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Marcinkevičiūtė M, Vilutytė L, Gailienė D. Experience of pre-suicidal suffering: insights from suicide attempt survivors. Int J Qual Stud Health Well-being 2024; 19:2370894. [PMID: 38913782 PMCID: PMC11198122 DOI: 10.1080/17482631.2024.2370894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
PURPOSE Psychache significantly contributes to the suicidal process. However, the transition from pre-suicidal suffering to a suicide crisis remains one of the least explored stages in suicidology. METHODS We retrospectively explored experience of pre-suicidal suffering through semi-structured, in-depth interviews with 12 individuals recruited from the Vilnius City Mental Health Center, Lithuania. Interpretative phenomenological analysis was employed to identify recurring patterns. RESULTS Nine primary group experiential themes emerged: Certain adverse life events occurring during the suicidal process were not immediately perceived as connected; Complex traumatic events laid the groundwork for a profound sense of lack; A compensatory mechanism balanced the experience of profound lack; Exhaustion ensued from efforts to sustain the compensatory mechanism; The main trigger directly challenged the compensatory mechanism; The affective state followed the experience of the main triggering event; Dissociation served to isolate psychache; Thoughts of suicide experienced as automatic; Suicide was perceived as a means to end suffering. CONCLUSION The findings suggest that the suicidal process unfolds over an extended period of suffering, culminating in a crisis to alleviate unbearable psychological pain. In clinical practice, identifying the main triggering event discussed in this study can be pivotal in understanding the essence of suffering characterized by profound lacking and developed compensatory mechanisms.
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Affiliation(s)
- Miglė Marcinkevičiūtė
- Centre for Suicidology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | - Danutė Gailienė
- Centre for Suicidology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Lawton R, Frankenberg E, Seeman T, Crimmins E, Sumantri C, Thomas D. Exposure to the Indian Ocean Tsunami shapes the HPA-axis resulting in HPA "burnout" 14 years later. Proc Natl Acad Sci U S A 2023; 120:e2306497120. [PMID: 37844215 PMCID: PMC10622908 DOI: 10.1073/pnas.2306497120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/29/2023] [Indexed: 10/18/2023] Open
Abstract
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.
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Affiliation(s)
- Ralph Lawton
- Graduate School of Arts and Sciences, Harvard University, Cambridge, MA02115
| | | | - Teresa Seeman
- Department of Medicine, Division of Geriatrics, University of California, Los Angeles, CA90095
| | - Eileen Crimmins
- Andrus Gerontology Center, Davis School of Gerontology, University of Southern California, Los Angeles, CA90089
| | | | - Duncan Thomas
- Department of Economics, Duke University, Durham, NC27708
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3
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Somatic symptoms in burnout in a general adult population. J Psychosom Res 2023; 168:111217. [PMID: 36921422 DOI: 10.1016/j.jpsychores.2023.111217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Burnout results in individual suffering and high societal costs, and is associated with somatic symptoms, anxiety and depression, calling for prevention by early identification. The objectives were to (i) determine prevalence of specific somatic symptoms in burnout, (ii) identify the symptoms, referred to as somatic symptoms of burnout (SS-B), that are particularly associated with burnout, (iii) determine their extent of association with burnout, and (iv) determine how well a certain number of SS-B differentiates participants with and without burnout in a general Swedish adult population. METHODS Cross-sectional, population-based data were used from 687 participants high on burnout, and 2544 referents based on the Shirom-Melamed Burnout Questionnaire. The Patient Health Questionnaire 15-item Somatic Symptom Severity Scale was used to assess common somatization symptoms, and the Hospital Anxiety and Depression Scale to assess anxiety and depression. RESULTS Feeling tired/having low energy, back pain, joint/limb pain, trouble sleeping, headaches, stomach pain, nausea/gas/indigestion, and constipation/loose bowels/diarrhea were most prevalent in burnout (57.2-95.0%). These symptoms, except for joint/limb pain, and dizziness, were also identified as the SS-B, with odds ratios of 2.34-12.74 and 1.95-9.11 when adjusted for background variables, and for anxiety and depression, respectively. Corresponding odds ratios for each additional number of SS-B were 1.69 and 1.52, respectively. The highest balanced accuracy (71.6%) for predicting burnout was found for ≥4 SS-B. CONCLUSION Fatigue, pain and gastrointestinal symptoms are particularly common in burnout. Further studies may show whether clinicians should consider screening for burnout when patients present with SS-B without pathophysiological explanations.
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Olivé V, Navinés R, Macías L, López JA, Ariz J, Quesada S, Barroso S, Filella X, Langohr K, Martin-Santos R. Psychosocial and biological predictors of resident physician burnout. Gen Hosp Psychiatry 2022; 78:68-71. [PMID: 35901627 DOI: 10.1016/j.genhosppsych.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome. OBJECTIVES To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors. METHODOLOGY We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis. RESULTS We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019-1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778-0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees. CONCLUSION Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels.
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Affiliation(s)
- V Olivé
- Department of Medicine, Psychiatry Functional Unit, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.; Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - R Navinés
- Department of Psychiatry and Psychology, Hospital Clinic, UB, Institut d' Investigació, Biomèdica August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain.
| | - L Macías
- Department of Biochemistry and Molecular Genetics, Center of Biomedic Diagnosis (CDB), Hospital Clinic, UB, IDIBAPS, Barcelona, Spain.
| | - J A López
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - J Ariz
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - S Quesada
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - S Barroso
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - X Filella
- Department of Biochemistry and Molecular Genetics, Center of Biomedic Diagnosis (CDB), Hospital Clinic, UB, IDIBAPS, Barcelona, Spain.
| | - K Langohr
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya/Barcelonatech (UPC), Barcelona, Spain.
| | - R Martin-Santos
- Department of Medicine, Psychiatry Functional Unit, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.; Department of Psychiatry and Psychology, Hospital Clinic, UB, Institut d' Investigació, Biomèdica August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain.
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Khammissa RAG, Nemutandani S, Feller G, Lemmer J, Feller L. Burnout phenomenon: neurophysiological factors, clinical features, and aspects of management. J Int Med Res 2022; 50:3000605221106428. [PMID: 36113033 PMCID: PMC9478693 DOI: 10.1177/03000605221106428] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Burnout syndrome is a distinct “occupational phenomenon” rather than a
medical condition, comprising emotional exhaustion, physical fatigue,
and cognitive weariness. Both exogenous work-related and endogenous
personal factors determine the extent and the severity of symptoms in
burnout syndrome. Persistent burnout is a cause of reduced quality of
life and is associated with increased risk of sleep impairment and
with several medical disorders including mild cognitive impairment,
diabetes, and cardiovascular disease. Active coping strategies promoting mental resilience and adaptive
behavior, stress-reducing activities, improving work conditions, and
reducing exposure to work stressors together may alleviate the
distress of burnout and should be introduced early in the clinical
course of burnout syndrome. The purpose of this review was to explain
this complex and puzzling phenomenon and to describe burnout
management.
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Affiliation(s)
- Razia A G Khammissa
- School of Dentistry, Faculty of Health Sciences. University of Pretoria, Pretoria, South Africa
| | - Simon Nemutandani
- School of Oral Health Sciences. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gal Feller
- Department of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
| | - Johan Lemmer
- Faculty of Dentistry, University of the Witwatersrand, Johannesburg, South Africa
| | - Liviu Feller
- School of Oral Health Sciences. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
OBJECTIVES Burnout is a state of exhaustion resulting from prolonged and excessive workplace stress. We sought to examine biological underpinnings of burnout, focussing on mechanisms and physical consequences. METHODS We searched the literature on burnout and evaluated studies examining biological parameters in patient populations (i.e. 'clinical' burnout) as well as in individuals from the general population judged as having some degree of burnout evaluated using a dimensional approach. RESULTS Findings suggest that burnout is associated with sustained activation of the autonomic nervous system and dysfunction of the sympathetic adrenal medullary axis, with alterations in cortisol levels. Limited studies have also shown altered immune function and changes in other endocrine systems. Consequences of burnout include increased allostatic load, structural and functional brain changes, excito-toxicity, systemic inflammation, immunosuppression, metabolic syndrome, cardiovascular disease and premature death. Limitations of studies include variability in study populations, low specificity of burnout measures, and mostly cross-sectional studies precluding examination of changes across the course of burnout. CONCLUSIONS Further examination of biological mechanisms of burnout would benefit from more homogeneous clinical samples, challenge tests and prospective studies. This would assist in differentiation from conditions such as depression and aid with development of specific treatment targets for burnout.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, UNSW, Sydney, Australia.,Black Dog Institute, Sydney, Australia
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Rehder K, Adair KC, Sexton JB. The Science of Health Care Worker Burnout: Assessing and Improving Health Care Worker Well-Being. Arch Pathol Lab Med 2021; 145:1095-1109. [PMID: 34459858 DOI: 10.5858/arpa.2020-0557-ra] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Problems with health care worker (HCW) well-being have become a leading concern in medicine given their severity and robust links to outcomes like medical error, mortality, and turnover. OBJECTIVE.— To describe the state of the science regarding HCW well-being, including how it is measured, what outcomes it predicts, and what institutional and individual interventions appear to reduce it. DATA SOURCES.— Peer review articles as well as multiple large data sets collected within our own research team are used to describe the nature of burnout, associations with institutional resources, and individual tools to improve well-being. CONCLUSIONS.— Rates of HCW burnout are alarmingly high, placing the health and safety of patients and HCWs at risk. To help address the urgent need to help HCWs, we summarize some of the most promising early interventions, and point toward future research that uses standardized metrics to evaluate interventions (with a focus on low-cost institutional and personal interventions).
