Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion

Is boredom at work bad for your health? Examining the links between job boredom and autonomic nervous system dysfunction

Job boredom refers to an unpleasant state of passiveness at work that has been found to negatively relate to self-reported health. To date, however, the relation between job boredom and physiological indicators of health has not been examined. The present study investigates whether job boredom relates to dysfunction in autonomic nervous system (ANS) activity as indicated by reduced heart rate variability (HRV) during night sleep. The sample of this study consisted of Finnish public sector workers (n = 125). Job boredom was assessed with an electronic questionnaire and HRV with an ambulatory monitoring period of two nights of sleep. The results supported the hypothesis by showing a negative relation between job boredom and HRV, after controlling for demographic and lifestyle factors. The findings extend previous knowledge on the detrimental consequences of job boredom by showing that it is related to dysfunction in ANS activity. Consequently, it is important to acknowledge boredom at work as a threat to occupational health and well-being and pay more attention to how it can be prevented at workplaces.

Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability

PURPOSE

Exhaustion symptoms are known to be associated with cardiovascular disease (CVD) risk; however, the underlying mechanisms remain unclear. Autonomic imbalance, as indicated by reductions in vagally-mediated heart rate variability (vmHRV), appears to be a valid candidate for such a biological link, as it has been associated with both exhaustion symptoms and CVD risk and mortality.

METHODS

The present study examined a potential mediation of vmHRV on the association between exhaustion symptoms and self-reported CVD risk factors as well as the age dependency of this mediation in a large, heterogeneous sample of the Dresden Burnout Study (N = 388; 72.9% females; Mage = 42.61, SD = 11.67).

RESULTS

Results indicate that exhaustion symptoms were indirectly associated with CVD risk factors through vmHRV even after adjusting for well-known confounders (i.e., sex, body mass index, depressive symptoms). Moreover, this pattern was significant only among middle-aged (i.e., 54.27 years) and older individuals.

CONCLUSIONS

Our findings add to growing evidence that autonomic imbalance may be a key biological link between exhaustion symptoms and CVD risk in middle-aged and older individuals. Implications for public health are discussed.

Heart Rate Variability for Evaluating Psychological Stress Changes in Healthy Adults: A Scoping Review

The utility of heart rate variability (HRV) for characterizing psychological stress is primarily impacted by methodological considerations such as study populations, experienced versus induced stress, and method of stress assessment. Here, we review studies on the associations between HRV and psychological stress, examining the nature of stress, ways stress was assessed, and HRV metrics used. The review was performed according to the PRISMA guidelines on select databases. Studies that examined the HRV-stress relationship via repeated measurements and validated psychometric instruments were included (n = 15). Participant numbers and ages ranged between 10 and 403 subjects and 18 and 60 years, respectively. Both experimental (n = 9) and real-life stress (n = 6) have been explored. While RMSSD was the most reported HRV metric (n = 10) significantly associated with stress, other metrics, including LF/HF (n = 7) and HF power (n = 6) were also reported. Various linear and nonlinear HRV metrics have been utilized, with nonlinear metrics used less often. The most frequently used psychometric instrument was the State-Trait Anxiety Inventory (n = 10), though various other instruments have been reported. In conclusion, HRV is a valid measure of the psychological stress response. Standard stress induction and assessment protocols combined with validated HRV measures in different domains will improve the validity of findings.

The role of sleep and heart rate variability in metabolic syndrome: evidence from the Midlife in the United States study

STUDY OBJECTIVES

Poor sleep and autonomic dysregulation can both disrupt metabolic processes. This study examined the individual and combined effects of poor sleep and reduced heart rate variability (HRV) on metabolic syndrome among 966 participants in the Midlife in the United States II (MIDUS II) study.

METHODS

Self-reported sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). HRV was acquired from 11-minute resting heart rate recordings. Spearman correlations, general linear regression, and logistic regression models were used to examine the study hypotheses.

