T1). Partners (n = 375 at T1) and mothers (n = 654 at T2 or T3) provided a 2 to 3-cm hair segment for hair analysis. Adjusted linear and cubic spline regressions were used to analyze (non-)linear relationships between potential stressors and hair cortisol (hairF) and hair cortisone (hairE) concentrations as well as the respective change scores between 12 months and 6 months. Lacking social recognition and high paternal work overload were significantly associated with paternal hairF in cubic spline models (test for overall association, chi² = 8.24, p = 0.041, chi² = 8.41, p = 0.038) but not in linear models. However, the association between ERI and hairF (chi² = 7.54, p = 0.059) was marginally significant. Maternal education was related to maternal hairF and hairE at T2. No association was observed between maternal postpartum employment and hair steroids at T2 or T3. Conversely, we could show a relationship between some change scores of stress and hairE in mothers. Considering non-linearity and family-related stressors, there are few associations between questionnaire-based stress measurements and hairF or hairE. Novelty of stressors was not shown to be a relevant factor.

Health vulnerabilities of readymade garment (RMG) workers: a systematic review

Background

There is a paucity of literature that addresses the health vulnerabilities of readymade garment (RMG) workers in South and Southeast Asian regions. Therefore, the aim of this systematic review is to identify the distinctive types of health vulnerabilities along with the causes and consequences of these vulnerabilities of the RMG workers in South and Southeast Asian regions.

Methods

Systematic review search methods were applied utilising the PRISMA protocol. Literature published between July 2007 to June 2017 on health vulnerabilities of the RMG workers of South and Southeast Asian countries were identified through electronic databases and manual searches.

Results

A total number of 19 studies (16 quantitative studies, 3 mixed-method studies) were included from the primary 17,001 papers identified. The quality of these studies was assessed by using the EPHPP (effective public health practice project) and the CASP (critical appraisal skills programme) tools. From the identified studies, 14 were considered ‘strong,’ with the remainder assessed as ‘moderate’ quality. The findings reported in these studies suggest that RMG workers of South and Southeast Asian countries are prone to several health vulnerabilities which include physical and psychological issues. Further, many of these health vulnerabilities arise from the nature of the RMG workplace, and include unhygienic and unsafe working environments, hazardous conditions of the factories, and lack of safety equipment.

Conclusions

This systematic review suggests that RMG workers’ health vulnerabilities are an emerging area of inquiry that needs to be better understood and solutions identified. Little is currently known about the distinctive types of health vulnerabilities of the RMG workers of these countries, other than Bangladesh and India, due to the lack of robust studies in other South and Southeast Asian countries. Although the health vulnerabilities of the Bangladeshi and Indian RMG workers have been previously highlighted, the health vulnerabilities arising from sudden disasters in the sector remain a neglected issue.

Associations of perceived stress with the present and subsequent cortisol levels in fingernails among medical students: a prospective pilot study

Purpose

Cortisol in fingernails could retrospectively reflect cumulative stress over a long period. However, the association between fingernail cortisol and perceived stress needs to be validated. This exploratory study aimed to investigate the associations of perceived stress with the present and subsequent cortisol levels in fingernails of the subjective stress measurement among medical students.

Methods

Students were recruited from a medical university in Shenyang, China. The final sample consisted of 51 students (16 men, 35 women). On the Day 30 of our data and fingernail collection procedure, the 10-item Perceived Stress Scale was used to measure perceived stress. Fingernail samples were collected twice, on Days 15 (denoted as FD15) and 45 (denoted as FD45) of the procedure, and participants were asked to grow fingernails for 15 days in each collection. Cortisol was determined by an enzyme immunoassay method using the ELISA kit. Multiple linear regression was performed to examine the association between perceived stress and cortisol level. The Bonferroni correction was made for multiple comparisons.

Results

The level of cortisol was 5.65 pg/mg (SD =1.88) for FD15 and 5.41 pg/mg (SD =1.63) for FD45. Perceived stress was not associated with the cortisol level of FD15 (β=−0.014, P=0.924), but it was significantly and positively associated with the cortisol level of FD45 (β=0.436, P=0.003), which remained significant after Bonferroni correction. The associations between fingernail cortisol and demographic variables (gender, age, BMI, and physical activity) were not significant.

Conclusion

This study was the first to investigate fingernail cortisol in China. Perceived stress was positively associated with the subsequent cortisol levels in fingernails, but not the present. The findings suggested that fingernail cortisol could indicate stress exposure in the past. Furthermore, a simple and easy self-reported measure could reflect cumulative stress as measured by fingernail cortisol.

Hair cortisol and work stress: Importance of workload and stress model (JDCS or ERI)

Hair cortisol concentrations (HCCs) are a potential physiological indicator of work related stress. However, studies that tested the relationship between HCC and self-reported stress in a work setting show mixed findings. This may be because few studies used worker samples that experience prolonged stress. Therefore, we compared a high workload sample (n = 81) and a normal workload sample (n = 91) and studied whether HCC was related to: (i) high job demands, low control, and low social support (JDCS model), and (ii) high effort, low reward, and high overcommitment (ERI model). Results showed that self-reported stress related to HCC only in the high workload sample and only for the variables of the ERI model. We found that HCC was higher when effort was high, reward low, and overcommitment high. An implication of this study is that a certain stress threshold may need to be reached to detect a relationship between self-reported stress and physiological measures such as HCC.