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Affiliation(s)
- Kyle Rehder
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - Kathryn C Adair
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
| | - J Bryan Sexton
- From the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina
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Crippa JAS, Zuardi AW, Guimarães FS, Campos AC, de Lima Osório F, Loureiro SR, dos Santos RG, Souza JDS, Ushirohira JM, Pacheco JC, Ferreira RR, Mancini Costa KC, Scomparin DS, Scarante FF, Pires-Dos-Santos I, Mechoulam R, Kapczinski F, Fonseca BAL, Esposito DLA, Pereira-Lima K, Sen S, Andraus MH, Hallak JEC. Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2120603. [PMID: 34387679 PMCID: PMC8363917 DOI: 10.1001/jamanetworkopen.2021.20603] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Frontline health care professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. OBJECTIVE To investigate the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline health care professionals working with patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This prospective open-label single-site randomized clinical trial used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline health care professionals (physicians, nurses, and physical therapists) working with patients with COVID-19 at the Ribeirão Preto Medical School University Hospital in São Paulo, Brazil. Participants were enrolled between June 12 and November 12, 2020. A total of 214 health care professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection. INTERVENTIONS Cannabidiol, 300 mg (150 mg twice per day), plus standard care or standard care alone for 28 days. MAIN OUTCOMES AND MEASURES The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. RESULTS A total of 120 participants were randomized to receive either CBD, 300 mg, plus standard care (treatment arm; n = 61) or standard care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age, 33.6 years [95% CI, 32.3-34.9 years]) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory significantly decreased at day 14 (mean difference, 4.14 points; 95% CI, 1.47-6.80 points; partial eta squared [ηp2] = 0.08), day 21 (mean difference, 4.34 points; 95% CI, 0.94-7.73 points; ηp2 = 0.05), and day 28 (mean difference, 4.01 points; 95% CI, 0.43-7.59 points; ηp2 = 0.04). However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery. CONCLUSIONS AND RELEVANCE In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among health care professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04504877.
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Affiliation(s)
- José Alexandre S. Crippa
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - Antonio W. Zuardi
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - Francisco S. Guimarães
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alline Cristina Campos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Flávia de Lima Osório
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - Sonia Regina Loureiro
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rafael G. dos Santos
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
| | - José Diogo S. Souza
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Juliana Mayumi Ushirohira
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Julia Cozar Pacheco
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rafael Rinaldi Ferreira
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karla Cristinne Mancini Costa
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Davi Silveira Scomparin
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Franciele Franco Scarante
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabela Pires-Dos-Santos
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Raphael Mechoulam
- Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Flávio Kapczinski
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Benedito A. L. Fonseca
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Danillo L. A. Esposito
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Karina Pereira-Lima
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | | | - Jaime E. C. Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- National Institute for Science and Technology–Translational Medicine, São Paulo, Brazil
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Cui J, Ren YH, Zhao FJ, Chen Y, Huang YF, Yang L, You XM. Cross-Sectional Study of the Effects of Job Burnout on Immune Function in 105 Female Oncology Nurses at a Tertiary Oncology Hospital. Med Sci Monit 2021; 27:e929711. [PMID: 33941757 PMCID: PMC8106256 DOI: 10.12659/msm.929711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nurses who work in hospitals experience a high level of burnout and the relationship between immune variables and burnout syndrome has yet to be elucidated. The aim of the present study was to investigate the effects of job burnout on immune function in female oncology nurses in a tertiary oncology hospital in Guangxi, China. The aspects of the human immune system evaluated were humoral and cellular immunity and complement components 3 (C3) and 4 (C4). Material/Methods We administered the Maslach Burnout Inventory-General Survey (MBI-GS), which includes scales for emotional exhaustion, depersonalization (DP), and personal accomplishment (PA), to measure variables related to immune function in 105 female nurses in a tertiary oncology hospital in Guangxi, China. Levels of humoral immunity and C3 and C4 were detected with immune turbidimetry. Cellular immunity was assessed with indirect immunofluorescence. Results A Spearman rank correlation analysis revealed that levels of C3, C4, and CD4- and CD8-positive T cells were significantly associated with burnout symptoms (P<0.05, P<0.01, and P<0.05, respectively). Furthermore, there was a correlation between demographic data and humoral and cellular immunity (both P<0.05). Multivariable linear regression analysis showed that C4 levels were closely related to DP (P<0.05) and that CD4 and CD8 levels were closely related to PA (P<0.01). Conclusions These results suggest that DP and PA have an impact on immune function, and that timely psychological and behavioral interventions can be used to reduce the degree of job burnout among nurses and regulate their immunity, thus enabling them to better serve patients.
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Affiliation(s)
- Jing Cui
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Yun-Hong Ren
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Feng-Juan Zhao
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Ying Chen
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Ying-Fan Huang
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Ling Yang
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
| | - Xue-Mei You
- Nursing Department, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China (mainland)
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Correlates of burnout among Indian primary school teachers. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2021. [DOI: 10.1108/ijoa-09-2020-2420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to examine the correlates of burnout among primary school teachers working with public schools in Chhattisgarh-India.
Design/methodology/approach
Data were collected from 713 teachers using a questionnaire survey. Using partial least square path modeling, this study tests the proposed measurement and structural model.
Findings
The study confirmed that general job demands and emotional job demands in a school environment significantly correlated with burnout, which, in turn, has increased somatic symptoms and decreased pro-social behavior among teachers. However, the association of burnout with absenteeism was insignificant. Emotional intelligence (EI) was found to buffer the adverse associations of general job demands and emotional job demands on burnout.
Practical implications
The findings of this study demonstrate that EI has buffering effects on high job demands that consequently reduce burnout. This will help educators and policymakers in shaping and formulating effective policies and practices to deal with burnout.
Originality/value
Earlier studies exploring burnout of primary school teachers, especially in the Indian context, had focused exclusively on demographic factors. This study is an early attempt to understand the impact of contextual factors on burnout thereby helping in designing appropriate interventions thereof. This study additionally rationalizes the unexplored association of burnout with pro-social behavior among educators.
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Potter G, Hatch D, Hagy H, Radüntz T, Gajewski P, Falkenstein M, Freude G. Slower information processing speed is associated with persistent burnout symptoms but not depression symptoms in nursing workers. J Clin Exp Neuropsychol 2021; 43:33-45. [PMID: 33402015 DOI: 10.1080/13803395.2020.1863340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Burnout and depression both occur with chronic work-related stress, and cognitive deficits have been found when symptom severity results in work disability. Less is known about cognitive deficits associated with milder symptoms among active workers, and few studies have examined whether cognitive deficits predict persistent burnout and depression symptoms. The goal of this study was to examine the association of information processing speed and executive function performance to burnout and depression symptoms at baseline and 12-month follow-up in a sample of actively working individuals (N = 372).Method: The design was prospective with laboratory cognitive data at baseline, and burnout and depressive symptoms assessed at baseline and monthly follow-ups. Information processing speed and executive functions were assessed in a task-switching paradigm, including single-task reaction time (RT), switching costs, and mixing costs. Burnout was assessed with the Exhaustion subscale of the Oldenburg Burnout Inventory and depression with the Patient Health Questionnaire-9.Results: Slower RT was modestly associated with higher levels of burnout symptoms both cross-sectionally and prospectively, but switching costs and mixing costs were not associated with burnout symptoms. None of the cognitive measures were associated with depression symptoms cross-sectionally or prospectively.Conclusions: Despite statistically significant findings of slowed RT in acute exhaustion-related burnout, the proportion of variance accounted for in the models was small and did not predict clinically significant levels of distress. The absence of statistically significant findings for depression symptoms suggests the cognitive profile associated with the exhaustion dimension of burnout may be distinct from that of depression, which reflects a more heterogeneous symptomatology. Our data suggest the clinical impact of burnout symptoms on actively working individuals is marginal; nonetheless, it is important to screen and intervene on burnout and depression symptoms in the workplace because they can lead to other forms of work impairment.
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Affiliation(s)
- Guy Potter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Daniel Hatch
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hannah Hagy
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Thea Radüntz
- Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Patrick Gajewski
- Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany
| | - Michael Falkenstein
- Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany.,Institute for Working, Learning, and Aging, Bochum, Germany
| | - Gabriele Freude
- Federal Institute for Occupational Safety and Health, Berlin, Germany
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12
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Wolpaw JT, Adair KC. Shoe Covers but Not Burnout? Making Burnout Reduction a Criteria for Centers for Medicare and Medicaid Services Funding Would Protect Patients. J Patient Saf 2021; 17:68-70. [PMID: 32217936 DOI: 10.1097/pts.0000000000000681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the United States, hospitals must meet eligibility criteria to receive federal funding. Regulatory bodies, such as the Joint Commission, are approved by the government to give, or withhold, accreditation to hospitals. This accreditation is a requisite to continue receiving funding. Hospitals are frequently cited for items such as inadequate wearing of boot covers or covering of facial hair in the operating rooms. There are very little, if any, data to support an improvement in patient safety when these items are complied with. There is, however, a large amount of data showing the negative consequences for patient safety when providers are burned out. We therefore propose that regulatory agencies such as the Joint Commission require that hospital systems measure burnout and reduce concerning levels of burnout in their employees to continue receiving certification. We briefly review evidence-based methods that hospital systems might consider to accomplish this goal.