RESULTS

Poor sleep quality was associated with metabolic syndrome when global PSQI scores were evaluated as a continuous (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.03 to 1.11) or categorical measure (cutoff > 5, OR: 1.58, 95% CI: 1.19 to 2.10), after adjustment for confounding. There also was an association between reduced HRV and metabolic syndrome (ln [HF-HRV] OR: 0.89, 95% CI: 0.80 to 0.99; ln [LF-HRV] OR: 0.82, 95% CI: 0.72 to 0.92; ln [SDRR] OR: 0.59, 95% CI: 0.43 to 0.79; ln [RMSSD] OR: 0.75, 95% CI: 0.60 to 0.94). When the combined effects of poor sleep and low HRV were examined, the association with metabolic syndrome was further strengthened relative to those with normal sleep and HRV.

CONCLUSIONS

To the best of the author's knowledge, this is the first study to suggest a combined effect of poor sleep and low HRV on the odds of metabolic syndrome.

Beliefs in Regulating Negative Emotions and Vagally Mediated Heart Rate Variability: Does Sex Make a Difference?

OBJECTIVE

This ecological study explored the association between regulatory emotional self-efficacy beliefs in managing negative emotions (RESE-NE) and heart rate variability (HRV), a measure of parasympathetic modulation of the heart that has been positively associated with a better ability to flexibly adjust to a changing environment and regulate emotions.

METHOD

To test these associations, we used data from 161 adults working in relational professions (about 40% men; mean [standard deviation] age = 40.45 [14.17] years) whose HRV was assessed continuously for 24 hours.

RESULTS

Individuals high in RESE-NE showed increased HRV levels ( β = -0.05, p = .011). However, this effect was moderated by biological sex ( β = -0.18, p = .0001) such that RESE-NE positively and significantly predicted HRV for men ( β = 0.18, p < .0001) but not for women ( β = -0.001, p = .989).

CONCLUSIONS

All in all, our study provides initial empirical support for the theoretical expectation derived from social cognitive theory that RESE-NE is positively correlated with a physiological indicator of adaptability to the environmental demands. This was true only for men, likely because of sex differences in physiological stress reactivity and regulation.

Impact of autonomic regulation on burnout and performance in thoracic surgery residents

Objective

This study sought to determine the feasibility of collecting physiologic data in thoracic surgery residents and whether it would correlate with burnout and burnout with performance.

Methods

This was a prospective study of thoracic surgery residents over a 5-month period. Participants were evaluated with a wearable biometric device (heart rate variability and sleep) and the Maslach Burnout Inventory. Resident performance was quantified using Accreditation Council for Graduate Medical Education Milestones (scale, 1-5) normalized to program-designated targets (3 for postgraduate year 6 or lower residents and 4 for postgraduate year 7 residents).

Results

The cohort consisted of 71% female participants (5/7) with 86% of residents having 1 or more children. High levels of emotional exhaustion (median, 30 [interquartile range, 20-36], where >26 is high) and high levels of depersonalization (median, 16 [interquartile range, 14-22], where >12 is high) were common, but personal accomplishment was also uniformly high (median, 43 [interquartile range, 41-46], where >38 is high). There was a significant correlation between heart rate variability and emotional exhaustion (r(12) = 0.65, P = .01) but not depersonalization (P = .28) or personal accomplishment (P = .24). Depersonalization and personal accomplishment did not correlate with resident performance (P = .12 and P = .75, respectively); however, increased emotional exhaustion showed a significant correlation with higher resident performance during periods when burnout was reported (r(6) = 0.76, P = .047).

Conclusions

Dynamic measurement of resting heart rate variability may offer an objective measure of burnout in thoracic surgery residents. Thoracic surgery residents who report high levels of burnout in this cohort maintained the ability to meet program-designated milestones at or above the level expected of their postgraduate year.

Determining the direction of prediction of the association between parasympathetic dysregulation and exhaustion symptoms

Stress-related exhaustion symptoms have a high prevalence which is only likely to increase further in the near future. Understanding the physiological underpinnings of exhaustion has important implications for accurate diagnosis and the development of effective prevention and intervention programs. Given its integrative role in stress-regulation, the parasympathetic branch of the autonomic nervous systems has been a valid starting point in the exploration of the physiological mechanisms behind exhaustion. The aim of the present study was to examine the directionality and specificity of the association between exhaustion symptoms and vagally-mediated heart rate variability (vmHRV), a relatively pure measure of parasympathetic tone. Exhaustion symptoms and vmHRV were measured at four annually assessment waves (2015-2018) of the Dresden Burnout Study. A total sample of N = 378 participants who attended at least two of the four annual biomarker measurements were included in the present analyses. Cross-lagged multi-level panel modelling adjusting for various covariates (e.g., age, sex, BMI) revealed that vmHRV was meaningfully predictive of exhaustion symptoms and not vice versa. In addition, these effects were specific for exhaustion symptoms as no effect was shown for the other burnout sub-dimensions, or for depressive symptoms. Our findings indicate a clear link between exhaustion symptoms and vmHRV which may hold great potential for both enhancing the diagnosis and treatment of exhaustion symptoms.

Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol

INTRODUCTION

COVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads to new challenges and threats to patient and clinician safety as suspected patients with COVID-19 need to be quickly detected and isolated among other patients with non-COVID-19-related illnesses. At the front lines, emergency physicians also face continued personal safety concerns and increased work burden, which heighten stress and anxiety, especially given the prolonged course of the pandemic. Burnout, already a serious concern for emergency physicians due to the cumulative stresses of their daily practice, may present as a longer-term outcome of these acute stressors.

METHODS AND ANALYSIS

We will implement a rapidly adaptive simulation-based approach to understand and improve physician preparedness while decreasing physician stress and anxiety. First, we will conduct semi-structured qualitative interviews and human factor observations to determine the challenges and facilitators of COVID-19 preparedness and mitigation of physician stress. Next, we will conduct a randomised controlled trial to test the effectiveness of a simulation preparedness intervention on physician physiological stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory.

ETHICS AND DISSEMINATION

The protocol was reviewed and approved by the Agency for Healthcare Research and Quality for funding, and ethics approval was obtained from the Yale University Human Investigation Committee in 2020 (HIC# 2000029370 and 2000029372). To support ongoing efforts to address clinician stress and preparedness, we will strategically disseminate the simulation intervention to areas most impacted by COVID-19. Using a virtual telesimulation and webinar format, the dissemination efforts will provide hands-on learning for ED and hospital administrators as well as simulation educators.

TRIAL REGISTRATION NUMBER

NCT04614844.

Associations between burnout symptoms and social behaviour: exploring the role of acute stress and vagal function

BACKGROUND

The study aimed to investigate the link between burnout symptoms and prosocial behaviour, as well as the role of acute stress and vagally-mediated heart rate variability (vmHRV) on this association.

METHODS

Seventy men were randomly assigned to either the stress or the control condition of the Trier Social Stress Test for Groups (TSST-G). Prosocial behaviour was assessed via a social decision-making paradigm during the respective TSST-G condition.

RESULTS

Correlation analyses revealed negative correlations between prosocial behaviour and burnout symptoms. Acute stress was also associated with reduced prosocial behaviour, whereas no interaction effects with burnout symptoms could be revealed. Exploratory analyses showed that vmHRV was negatively correlated with burnout symptoms during the social decision-making paradigm but did not mediate the link between burnout and prosocial behaviour.

CONCLUSION

In conclusion, we report first experimental evidence that burnout symptoms are negatively associated with prosocial behaviour. Further studies are needed to explore the causal relations.

Trends in Daily Heart Rate Variability Fluctuations Are Associated with Longitudinal Changes in Stress and Somatisation in Police Officers

The emergence of wearable sensors that allow for unobtrusive monitoring of physiological and behavioural patterns introduces new opportunities to study the impact of stress in a real-world context. This study explores to what extent within-subject trends in daily Heart Rate Variability (HRV) and daily HRV fluctuations are associated with longitudinal changes in stress, depression, anxiety, and somatisation. Nine Dutch police officers collected daily nocturnal HRV data using an Oura ring during 15–55 weeks. Participants filled in the Four-Dimensional Symptoms Questionnaire every 5 weeks. A sample of 47 five-week observations was collected and analysed using multiple regression. After controlling for trends in total sleep time, moderate-to-vigorous physical activity and alcohol use, an increasing trend in the seven-day rolling standard deviation of the HRV (HRVsd) was associated with increases in stress and somatisation over 5 weeks. Furthermore, an increasing HRV trend buffered against the association between HRVsd trend and somatisation change, undoing this association when it was combined with increasing HRV. Depression and anxiety could not be related to trends in HRV or HRVsd, which was related to observed floor effects. These results show that monitoring trends in daily HRV via wearables holds promise for automated stress monitoring and providing personalised feedback.