Associations of work stress with hair cortisol concentrations - initial findings from a prospective study

There is ample evidence supporting the link between stress at the workplace and physical and mental health. One of the pathways potentially mediating those associations may involve the hypothalamic-pituitary-adrenal (HPA) axis, with cortisol as an end product. While theoretically plausible, findings on the association of self-reported work stress with hair cortisol concentrations (HCC) are inconclusive, being potentially biased by omitted pertinent factors. This issue can be addressed, among others, by eliminating time-invariant factors through consideration of variation within persons over time. To this end, the present study examined the association between variation in HCC and perceived work stress - as assessed by the Effort-Reward-Imbalance (ERI) model - between two points in time (t1 and t2) over one year in a sample of 40 male factory workers. Neither a cross-sectional association, nor a link between change in ERI and HCC levels at t2 was observed. There was however a robust association of the change in ERI with the change of HCC. This effect was independent of baseline HCC and other confounders (Beta = 0.414, S.E. = 0.155, p = 0.012). Accordingly, this is the first study revealing prospective evidence for the associations of work stress with HCC, while excluding potentially time-stable confounding factors, like genetic factors or phenotypic hair color.

Effects of psychosocial work characteristics on hair cortisol - findings from a post-trial study

Prolonged work stress, as indicated by the effort-reward imbalance (ERI) model, jeopardizes health. Cortisol represents a candidate mechanism connecting stress to ill health. However, previous findings appear inconclusive, and recommendations were made to assess work stress at multiple time points and also to investigate ERI (sub-)components. This study therefore examines the effects of two single time points, as well as the mean and change scores between time points of ERI and its components on hair cortisol concentration (HCC), a long-term cortisol measurement. Participants were 66 male factory workers (age: 40.68 ± 6.74 years; HCC: 9.00 ± 7.11 pg/mg), who were followed up after a stress management intervention (2006-2008). In 2008 (T1) and 2015 (T2), participants completed a 23-item ERI questionnaire, assessing effort, the three reward components (esteem, job security, job promotion) and over-commitment. In 2015, participants also provided a 3-cm hair segment close to the scalp for HCC analysis, as well as information on relevant confounders (i.e. medication intake, age, work characteristics, socioeconomic and lifestyle factors, number of stressful life events). Linear regressions revealed hardly any cross-sectional or longitudinal effect of ERI and its components on HCC. Only the change scores between T1 and T2 of job security were negatively associated with lower HCC in unadjusted (β = -.320; p = .009) and adjusted (β = -.288; p = .044) models. In this study, only a decrease of perceived job security over time was significantly associated with higher HCC, and other predictors were not related to this outcome. Especially after correction for multiple testing, this study revealed just a weak association of different psychosocial work measurements with HCC. Lay summary This study showed that an increase in perceived job insecurity is correlated with higher levels of the stress hormone cortisol. The higher levels of cortisol might represent a biological explanation for the negative health effects of job insecurity. The association was, however, relatively low, and more and more voices are questioning whether cortisol in hair is a reliable marker for perceived work stress.

Hair and stress: A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress

Mouse models show that experimental stress mimicking prolonged life-stress exposure enhances neurogenic inflammation, induces adaptive immunity cytokine-imbalance characterized by a shift to Type 1 T-helper cell cytokines and increases apoptosis of epithelial cells. This affects hair growth in otherwise healthy animals. In this study, we investigate whether a prolonged naturalistic life-stress exposure affects cytokine balance and hair parameters in healthy humans. 33 (18 exam, 15 comparison) female medical students with comparable sociobiological status were analyzed during a stressful final examination period, at three points in time (T) 12 weeks apart. T1 was before start of the learning period, T2 between the three-day written exam and an oral examination, and T3 after a 12 week rest and recovery from the stress of the examination period. Assessments included: self-reported distress and coping strategies (Perceived Stress Questionnaire [PSQ], Trier Inventory for the Assessment of Chronic Stress [TICS]), COPE), cytokines in supernatants of stimulated peripheral blood mononucleocytes (PBMCs), and trichogram (hair cycle and pigmentation analysis). Comparison between students participating in the final medical exam at T2 and non-exam students, revealed significantly higher stress perception in exam students. Time-wise comparison revealed that stress level, TH1/TH2 cytokine balance and hair parameters changed significantly from T1 to T2 in the exam group, but not the control. However, no group differences were found for cytokine balance or hair parameters at T2. The study concludes that in humans, naturalistic stress, as perceived during participation in a major medical exam, has the potential to shift the immune response to TH1 and transiently hamper hair growth, but these changes stay within a physiological range. Findings are instructive for patients suffering from hair loss in times of high stress. Replication in larger and more diverse sample populations is required, to assess suitability of trichogram analysis as biological outcome for stress studies.