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Affiliation(s)
- Jed T Wolpaw
- From the Johns Hopkins Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland
| | - Kathryn C Adair
- The Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC
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13
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Sjörs Dahlman A, Jonsdottir IH, Hansson C. The hypothalamo-pituitary-adrenal axis and the autonomic nervous system in burnout. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:83-94. [PMID: 34266613 DOI: 10.1016/b978-0-12-819973-2.00006-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Burnout constitutes a serious health concern in the modern working environment. It is a stress-related condition that has developed as a result of a prolonged psychosocial stress exposure causing a persistent mismatch between demands and resources. The main symptom is emotional exhaustion, but physical fatigue, diminished professional efficacy, cynicism, and cognitive impairments are also associated with this condition. Burnout has been used both as a psychologic term in occupational settings and as a clinical diagnosis in patient populations, and there is currently no universally accepted definition and diagnostic criteria of burnout. It has been hypothesized that the two main stress response systems, the autonomic nervous system (ANS) and the hypothalamus-pituitary-adrenal axis (HPA axis), are involved in the pathogenesis of burnout. A common hypothesis is that in the early stages of chronic stress, the HPA axis and sympathetic ANS activity tend to be higher, while it will decrease with a longer duration of chronic stress to ultimately reach a state of hypoactivity in clinical burnout. The current research in this field shows many contradictory results. Thus there is no compelling evidence of either ANS or HPA dysfunction in burnout. However, there is partial support for the hypothesis of HPA and sympathetic hyperactivity in early stages, and HPA hyporeactivity and low vagal activity in more severe burnout cases, but high-quality studies investigating the causal links are still lacking.
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Affiliation(s)
- Anna Sjörs Dahlman
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; Human Factors Department, Swedish National Road and Transport Research Institute, Gothenburg, Sweden.
| | - Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Hansson
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic. J Perinatol 2021; 41:961-969. [PMID: 33727700 PMCID: PMC7962434 DOI: 10.1038/s41372-021-01014-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess maternal and neonatal healthcare workers (HCWs) perspectives on well-being and patient safety amid the COVID-19 pandemic. STUDY DESIGN Anonymous survey of HCW well-being, burnout, and patient safety over the prior conducted in June 2020. Results were analyzed by job position and burnout status. RESULT We analyzed 288 fully completed surveys. In total, 66% of respondents reported symptoms of burnout and 73% felt burnout among their co-workers had significantly increased. Workplace strategies to address HCW well-being were judged by 34% as sufficient. HCWs who were "burned out" reported significantly worse well-being and patient safety attributes. Compared to physicians, nurses reported higher rates of unprofessional behavior (37% vs. 14%, p = 0.027) and difficulty focusing on work (59% vs. 36%, p = 0.013). CONCLUSION Three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.
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15
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Palego L, Giannaccini G, Betti L. Neuroendocrine Response to Psychosocial Stressors, Inflammation Mediators and Brain-periphery Pathways of Adaptation. Cent Nerv Syst Agents Med Chem 2020; 21:2-19. [PMID: 33319677 DOI: 10.2174/1871524920999201214231243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Threats, challenging events, adverse experiences, predictable or unpredictable, namely stressors, characterize life, being unavoidable for humans. The hypothalamus-pituitary-adrenal axis (HPA) and the sympathetic nervous system (SNS) are well-known to underlie adaptation to psychosocial stress in the context of other interacting systems, signals and mediators. However, much more effort is necessary to elucidate these modulatory cues for a better understanding of how and why the "brain-body axis" acts for resilience or, on the contrary, cannot cope with stress from a biochemical and biological point of view. Indeed, failure to adapt increases the risk of developing and/or relapsing mental illnesses such as burnout, post-traumatic stress disorder (PTSD), and at least some types of depression, even favoring/worsening neurodegenerative and somatic comorbidities, especially in the elderly. We will review here the current knowledge on this area, focusing on works presenting the main brain centers responsible for stressor interpretation and processing, together with those underscoring the physiology/biochemistry of endogenous stress responses. Autonomic and HPA patterns, inflammatory cascades and energy/redox metabolic arrays will be presented as allostasis promoters, leading towards adaptation to psychosocial stress and homeostasis, but also as possible vulnerability factors for allostatic overload and non-adaptive reactions. Besides, the existence of allostasis buffering systems will be treated. Finally, we will suggest promising lines of future research, particularly the use of animal and cell culture models together with human studies by means of high-throughput multi-omics technologies, which could entangle the biochemical signature of resilience or stress-related illness, a considerably helpful facet for improving patients' treatment and monitoring.
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Affiliation(s)
- Lionella Palego
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Laura Betti
- Department of Pharmacy, University of Pisa, Pisa, Italy
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16
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Sandrini L, Ieraci A, Amadio P, Zarà M, Barbieri SS. Impact of Acute and Chronic Stress on Thrombosis in Healthy Individuals and Cardiovascular Disease Patients. Int J Mol Sci 2020; 21:ijms21217818. [PMID: 33105629 PMCID: PMC7659944 DOI: 10.3390/ijms21217818] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Psychological stress induces different alterations in the organism in order to maintain homeostasis, including changes in hematopoiesis and hemostasis. In particular, stress-induced hyper activation of the autonomic nervous system and hypothalamic–pituitary–adrenal axis can trigger cellular and molecular alterations in platelets, coagulation factors, endothelial function, redox balance, and sterile inflammatory response. For this reason, mental stress is reported to enhance the risk of cardiovascular disease (CVD). However, contrasting results are often found in the literature considering differences in the response to acute or chronic stress and the health condition of the population analyzed. Since thrombosis is the most common underlying pathology of CVDs, the comprehension of the mechanisms at the basis of the association between stress and this pathology is highly valuable. The aim of this work is to give a comprehensive review of the studies focused on the role of acute and chronic stress in both healthy individuals and CVD patients, focusing on the cellular and molecular mechanisms underlying the relationship between stress and thrombosis.
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Affiliation(s)
- Leonardo Sandrini
- Unit of Brain-Heart Axis: Cellular and Molecular Mechanisms, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (P.A.); (M.Z.)
- Correspondence: (L.S.); (S.S.B.); Tel.: +39-02-58002021 (L.S. & S.S.B.)
| | - Alessandro Ieraci
- Laboratory of Neuropsychopharmacology and Functional Neurogenomics, Dipartimento di Scienze Farmaceutiche, Sezione di Fisiologia e Farmacologia, University of Milan, 20133 Milan, Italy;
| | - Patrizia Amadio
- Unit of Brain-Heart Axis: Cellular and Molecular Mechanisms, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (P.A.); (M.Z.)
| | - Marta Zarà
- Unit of Brain-Heart Axis: Cellular and Molecular Mechanisms, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (P.A.); (M.Z.)
| | - Silvia Stella Barbieri
- Unit of Brain-Heart Axis: Cellular and Molecular Mechanisms, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (P.A.); (M.Z.)
- Correspondence: (L.S.); (S.S.B.); Tel.: +39-02-58002021 (L.S. & S.S.B.)
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17
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Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A. Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neurosci Biobehav Rev 2020; 114:232-270. [DOI: 10.1016/j.neubiorev.2020.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
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18
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Is it all about Depression? Determinants of Burnout among Employees Referred for Inpatient Treatment of Job-Related Stress Disorders. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 65:183-197. [PMID: 31154931 DOI: 10.13109/zptm.2019.65.2.183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: There is an ongoing debate as to whether job burnout and depression are overlapping concepts or differ from each other, although this has not been scrutinized in inpatients. To further elucidate the robustness of this relationship, we used three different measurements of depression. We further examined the influence of psychological distress, perceived stress and sleep quality in the link between depressive symptoms and burnout. Methods: We investigated 723 consecutive inpatients, aged 23 to 82 years, 51.2 % women, referred to a hospital specialized in the treatment of job stress-related disorders. Patients completed the Maslach Burnout Inventory, the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index. Results: We found significant correlations between burnout total scores as well as subscales (emotional exhaustion, depersonalization, lack of accomplishment) and depressive symptoms, virtually independent of the applied depression measure. The shared variance ranged between 1.1 % and 19.4 %. Greater levels of burnout were directly associated with cognitiveaffective symptoms and, although to a lesser extent, also with somatic-affective symptoms of depression. In the multivariable analysis, significantly more total burnout symptoms were revealed in more depressed and younger patients, in men than women, and in employees with greater levels of psychological distress and perceived stress, respectively. Conclusions: The findings suggest that although burnout and depression do not represent the same psychopathology, there is considerable overlap between the two constructs; the extent of this overlap may vary depending upon the applied depression measure.
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19
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Stress and inflammation - The need to address the gap in the transition between acute and chronic stress effects. Psychoneuroendocrinology 2019; 105:164-171. [PMID: 30826163 DOI: 10.1016/j.psyneuen.2019.02.021] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 12/19/2022]
Abstract
Stress responses help us navigate our environment and respond appropriately to threats. Stress systems communicate threats to the entire organism, and as such, also stimulate inflammatory mechanisms. This modulation might serve protective functions in the short term, but sustained low-grade inflammation has severe long-term health consequences. While we have reached a reasonable level of understanding of acute, as well as chronic stress effects on inflammatory mechanisms, there is a significant gap in our understanding of the transitional phase between acute and chronic stress. The purpose of this review is to first summarize current knowledge of our understanding of acute stress effects on inflammation, as well as of chronic stress effects on inflammation, and to then analyze the state of knowledge about the transitional phase between acute and chronic stress. Research discussed here shows that we are beginning to understand the early phase of repeated acute stress, but lack information on longer term exposure to repeated acute stress experiences. More research is needed to bridge this important gap und our conceptualization and understanding of the stress and health relationship.
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Deneva T, Ianakiev Y, Keskinova D. Burnout Syndrome in Physicians-Psychological Assessment and Biomarker Research. ACTA ACUST UNITED AC 2019; 55:medicina55050209. [PMID: 31137738 PMCID: PMC6571619 DOI: 10.3390/medicina55050209] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/15/2022]
Abstract
Background and objectives: Burnout is a syndrome typically occurring in work environments with continuous and chronic stress. Physicians are at increased risk for burnout, as a result of 24-h work, delayed work–life balance gratification, and the challenges associated with patient care. The aim of the present study was to evaluate the psychological parameters of burnout symptoms in relation to biomarkers of stress among physicians with different medical specialties. Materials and methods: A total of 303 physicians were contacted as potential participants. A comparison group of 111 individuals working outside medicine was used as a control to verify the results. The physicians were specialists in internal medicine, general surgery, pathology, and primary care. Serum cortisol, salivary cortisol, adrenocorticotropic hormone (ACTH), insulin (IRI), and prolactin levels were analyzed by chemiluminescence enzyme immunoassay (Access 2, Beckman Coulter). Fasting glucose in serum and glycated hemoglobin (HbA1C) in whole blood were measured using the automatic analyzer AU 480 Beckman Coulter system. Symptoms of burnout were measured with the Maslach Burnout Inventory (MBI). Results: The group with burnout presented significantly higher levels of serum and saliva cortisol, ACTH, prolactin, fasting glucose, and HbA1C compared with the control group. The correlation analysis between biomarkers showed a positive correlation with moderate strength between serum and saliva cortisol (r = 0.516, p = 0.01),as well as serum and saliva cortisol with ACTH (r = 0.418; r = 0.412, p = 0.01) and HbA1C (r = 0.382; r = 0.395, p = 0.01). A weak positive correlation was found between serum and saliva cortisol with prolactin (r = 0.236; r = 0.267, p < 0.01) and glucose (r = 0.271; r = 0.297, p < 0.01). In the multiple logistic regression model, saliva cortisol, HbA1C, and age were significantly associated with burnout (chi-square = 16.848, p < 0.032). Conclusion: Our findings demonstrated the interest of exploring biomarkers of stress related to burnout in health professionals.
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Affiliation(s)
- Tanya Deneva
- Department of Clinical Laboratory, Medical University, University Hospital "St. George", 4002 Plovdiv, Bulgaria.
| | - Youri Ianakiev
- Department of Psychology, University of Plovdiv Paisii Hilendarski, 4000 Plovdiv, Bulgaria.
| | - Donka Keskinova
- Department of Applied and Institutional Sociology, University of Plovdiv Paisii Hilendarski, 4000 Plovdiv, Bulgaria.
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21
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Sexton JB, Adair KC. Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. BMJ Open 2019; 9:e022695. [PMID: 30898795 PMCID: PMC6475256 DOI: 10.1136/bmjopen-2018-022695] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES High rates of healthcare worker (HCW) burn-out have led many to label it an 'epidemic' urgently requiring interventions. This prospective pilot study examined the efficacy, feasibility and evaluation of the 'Three Good Things' (3GT) intervention for HCWs, and added burn-out and work-life balance to the set of well-being metrics. METHODS 228 HCWs participated in a prospective, repeated measures study of a web-based 15-day long 3GT intervention. Assessments were collected at baseline and 1, 6 and 12-month post-intervention. The primary measure of efficacy was a derivative of the emotional exhaustion subscale of the Maslach Burnout Inventory. The secondary measures were validated instruments assessing depression symptoms, subjective happiness, and work-life balance. Paired samples t-tests and Cohen's d effect sizes for correlated samples were used to examine the efficacy of the intervention. RESULTS 3GT participants exhibited significant improvements from baseline in emotional exhaustion, depression symptoms and happiness at 1 month, 6 months and 12 months, and in work-life balance at 1 month and 6 months (effect sizes 0.16-0.52). Exploratory subgroup analyses of participants meeting 'concerning' criteria at baseline revealed even larger effects at all assessment points (0.55-1.57). Attrition rates were similar to prior 3GT interventions. CONCLUSION 3GT appears a promising low-cost and brief intervention for improving HCW well-being. ETHICS AND DISSEMINATION This study is approved by the Institutional Review Board of Duke University Health System (Pro00063703). All participants are required to give their informed consent prior to any study procedure.
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Affiliation(s)
- J Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina, USA
- Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn C Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina, USA
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Jonsdottir IH, Sjörs Dahlman A. MECHANISMS IN ENDOCRINOLOGY: Endocrine and immunological aspects of burnout: a narrative review. Eur J Endocrinol 2019; 180:R147-R158. [PMID: 30576285 PMCID: PMC6365671 DOI: 10.1530/eje-18-0741] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Burnout has several different definitions, and attempts have been made to discriminate between burnout as a psychological construct and burnout as a clinical entity. A large body of research has focused on elucidating the biological link between stress exposure and burnout and/or finding a clinically usable biomarker for burnout. The objective of this narrative review is to summarize the main endocrine and immune findings in relation to burnout. The literature has primarily focused on dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. However, albeit the large body of studies, it cannot be concluded that clear effects are seen on HPA axis function in people with burnout. The HPA axis and anabolic acute reactivity to stress might be affected in clinical burnout. Plausible, effects of chronic stress might rather be seen when measuring responses to acute stress rather than resting state hormonal levels. Studies on other hormones, including thyroid hormones, prolactin and growth hormone in burnout subjects are inconclusive. It is important to note that this field is faced with many methodological challenges, one being the diurnal and pulsatile nature of many of the hormones of interest, including cortisol, which is not always considered. Another challenge is the heterogeneity regarding definitions and measurements of stress and burnout. Existing studies on burnout and immune function are heterogeneous regarding the results and no firm conclusion can be made if clinically relevant immune changes are present in burnout subjects. An overall conclusion is that existing research cannot confirm any homogenous reliable endocrinological or immunological changes related to burnout.
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Affiliation(s)
- Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
- Correspondence should be addressed to I H Jonsdottir;
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Edwards KL, Edes AN, Brown JL. Stress, Well-Being and Reproductive Success. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1200:91-162. [DOI: 10.1007/978-3-030-23633-5_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Penz M, Wekenborg MK, Pieper L, Beesdo-Baum K, Walther A, Miller R, Stalder T, Kirschbaum C. The Dresden Burnout Study: Protocol of a prospective cohort study for the bio-psychological investigation of burnout. Int J Methods Psychiatr Res 2018; 27:e1613. [PMID: 29611872 PMCID: PMC6877172 DOI: 10.1002/mpr.1613] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/21/2017] [Accepted: 01/23/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The Dresden Burnout Study (DBS) is a 12-year longitudinal cohort study that aims to provide a description of the burnout syndrome on the basis of time and symptom criteria with a special focus on the search for biomarkers. Biological and psychosocial approaches are applied to examine the long-term course and consequences of burnout within a population-based German-speaking sample aged 18 to 68 years. METHODS Demographics and psychosocial data are generated by online assessments, including demographics and questionnaires on burnout, burnout-related constructs, work-environment, and health-related factors. The lab-based biomarker assessment includes endocrine, physiological, immunological, and epigenetic markers obtained from blood and hair samples. In addition, heart rate variability is also measured repeatedly. Within the first 2 years, the DBS collected psychosocial data from over 7,600 participants with biological data obtained from more than 800 individuals. During the following 10 years, detailed assessments of biomarkers and psychosocial factors will be collected in annual study waves. RESULTS Results will be generated during the following decade. CONCLUSION The findings of the DBS are expected to pave the road for an in-depth biopsychosocial characterization of burnout and to give insight into the long-term course and potential mental and physical health consequences of the burnout syndrome.
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Affiliation(s)
- Marlene Penz
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Magdalena K Wekenborg
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Lars Pieper
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Behavioral Epidemiology, Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Andreas Walther
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Robert Miller
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Tobias Stalder
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany.,Clinical Psychology, University of Siegen, Siegen, Germany
| | - Clemens Kirschbaum
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
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Leistner C, Menke A. How to measure glucocorticoid receptor's sensitivity in patients with stress-related psychiatric disorders. Psychoneuroendocrinology 2018; 91:235-260. [PMID: 29449045 DOI: 10.1016/j.psyneuen.2018.01.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/07/2017] [Accepted: 01/28/2018] [Indexed: 12/31/2022]
Abstract
Stress is a state of derailed homeostasis and a main environmental risk factor for psychiatric diseases. Chronic or uncontrollable stress may lead to a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a common feature of stress-related psychiatric disorders. One of the key mechanisms underlying a disturbed HPA axis is an impaired function of the glucocorticoid receptor (GR) with an enhanced or reduced feedback sensitivity for glucocorticoids and subsequently altered concentrations of peripheral cortisol. GR function is regulated by a multiprotein complex including the different expression of the hsp90 co-chaperone FK 506 binding protein 51 (FKBP5) that may be genetically determined or acquired in response to stressful stimuli. Specific patterns of a dysregulation of the HPA axis and GR function are found in different stress-related psychiatric entities e.g. major depression, job-related exhaustion or posttraumatic stress disorder. GR challenge tests like the dexamethasone-suppression test (DST), the dexamethasone-corticotropin-releasing hormone (dex-CRH) test or most recently the analysis of the dexamethasone-induced gene expression are employed to sensitively measure HPA axis activity in these disorders. They provide information for a stratification of phenotypic similar but neurobiological diverse psychiatric disorders. In this review we present a synopsis of GR challenge tests with a focus on the application of the DST, the CRH test and the dex-CRH test as well as the dexamethasone-induced gene expression in stress-related psychiatric entities.