Stress-related and basic determinants of hair cortisol in humans: A meta-analysis

The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol levels, which is increasingly used in psychoneuroendocrinological research. Here, we conduct a first comprehensive meta-analysis of HCC research based on aggregated data from a total of 124 (sub)samples (66 independent studies; total N=10,289). We seek to answer two central questions: (i) Which covariates and basic features of HCC need to be considered in future research? (ii) What are the main determinants of HCC in terms of chronic stress exposure and mental health? Concerning basic characteristics, our findings identify several covariates to be considered (age, sex, hair washing frequency, hair treatment, oral contraceptive use), confirm a decline of HCC from the first to the second proximal 3cm hair segment, and show positive associations between HCC and short-term salivary cortisol measures. Regarding chronic stress, we show that stress-exposed groups on a whole exhibit 22% increased HCC. This long-term cortisol hypersecretion emerges particularly when stress is still ongoing at the time of study (+43% HCC) but is not present in conditions of past/absent stress (-9% HCC, n.s.). We also report evidence for 17%-reduced HCC in anxiety disorders, such as PTSD. Interestingly, no consistent associations with mood disorders and self-reports of perceived stress, depressiveness or social support are found. However, our findings reveal positive associations of HCC with stress-related anthropometric (body mass index, waist-to-hip ratio) and hemodynamic measures (systolic blood pressure). These meta-analytic results are discussed in the light of their practical implications and important areas for future inquiry are outlined.

Hair cortisol and self-reported stress in healthy, working adults

Chronic stress can be important in the pathology of chronic disease. Hair cortisol concentrations (HCC) are proposed to reflect long term cortisol secretion from exposure to stress. To date, inconsistencies in the relationship between HCC and self-reported stress have been attributed to variation and limitations of perceived stress measurement. We report data from employees of two large public sector worksites (n=132). Socio-demographic, health, lifestyle, perceived stress scale (PSS), and work-related effort reward imbalance (ERI) were collected at baseline. Participants were asked to respond to mobile text messages every two days, asking them to report current stress levels (Ecological momentary assessment, EMA), and mean stress was determined overall, during work hours, and out of work hours. At 12 weeks, the appraisal of stressful life events scale (ALES) was completed and 3 cm scalp hair samples were taken, from which HCC was determined (to reflect cortisol secretion over the past 12 weeks). Mean response rate to EMA was 81.9 ± 14.9%. Associations between HCC and the various self-reported stress measures (adjusted for use of hair dye) were weak (all<.3). We observed significant associations with HCC for EMA measured stress responses received out of work hours (ρ=.196, p=.013) and ALES Loss subscale (ρ=.241, p=.003), and two individual items from ERI (relating to future work situation). In regression analysis adjusting for other possible confounders, only the HCC-ALES Loss association remained significant (p=.011). Overall, our study confirms that EMA provides a useful measurement tool that can gather perceived stress measures in real-time. But, there was no relationship between self-reported stress collected in this way, and HCC. The modest association between HCC and stress appraisal does however, provide some evidence for the role of cognitive processes in chronic stress.

Clinical applications of cortisol measurements in hair

Cortisol measurements in blood, saliva and urine are frequently used to examine the hypothalamus-pituitary-adrenal (HPA) axis in clinical practice and in research. However, cortisol levels are subject to variations due to acute stress, the diurnal rhythm and pulsatile secretion. Cortisol measurements in body fluids are not always a reflection of long-term cortisol exposure. The analysis of cortisol in scalp hair is a relatively novel method to measure cumulative cortisol exposure over months up to years. Over the past years, hair cortisol concentrations (HCC) have been examined in association with a large number of somatic and mental health conditions. HCC can be used to evaluate disturbances of the HPA axis, including Cushing's syndrome, and to evaluate hydrocortisone treatment. Using HCC, retrospective timelines of cortisol exposure can be created which can be of value in diagnosing cyclic hypercortisolism. HCC have also been shown to increase with psychological stressors, including major life events, as well as physical stressors, such as endurance exercise and shift work. Initial studies show that HCC may be increased in depression, but decreased in general anxiety disorder. In posttraumatic stress disorder, changes in HCC seem to be dependent on the type of traumatic experience and the time since traumatization. Increased hair cortisol is consistently linked to obesity, metabolic syndrome and cardiovascular disease. Potentially, HCC could form a future marker for cardiovascular risk stratification, as well as serve as a treatment target.

Seasonal variation in cortisol biomarkers in Hispanic mothers living in an agricultural region

CONTEXT

Characterization of stress exposure requires understanding seasonal variability in stress biomarkers.

OBJECTIVE

To compare acute and chronic stress biomarkers between two seasons in a cohort of rural, Hispanic mothers.

METHODS

Stress questionnaires and cortisol measurements (hair, blood and saliva) were collected in the summer and fall.

RESULTS

Cortisol biomarkers were significantly different and stress questionnaires were significantly correlated between seasons.

DISCUSSION

The variability in cortisol and relative stability of questionnaires between seasons may indicate that cortisol responds to subtle stressors not addressed in questionnaires.

CONCLUSIONS

There are significant differences in stress biomarkers in our cohort between seasons.