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Affiliation(s)
- Carolin Leistner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany
| | - Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany; Comprehensive Heart Failure Center, University Hospital of Wuerzburg, Am Schwarzenberg 15, Wuerzburg, 97080, Germany.
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26
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Chow Y, Masiak J, Mikołajewska E, Mikołajewski D, Wójcik GM, Wallace B, Eugene A, Olajossy M. Limbic brain structures and burnout-A systematic review. Adv Med Sci 2018; 63:192-198. [PMID: 29175078 DOI: 10.1016/j.advms.2017.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/11/2017] [Accepted: 11/13/2017] [Indexed: 12/24/2022]
Abstract
More profound understanding of the relationship between the burnout and the limbic system function can provide better insight into brain structures associated with the burnout syndrome. The objective of this review is to explore all evidence of limbic brain structures associated with the burnout syndrome. In total, 13 studies were selected. Four of them applied the neuroimaging technology to investigate the sizes/volumes of the limbic brain structures of burnout patients. Six other studies were to investigate the hypothalamus-pituitary-adrenal (HPA) axis of burnout patients. Based on the results of the studies on the HPA-axis and neuroimaging of the limbic brain structures, one can see great impact of the chronic occupational stress on the limbic structures in terms of HPA dysregulation, a decrease of BDNF, impaired neurogenesis and limbic structures atrophy. It can be concluded that chronic stress inhibits the feedback control pathway in the HPA axis, causes the decrease of brain-derived neurotrophic factor (BDNF), then impaired neurogenesis and eventually neuron atrophy.
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Affiliation(s)
- YeeKong Chow
- Neurophysiological Independent Unit, Department of Psychiatry, Medical University of Lublin, Poland
| | - Jolanta Masiak
- Neurophysiological Independent Unit, Department of Psychiatry, Medical University of Lublin, Poland
| | - Emilia Mikołajewska
- Department of Physiotherapy, Ludwik Rydygier Collegium Medicum of Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
| | - Dariusz Mikołajewski
- Department of Teleinformatics, Institute of Mechanics and Applied Computer Sciences, Kazimierz Wielki University of Bydgoszcz, Poland; Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University of Toruń, Poland
| | - Grzegorz Marcin Wójcik
- Department of Neuroinformatics, Institute of Informatics, Maria Curie-Skłodowska University of Lublin, Poland
| | | | - Andy Eugene
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, USA
| | - Marcin Olajossy
- Department of Psychiatry, Medical University of Lublin, Poland
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Gajewski PD, Boden S, Freude G, Potter GG, Claus M, Bröde P, Watzl C, Getzmann S, Falkenstein M. Executive control, ERP and pro-inflammatory activity in emotionally exhausted middle-aged employees. Comparison between subclinical burnout and mild to moderate depression. Psychoneuroendocrinology 2017; 86:176-186. [PMID: 28972891 DOI: 10.1016/j.psyneuen.2017.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/01/2017] [Accepted: 09/14/2017] [Indexed: 01/11/2023]
Abstract
Burnout is a syndrome occurring mainly in individuals with long-term stressful work. The main complaints are emotional exhaustion and reduced performance. Burnout also largely overlaps with depression. Both are characterized by increased incidence of infections due to dysregulation of the immune system, overexpression of pro-inflammatory cytokines and cognitive deficits, particularly related to executive functions. To distinguish between burnout and depression already at the pre-clinical stage, the present double-blinded study compared immunological and cognitive parameters in seventy-six employees from emotionally demanding occupations who were post-hoc subdivided into two groups scoring low (EE-) and high (EE+) in emotional exhaustion and low (DE-) and high (DE+) in depression. Immunological parameters were measured from blood samples. Executive functions were studied by analyzing event-related brain potentials (ERPs) and performance during a task switching paradigm. Psychosocial job parameters were measured with standardized questionnaires. Burnout and mild to moderate depression largely overlapped. However, several subjects showed burnout without depressive symptoms. Higher levels of the pro-inflammatory cytokines IL-6 and IL-12 were correlated with burnout severity and depressive symptoms in male individuals. In the switch task a trend for lower performance in the EE+ vs. EE- group and no difference between DE+ and DE- groups were found. In the ERPs, however, differences were observed which distinguished between subclinical burnout and depression: the terminal contingent negative variation (CNV), indicating preparatory activity and the P3b, related to allocation of cognitive resources were generally reduced in EE+ vs. EE-, whereas no differences were found in the DE+ vs. DE- groups. The frontal P3a was selectively reduced in switch trials in the EE+ vs. EE- group and showed only a trend in DE+ vs. DE-, indicating impairment of executive control in subclinical burnout. Taken together, the results unveil specific immunological changes and declines in brain functions in employees with subclinical burnout that are not apparent in persons with moderate depression. Hence, the combination of immunological, behavioral and ERP methods renders a promising method for distinguishing both syndromes and for improving an early diagnosis of burnout before a clinical stage is reached.
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Affiliation(s)
- Patrick D Gajewski
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1.
| | - Sylvia Boden
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Gabriele Freude
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Guy G Potter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Maren Claus
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Peter Bröde
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Carsten Watzl
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Stephan Getzmann
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1
| | - Michael Falkenstein
- Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany1; Institute for Working, Learning and Aging, Bochum, Germany
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Hirokawa K, Fujii Y, Taniguchi T, Takaki J, Tsutsumi A. Association Between Cortisol to DHEA-s Ratio and Sickness Absence in Japanese Male Workers. Int J Behav Med 2017; 25:362-367. [PMID: 29164484 DOI: 10.1007/s12529-017-9700-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to investigate the association between serum levels of cortisol and dehydroepiandrosterone sulfate (DHEA-s) and sickness absence over 2 years in Japanese male workers. METHOD A baseline survey including questions about health behavior, along with blood sampling for cortisol and DHEA-s, was conducted in 2009. In total, 429 men (mean ± SD age, 52.9 ± 8.6 years) from whom blood samples were collected at baseline were followed until December 31, 2011. The hazard ratios (HR) and 95% confidence intervals (CI) for sickness absence were calculated using a Cox proportional hazard model, adjusted for potential confounders. RESULTS Among 35 workers who took sickness absences, 31 had physical illness. A high cortisol to DHEA-s ratio increased the risk of sickness absence (crude HR = 2.68, 95% CI 1.12-6.41; adjusted HR = 3.33, 95% CI 1.35-8.20). The cortisol to DHEA-s ratio was linearly associated with an increased risk of sickness absence (p for trend < .050). Single effects of cortisol and DHEA-s levels were not associated with sickness absences. This trend did not change when limited to absences resulting from physical illness. CONCLUSION Hormonal conditions related to the hypothalamus-pituitary-adrenocortical axis and adrenal function should be considered when predicting sickness absence. The cortisol to DHEA-s ratio may be more informative than single effects of cortisol and DHEA-s levels.
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Affiliation(s)
- Kumi Hirokawa
- Department of Nursing, Baika Women's University, 2-19-5 Shukunosho, Ibaraki, Osaka, 567-8578, Japan.
| | - Yasuhito Fujii
- Department of Welfare System and Health Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama, 719-1197, Japan
| | - Toshiyo Taniguchi
- Department of Welfare System and Health Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama, 719-1197, Japan
| | - Jiro Takaki
- Department of Public Health, Sanyo Gakuen University Graduate School of Nursing, 1-14-1 Hirai, Naka-ku, Okayama, 703-8501, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
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Gajewski PD, Boden S, Freude G, Potter GG, Falkenstein M. Burnout is associated with changes in error and feedback processing. Biol Psychol 2017; 129:349-358. [DOI: 10.1016/j.biopsycho.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/21/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
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Kamin HS, Kertes DA. Cortisol and DHEA in development and psychopathology. Horm Behav 2017; 89:69-85. [PMID: 27979632 DOI: 10.1016/j.yhbeh.2016.11.018] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/19/2016] [Accepted: 11/30/2016] [Indexed: 01/01/2023]
Abstract
Dehydroepiandrosterone (DHEA) and cortisol are the most abundant hormones of the human fetal and adult adrenals released as end products of a tightly coordinated endocrine response to stress. Together, they mediate short- and long-term stress responses and enable physiological and behavioral adjustments necessary for maintaining homeostasis. Detrimental effects of chronic or repeated elevations in cortisol on behavioral and emotional health are well documented. Evidence for actions of DHEA that offset or oppose those of cortisol has stimulated interest in examining their levels as a ratio, as an alternate index of adrenocortical activity and the net effects of cortisol. Such research necessitates a thorough understanding of the co-actions of these hormones on physiological functioning and in association with developmental outcomes. This review addresses the state of the science in understanding the role of DHEA, cortisol, and their ratio in typical development and developmental psychopathology. A rationale for studying DHEA and cortisol in concert is supported by physiological data on the coordinated synthesis and release of these hormones in the adrenal and by their opposing physiological actions. We then present evidence that researching cortisol and DHEA necessitates a developmental perspective. Age-related changes in DHEA and cortisol are described from the perinatal period through adolescence, along with observed associations of these hormones with developmental psychopathology. Along the way, we identify several major knowledge gaps in the role of DHEA in modulating cortisol in typical development and developmental psychopathology with implications for future research.
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Affiliation(s)
- Hayley S Kamin
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Darlene A Kertes
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; University of Florida Genetics Institute, University of Florida, Gainesville, FL 32611, USA.
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Kasper S, Dienel A. Multicenter, open-label, exploratory clinical trial with Rhodiola rosea extract in patients suffering from burnout symptoms. Neuropsychiatr Dis Treat 2017; 13:889-898. [PMID: 28367055 PMCID: PMC5370380 DOI: 10.2147/ndt.s120113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study is the first clinical trial aiming to explore the clinical outcomes in burnout patients treated with Rhodiola rosea. The reported capacity of R. rosea to strengthen the organism against stress and its good tolerability offer a promising approach in the treatment of stress-related burnout. The aim of the treatment was to increase stress resistance, thus addressing the source rather than the symptoms of the syndrome and preventing subsequent diseases associated with a history of burnout. The objective of the trial was to provide the exploratory data required for planning future randomized trials in burnout patients in order to investigate the clinical outcomes of treatment with R. rosea dry extract in this target group. METHODS The study was planned as an exploratory, open-label, multicenter, single-arm trial. A wide range of rating scales were assessed and evaluated in an exploratory data analysis to generate hypotheses regarding clinical courses and to provide a basis for the planning of subsequent studies. A total of 118 outpatients were enrolled. A daily dose of 400 mg R. rosea extract (WS® 1375, Rosalin) was administered over 12 weeks. Clinical outcomes were assessed by the German version of the Maslach Burnout Inventory, Burnout Screening Scales I and II, Sheehan Disability Scale, Perceived Stress Questionnaire, Number Connection Test, Multidimensional Mood State Questionnaire, Numerical Analogue Scales for different stress symptoms and impairment of sexual life, Patient Sexual Function Questionnaire, and the Clinical Global Impression Scales. RESULTS The majority of the outcome measures showed clear improvement over time. Several parameters had already improved after 1 week of treatment and continued to improve further up to the end of the study. The incidence of adverse events was low with 0.015 events per observation day. DISCUSSION The trial reported here was the first to investigate clinical outcomes in patients suffering from burnout symptoms when treated with R. rosea. During administration of the study drug over the course of 12 weeks, a wide range of outcome measures associated with the syndrome clearly improved. CONCLUSION The results presented provide an encouraging basis for clinical trials further investigating the clinical outcomes of R. rosea extract in patients with the burnout syndrome.
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Affiliation(s)
- Siegfried Kasper
- Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Wien, Austria
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Lennartsson AK, Theorell T, Kushnir MM, Jonsdottir IH. Changes in DHEA-s levels during the first year of treatment in patients with clinical burnout are related to health development. Biol Psychol 2016; 120:28-34. [DOI: 10.1016/j.biopsycho.2016.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 06/13/2016] [Accepted: 08/11/2016] [Indexed: 02/08/2023]
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Hintsa T, Elovainio M, Jokela M, Ahola K, Virtanen M, Pirkola S. Is there an independent association between burnout and increased allostatic load? Testing the contribution of psychological distress and depression. J Health Psychol 2016; 21:1576-86. [DOI: 10.1177/1359105314559619] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Burnout has been suggested to be related to depression. We examined the relationship between burnout and allostatic load, and whether this association is independent of psychological distress and depression. We measured burnout psychological distress, depression, and allostatic load in 3283 participants. Higher burnout ( β = 0.06, p =0.003) and cynicism ( β = 0.03, p = 0.031) and decreased professional efficacy ( β = 0.03, p = 0.007) were related to higher allostatic load independent of age, sex, education, occupation and psychological distress. Depression, however, explained 60 percent of the association. Burnout is related to higher allostatic load, and this association partly overlaps with co-occurring depression.
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Affiliation(s)
| | | | | | - Kirsi Ahola
- Finnish Institute of Occupational Health, Finland
| | | | - Sami Pirkola
- National Institute for Health and Welfare, Finland
- Lapland Hospital District, Finland
- University of Oulu, Finland
- Helsinki University Central Hospital, Finland
- University of Tampere, Finland
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Chan L, Wang HM, Chen KY, Lin YC, Wu PJ, Hsieh WL, Chen YR, Liu CP, Tsai HY, Chen YR, Chang HH, Hsieh YC, Hu CJ. Effectiveness of Essence of Chicken in Improving Cognitive Function in Young People Under Work-Related Stress: A Randomized Double-Blind Trial. Medicine (Baltimore) 2016; 95:e3640. [PMID: 27175681 PMCID: PMC4902523 DOI: 10.1097/md.0000000000003640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Work-related stress (WS) can result in considerable and extensive changes in physiological and psychological performance. WS beyond the optimal levels induces anxiety, confusion, exhaustion, and burnout. Chronic WS affects neurocognitive performance, particularly attention and visuospatial memory. Essence of chicken (EC) has been reported to improve neurocognitive function after mental stress.To investigate the beneficial effects of EC in improving neurocognitive performance under WS, we conducted a randomized, double blind trial. Total 102 young workers in New Taipei City with high WS, evaluated using the Individual Subjective Perception Job Stress Scale scores (>36 for job leaders and 33 for nonleaders) were recruited. Fifty-one participants received 70 mL of EC and 51 received a placebo daily for 2 weeks. Blood tests and neurocognitive assessment were performed before treatment, at the end of treatment, and 2 weeks after treatment.EC improved the performance of participants with high depression scores in the form-color associative memory test, used for assessing short-term memory. Although creatinine and glutamic-pyruvic transaminase (GPT) levels increased in week 2, but the levels returned to the baseline in week 4. Blood urea nitrogen (BUN) levels decreased in week 4.EC significantly improved short-term memory in participants with high WS and concomitant depressive mood, although it slightly increased GPT and creatinine levels and reduced BUN levels. The long-term treatment effects of EC warrant further investigation.
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Affiliation(s)
- Lung Chan
- From the Department of Neurology (LC, K-YC, P-JW, C-JH), Shuang-Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City; Department of Psychiatry (H-MW), Chang Gung Memorial Hospital, Chiayi; Department of Family Medicine (Y-CL, Y-RC, C-PL), Shuang-Ho Hospital, School of Medicine, College of Medicine, Taipei Medical University; Department of Psychiatry (W-LH); Sleep Center (H-YT); Health Management Center (Y-RC), Shuang-Ho Hospital, School of Medicine, Taipei Medical University, New Taipei City; Department of International Trade (H-HC), Chungyu Institute of Technology, Keelung; Graduate Institute for Neural Regenerative Medicine (Y-CH), College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Navinés R, Martín-Santos R, Olivé V, Valdés M. [Work-related stress: Implications for physical and mental health]. Med Clin (Barc) 2016; 146:359-66. [PMID: 26806767 DOI: 10.1016/j.medcli.2015.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Ricard Navinés
- Servei de Psiquiatria i Psicologia, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España.
| | - Rocío Martín-Santos
- Servei de Psiquiatria i Psicologia, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - Victòria Olivé
- Servei de Prevenció de Riscos Laborals, Hospital Clínic, Barcelona, España
| | - Manuel Valdés
- Servei de Psiquiatria i Psicologia, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
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Lagraauw HM, Kuiper J, Bot I. Acute and chronic psychological stress as risk factors for cardiovascular disease: Insights gained from epidemiological, clinical and experimental studies. Brain Behav Immun 2015; 50:18-30. [PMID: 26256574 DOI: 10.1016/j.bbi.2015.08.007] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) remains a leading cause of death worldwide and identification and therapeutic modulation of all its risk factors is necessary to ensure a lower burden on the patient and on society. The physiological response to acute and chronic stress exposure has long been recognized as a potent modulator of immune, endocrine and metabolic pathways, however its direct implications for cardiovascular disease development, progression and as a therapeutic target are not completely understood. More and more attention is given to the bidirectional interaction between psychological and physical health in relation to cardiovascular disease. With atherosclerosis being a chronic disease starting already at an early age the contribution of adverse early life events in affecting adult health risk behavior, health status and disease development is receiving increased attention. In addition, experimental research into the biological pathways involved in stress-induced cardiovascular complications show important roles for metabolic and immunologic maladaptation, resulting in increased disease development and progression. Here we provide a concise overview of human and experimental animal data linking chronic and acute stress to CVD risk and increased progression of the underlying disease atherosclerosis.
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Affiliation(s)
- H Maxime Lagraauw
- Division of Biopharmaceutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Johan Kuiper
- Division of Biopharmaceutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Ilze Bot
- Division of Biopharmaceutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
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Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand J Psychol 2015; 56:626-36. [DOI: 10.1111/sjop.12251] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/20/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Giorgio Grossi
- Stress Research Institute; Stockholm University; Stockholm Sweden
- The Stress Clinic Foundation; Stockholm Sweden
- Center for Social Sustainability; Department of Neurobiology, Care Sciences and Society; Karolinska institute; Stockholm Sweden
| | - Aleksander Perski
- Stress Research Institute; Stockholm University; Stockholm Sweden
- The Stress Clinic Foundation; Stockholm Sweden
| | - Walter Osika
- Center for Social Sustainability; Department of Neurobiology, Care Sciences and Society; Karolinska institute; Stockholm Sweden
| | - Ivanka Savic
- Department of Women's and Children's Health, and Neurology Clinic; Karolinska Institute and Hospital; Stockholm Sweden
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Lennartsson AK, Theorell T, Kushnir MM, Jonsdottir IH. Low Levels of Dehydroepiandrosterone Sulfate in Younger Burnout Patients. PLoS One 2015; 10:e0140054. [PMID: 26441131 PMCID: PMC4595129 DOI: 10.1371/journal.pone.0140054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/21/2015] [Indexed: 12/31/2022] Open
Abstract
Objective Dehydroepiandrosterone sulphate (DHEA-s) is an anabolic protective hormone of importance for maintenance of health. DHEA-s levels peak in young adults and decline thereafter with age. DHEA-s has previously been shown to be lower in individuals reporting prolonged stress. This study investigates DHEA-s levels in patients with clinical burnout, a disorder caused by long-term psychosocial stress. Methods 122 patients (51% men) and 47 controls (51% men) in the age 25–54 years were included in the study. DHEA-s levels were compared between patients and controls in the whole sample and within each of the three 10-year-interval age groups. Results In the youngest age group (25–34 years), DHEA-s levels were on average 25% lower in the patients (p = 0.006). The differences in DHEA-s levels between patients and controls were more pronounced among female than male participants (on average 32% and 13% lower, respectively). There were no differences in DHEA-s levels between patients and controls in the age group 35–44 years (p = 0.927) or 45–54 years (p = 0.897) or when analyzing all age groups together (p = 0.187). Conclusion The study indicates that levels of the health promoting “youth” hormone DHEA-s are low in younger burnout patients. The fact that younger adults have much higher DHEA-s levels and more pronounced inter-subject variability in DHEA-s levels than older individuals might explain why burnout status differentiates patients from controls only among the youngest patients included in this study.
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Affiliation(s)
- Anna-Karin Lennartsson
- Institute of Stress Medicine, Gothenburg, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Töres Theorell
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Mark M. Kushnir
- ARUP Institute for Clinical and Experimental Laboratory, Salt Lake City, Utah, United States of America
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Lennartsson AK, Sjörs A, Jonsdottir IH. Indication of attenuated DHEA-s response during acute psychosocial stress in patients with clinical burnout. J Psychosom Res 2015; 79:107-11. [PMID: 26071787 DOI: 10.1016/j.jpsychores.2015.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/25/2015] [Accepted: 05/13/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Dehydroepiandrosterone sulphate (DHEA-s) is an anabolic protective hormone. We have previously reported that DHEA-s production capacity is attenuated in stressed individuals. The aim of the present study was to investigate the DHEA-s response during acute psychosocial stress in patients with clinical burnout. METHODS Seventeen patients with clinical burnout were compared to 13 non-chronically stressed healthy controls, aged 31-50 years (mean age 41 years, SD 6 years), as they underwent the Trier Social Stress Test (TSST). All patients fulfilled diagnostic criteria for stress-related exhaustion disorder, which is a criteria-based diagnosis that has been used in Sweden since 2005 to define patients seeking health-care for clinical burnout. Blood samples were collected before, directly after the stress test, and after 30 min of recovery. DHEA-s levels were measured and delta values (peak levels minus baseline levels) plus area under the curve with respect to increase (AUCI) were calculated. RESULTS The patients had 43% smaller AUCI DHEA-s (p=0.041) during the stress test. The delta DHEA-s was 34% lower in the patients, however, this difference was not statistically significant (p=0.054). CONCLUSION The study indicates that DHEA-s production capacity during acute stress may be attenuated in patients with clinical burnout. Reduced DHEA-s production may constitute one of the links between stress, burnout and the associated adverse health.
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Affiliation(s)
| | - Anna Sjörs
- The Institute of Stress Medicine, Göteborg, Sweden
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Oosterholt BG, Maes JHR, Van der Linden D, Verbraak MJPM, Kompier MAJ. Burnout and cortisol: evidence for a lower cortisol awakening response in both clinical and non-clinical burnout. J Psychosom Res 2015; 78:445-451. [PMID: 25433974 DOI: 10.1016/j.jpsychores.2014.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/22/2014] [Accepted: 11/04/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although the relationship between burnout and cortisol levels has been examined in previous studies, the results are mixed. By adopting a design in which we attempted to overcome important limitations of earlier research, the purpose of the present study was to improve the understanding of the biological underpinnings of burnout and to further the knowledge about the relationship between burnout and cortisol. METHODS A clinical burnout patient group (n =32), a non-clinical burnout group (n =29), and a healthy control group (n =30) were compared on burnout symptoms, physical and psychological complaints, and on cortisol levels. In order to examine a broad range of cortisol indices, including different measures of the cortisol awakening response (CAR) and several day-curve measures, salivary cortisol was collected six times a day during two consecutive non-workdays. RESULTS As expected, the clinical burnout group reported more burnout symptoms, and physical and psychological complaints than the non-clinical burnout group, which in turn reported more burnout symptoms and physical and psychological complaints than the healthy control group. With regard to cortisol levels, we found that until 30 min after awakening, the CAR of both the clinical and the non-clinical burnout group was lower compared with the healthy control group. Furthermore, there was some evidence that the decline of cortisol during the day was smaller in the non-clinical burnout group than in the healthy control group. CONCLUSION The results of the present study provide support for lowered cortisol in both clinical and non-clinical burnout.
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Affiliation(s)
- Bart G Oosterholt
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands.
| | - Joseph H R Maes
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
| | | | - Marc J P M Verbraak
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands; HSK Group, Arnhem, the Netherlands
| | - Michiel A J Kompier
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
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Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial. Internet Interv 2014. [DOI: 10.1016/j.invent.2014.06.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Psychosocial stress is an important precursor of disease and reduced quality of life in humans. The biological pathways between stress exposure and pathophysiological processes underlying disease have received substantial scientific attention, although the roles of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system remain insufficiently understood. Recent attention has focused on chronic systemic low-grade inflammation as a promising pathway because elevated inflammation often accompanies chronic psychosocial distress. These alterations of inflammatory activity play a key role in the pathophysiology of diseases that are adversely affected by chronic distress, such as cardiovascular disease. Transient increases in systemic inflammation are observed in response to acute psychosocial stress, with larger responses among individuals reporting adverse psychosocial states or conditions such as depression, lower self-esteem, or lower self-compassion. Recent evidence shows that lower subjective social status and perceived purpose in life are associated with sensitization of inflammatory stress responses to repeated stress exposure. The aims of this selective review article are to summarize current knowledge of the role of acute and chronic psychosocial stress on low-grade inflammation in humans and to discuss potential relationships between inflammatory responses to acute psychosocial stress and long-term development of disease.
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Bruenahl CA, Arck PC, Linden M. Limitation of pro- and anti-inflammatory cytokine analysis to discriminate biological stress effects in patients suffering from chronic psychological distress. Nord J Psychiatry 2013; 67:191-6. [PMID: 22817281 DOI: 10.3109/08039488.2012.700947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Research endeavors aiming to evaluate the effect of prolonged psychological distress on the immune system have been pursed over the past decades. Due to the complexity of the two systems involved, the mental and immune status, a large number of questions still remains to be addressed. AIM In the present study, we aimed to test if chronic distress is associated with pro- and anti-inflammatory cytokine levels in a well-defined study cohort. METHODS We recruited 42 inpatients suffering from post-traumatic embitterment disorder (PTED), a condition that has been demonstrated to cause intense and persistent psychological distress. Study participants completed established questionnaires to evaluate stress perception, depression and quality of life before and after psychotherapy, aiming to improve stress coping. Venous blood samples to detect serum levels of pro- and anti-inflammatory cytokines [interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, interferon (IFN)-γ] were obtained pre- and post-treatment. RESULTS The psychological assessments showed an increase of quality of life, a decrease of perceived stress and depressive symptoms, between the two groups. These findings are not associated with significant alterations of the cytokine levels before and after treatment. CONCLUSIONS In our study, the psychological treatment of inpatients suffering from chronic psychological distress does not result in changes in cytokine levels. Further research with a broader analysis of immune markers and enhanced detection methods may be required to unveil psycho-immunological association in PTED patients.
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Affiliation(s)
- Christian Andreas Bruenahl
- Research Group Psychosomatic Rehabilitation at Charité University Medicine Berlin & Rehabilitation Centre Seehof, Teltow/Berlin, Germany
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Bellingrath S, Rohleder N, Kudielka BM. Effort-reward-imbalance in healthy teachers is associated with higher LPS-stimulated production and lower glucocorticoid sensitivity of interleukin-6 in vitro. Biol Psychol 2012; 92:403-9. [PMID: 23246534 DOI: 10.1016/j.biopsycho.2012.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 11/30/2012] [Accepted: 12/05/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND According to the effort-reward-imbalance (ERI) model, a lack of reciprocity between costs and gains at work increases the risk for adverse health outcomes. Inflammation has been shown to play a crucial role in a variety of stress-related diseases and alterations in immune system glucocorticoid sensitivity may help to explain the increased risk for cardiovascular disease (CVD) and depression related to chronic work stress. METHODS Changes in lipopolysaccharide (LPS)-induced interleukin (IL)-6 production and inhibition of IL-6 production by dexamethasone in reaction to the Trier Social Stress Test (TSST) were assessed in forty-six healthy school teachers to test whether chronic work stress is accompanied by alterations in inflammatory activity and glucocorticoid sensitivity of the innate immune system. RESULTS High ERI was associated with an increase in pro-inflammatory potential, reflected in elevated IL-6 production before and after stress and with a lower capacity of dexamethasone to suppress IL-6 production in vitro over all measurement time points. ERI was not associated with stress-related changes in GC sensitivity. CONCLUSION The present findings suggest a less effective anti-inflammatory regulation by glucocorticoids in teachers suffering from chronic work stress.
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Affiliation(s)
- Silja Bellingrath
- Institute of Psychology, University of Duisburg-Essen, Berliner Platz 6-8, 45127 Essen, Germany.
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Lac G, Dutheil F, Brousse G, Triboulet-Kelly C, Chamoux A. Saliva DHEAS changes in patients suffering from psychopathological disorders arising from bullying at work. Brain Cogn 2012; 80:277-81. [PMID: 22940752 DOI: 10.1016/j.bandc.2012.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Psychological disorders arising from bullying at work (BW) are common. The relationship between these disorders and putative markers is not well established. AIMS To measure saliva dehydroepiandrosterone sulphate (DHEAS) and saliva cortisol as putative markers in individuals suffering from BW. METHODS Forty one subjects suffering from BW were screened for mental distress at the institute of occupational health in Clermont-Ferrand, France. They were compared with 28 psychologically healthy controls (group C). The conditions causing BW were recorded. The hospital anxiety and depression (HAD) scale, the Beech questionnaire and the visual analogic scale (VAS) of stress were used to determine the psychological consequences of BW. Saliva samples were collected at awakening (7 am), 30 and 60 min after awakening, and then every 2 h until bed time (11 pm). RESULTS The BW group had significantly higher scores on the HAD scale, higher stress on the VAS, and a higher score on the Beech questionnaire. They also had a significantly higher saliva concentration of DHEAS. There was no significant difference between groups in cortisol levels at any time, nor in area under the curve (AUC) and cortisol awakening response (CAR). There was a significant positive correlation between HAD and VAS scores and DHEAS levels, but not between cortisol levels or AUC or CAR. CONCLUSION In contrast to saliva cortisol levels, saliva DHEAS levels are modified after psychological distress arising from BW. This discrepancy probably arises from the stability conferred by the very long half life of DHEAS of about 15 h.
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Affiliation(s)
- Gérard Lac
- PRES Clermont Université, Blaise Pascal University, AME2P, EA 3533, BP 80026, F-63000 Clermont-Ferrand, France.
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Rohleder N. Acute and chronic stress induced changes in sensitivity of peripheral inflammatory pathways to the signals of multiple stress systems --2011 Curt Richter Award Winner. Psychoneuroendocrinology 2012; 37:307-16. [PMID: 22226321 DOI: 10.1016/j.psyneuen.2011.12.015] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 12/12/2011] [Accepted: 12/14/2011] [Indexed: 01/09/2023]
Abstract
Exposure to psychosocial stress has been associated with increasing rates of morbidity in humans and in animal models, but the underlying mechanisms are not completely understood. Major stress responsive systems, such as the hypothalamus-pituitary adrenal (HPA) axis and the autonomic nervous system (ANS) are under investigation as underlying pathways, but although acute stress reliably activates these systems, findings of long-term alternations in baseline activity are inconsistent at present. Emerging evidence suggests that stress-related changes in the sensitivity of target systems toward glucocorticoid (GC) regulation, i.e. development of GC resistance, might help explain inflammatory disinhibition and development of disease related to inflammation. More recent findings further show that the autonomic nervous system might play an important role in the regulatory control of the inflammatory cascade. The major argument put forward in this manuscript is that target tissues for stress system modulation, such as the inflammatory cascade, vary in their ability to respond to stress system signaling, and that assessing alterations in this stress signal sensitivity which can be caused by stress or disease processes, might be necessary to understand and explain stress effects on health. This review focuses on the inflammatory system in particular, because anti-inflammatory effects of most stress systems have been documented, but the general assumption might have to be generalized to other target systems. The main conclusion to be made is that reduction in glucocorticoid sensitivity of target tissues is the most consistent finding at present, and that assessing such changes in glucocorticoid sensitivity might be necessary to understand many stress-related changes in physiology.
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Affiliation(s)
- Nicolas Rohleder
- Department of Psychology & Volen National Center for Complex Systems, Brandeis University, 415 South Street, MS062 PO Box 549110, Waltham, MA 02454, USA.
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Sjörs A, Ljung T, Jonsdottir IH. Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion. BMJ Open 2012; 2:bmjopen-2012-001091. [PMID: 22786949 PMCID: PMC3400075 DOI: 10.1136/bmjopen-2012-001091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Studies on hypothalamus-pituitary-adrenal (HPA) axis activity in stress-related exhaustion and burnout have revealed incongruent results, and few longitudinal studies on clinical populations have been performed. This study was designed to investigate differences in HPA axis activity between patients with stress-related exhaustion and healthy controls and to investigate longitudinal changes in HPA axis activity in the patient group as they entered a multimodal treatment programme. DESIGN HPA axis activity was assessed through the cortisol awakening response (CAR). Salivary cortisol was sampled at awakening and after 15 min. Follow-up measurements were performed in the patient group after 3, 6, 12 and 18 months. SETTING An outpatient clinic specialising in stress-related illness. PARTICIPANTS Patients with clinically diagnosed stress-related exhaustion (n=162) and healthy controls (n=79). PRIMARY AND SECONDARY OUTCOME MEASURES The primary measure was CAR measured as the difference between the two salivary cortisol samples. Changes in CAR during follow-up were related to changes in symptoms of burnout, depression and anxiety. RESULTS Patients showed similar CAR as the controls and their CAR did not change significantly during treatment. No association was found between CAR and symptom development during treatment. CONCLUSIONS The authors conclude that CAR does not seem to discriminate clinically defined patients with exhaustion from healthy controls and it appears not to change during treatment. CAR, measured as salivary cortisol, at awakening and after 15 min, is thus not a valid marker for stress-related exhaustion.
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Affiliation(s)
- Anna Sjörs
- The Institute of Stress Medicine, Gothenburg, Sweden
- Rehabilitation Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Thomas Ljung
- County Council of Jämtland, R&D-unit, Östersund, Sweden
- Mid Sweden University, IHV, Östersund, Sweden
| | - Ingibjörg H Jonsdottir
- The Institute of Stress Medicine, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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48
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Abstract
The purpose of this review was to provide current knowledge about the possible association between psychosocial job stress and immune parameters in blood, saliva, and urine. Using bibliographic databases (PubMed, PsychINFO, Web of Science, Medline) and the snowball method, 56 studies were found. In general, exposure to psychosocial job stress (high job demands, low job control, high job strain, job dissatisfaction, high effort-reward imbalance, overcommitment, burnout, unemployment, organizational downsizing, economic recession) had a measurable impact on immune parameters (reduced NK cell activity, NK and T cell subsets, CD4+/CD8+ ratio, and increased inflammatory markers). The evidence supports that psychosocial job stresses are related to disrupted immune responses but further research is needed to demonstrate cause-effect relationships.
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Affiliation(s)
- Akinori Nakata
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA.
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Bruenahl CA, Linden M. Common laboratory measures of global health may not be suited to assess, discriminate or predict chronic stress effects on biological systems. Nord J Psychiatry 2011; 65:266-8. [PMID: 21142646 DOI: 10.3109/08039488.2010.542589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a longstanding discussion that prolonged psychological stress can have negative somatic effects, especially in respect to endocrinological and immunological changes. Yet, the clinical significance of these findings is still unclear. Patients with prolonged stress should show more signs and symptoms of related illnesses. AIM The question we like to answer in this study is: are laboratory measures of global health suited to assess, discriminate or predict chronic psychological stress effects on biological systems? METHODS Included were 50 inpatients who were suffering from post-traumatic embitterment disorder (PTED), a condition that causes persistent and intense psychological distress. They were compared with a group of 50 matched control patients with unselected psychosomatic disorders but no immediate stress and strain. Gender distribution and age were the same in both samples because of the matching (60% women; mean age: 49 years). PTED patients had an average duration of illness of 31.7 (±35.5) months. In the SCL-90 they showed an average GSI score of 1.13 (±0.55) compared with 0.74 (±0.50) in the controls, as indicator of their increased psychological strain. Between groups, we compared the results of 24 laboratory tests, which can be seen as indicators of functioning of all important body systems. RESULTS There was no significant difference in the results of laboratory tests between groups and especially no indicators for different rates of immunological or inflammatory illnesses. CONCLUSION Laboratory measures of global health may not be suited to assess, discriminate or predict psychological chronic stress effects on important biological systems.
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Affiliation(s)
- Christian Andreas Bruenahl
- Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin and the Rehabilitation Centre Seehof, Teltow/Berlin, Germany
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Association of general fatigue with cellular immune indicators among healthy white-collar employees. J Occup Environ Med 2011; 53:1078-86. [PMID: 21860327 DOI: 10.1097/jom.0b013e318229a938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Although fatigue is a common complaint in the working population, underlying immunological mechanisms are not well understood. This study investigated the association of general fatigue with cellular immune indicators. METHODS A total of 148 healthy white-collar employees (70% men) underwent a blood draw for the measurement of natural killer (NK), B, and T cell counts as well as NK cell cytotoxicity (NKCC) and completed two different fatigue scales, that is, Profile of Mood State (POMS) and Maastricht Questionnaire (MQ). RESULTS Multiple linear regression analyses revealed that POMS fatigue score was significantly associated with decreases of NK cells (β = -.407) and NKCC (β = -.215), whereas MQ fatigue score was significantly associated with reduced NK cells (β = -.290) but not with NKCC (β = -.127). CONCLUSION The results suggest that general fatigue may be related to impaired NK cell competency among healthy employees.
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