Orthopaedic Surgeon Physiological Indicators of Strain as Measured by a Wearable Fitness Device

INTRODUCTION

Symptoms of stress, depression, and burnout are prevalent in medicine, adversely affecting physician performance. We investigated real-time measurements of physiological strain in orthopaedic resident and faculty surgeon volunteers and identified potential daily stressors.

METHODS

We performed a prospective blinded cohort pilot study in our academic orthopaedic department. Physicians used a wearable fitness device for 12 weeks to objectively measure heart rate variability (HRV), a documented parameter of overall well-being. Baseline burnout levels were assessed using the Maslach Burnout Inventory questionnaire. Daily surveys inquiring on work responsibilities (clinic, operating room [OR], or "other") were correlated with physiological parameters of strain. Descriptive statistics and linear mixed effects modeling were used to evaluate bivariate relationships.

RESULTS

Of the 21 participating surgeons, 9 faculty and 12 residents, there was a response rate of 95.2% for the initial burnout survey. Daily surveys were completed for 63.8% (54.9 ± 22.3 days) of the total collection window, and surgeons wore the device for 83.2% of the study (71.6 ± 25.0 days). Residents trended toward lower personal accomplishment and greater psychological detachment on the Maslach Burnout Inventory, with 5 surgeons including 1 faculty surgeon (11.1%) and 4 resident surgeons (33.3%) found to have negatively trending HRV throughout the study period demonstrating higher physiological strain. Time in the OR led to increased next-day HRV (y-intercept = 47.39; B = 4.90; 95% confidence interval, 2.14-7.66; P < 0.001), indicative of lower physiological strain. An increase in device-reported sleep from a surgeon's baseline resulted in a significant increase in next-day HRV (y-intercept = 50.46; B = 0.64; 95% confidence interval, 0.11-1.17; P = 0.02).

DISCUSSION

Orthopaedic residents, more than faculty, had physiologic findings suggestive of burnout. Time in the OR and increased sleep improved physiological strain parameters. Real-time biometric measurements can identify those at risk of burnout and in need of well-being interventions.

LEVEL OF EVIDENCE

Level III.

Prediction of emotional exhaustion over the course of the COVID-19 pandemic in primary care dental staff: an intensive longitudinal study

Objective

To investigate the fatigue trajectory during a 6-month duration of the COVID-19 pandemic for dental health professionals in primary dental care and for those in training.

Design

A longitudinal intensive panel diary was conducted (July–December 2020) assessing weekly self-ratings of emotional fatigue.

Setting

Dental care services in Scotland.

Participants

Dental trainees and primary dental care staff (N=53). These data were merged with respondents’ replies to a cross-sectional baseline survey (Humphris et al). Recruitment was through ‘Portal’, an online tool administered by National Health Service Education for Scotland. Questback software was employed for data collection.

Primary and secondary outcome measures

The diary questionnaire, consisted of a three-item fatigue scale and, from the baseline survey, three multi-item scales including: preparedness (14 items of the Dental Professional Preparedness for Practice Scale), the 22-item Impact of Event Scale-Revised and depressive symptomatology using the Patient Health Questionnaire-2. Statistical analysis included estimating the variability of fatigue over the study duration using a multilevel linear growth model. In addition, a path analysis was performed to determine the ability of preparedness and COVID-19 pandemic trauma to predict fatigue trajectories directly, or mediated through depressive symptomatology.

Results

A large variation of fatigue trajectories (p<0.001) was found from staff who completed a mean of 11 weekly uploads of their diary (diary uploads: minimum 4–maximum 24). The average slope was positive (standardised estimate=0.13, 95% CI: 0.07 to 0.19, p<0.001). Slope variation was modelled successfully from baseline data showing direct and indirect effects from preparedness, trauma and depressive symptoms.

Conclusion

Staff who volunteered to participate over a significant period of the COVID-19 pandemic in Scotland displayed a highly significant variety of individual trajectories. The results show some consistency with a job demands-resources model of burnout development. Suitable resource structures are indicated for staff over periods of extensive public service change.

Working With Type 1 Diabetes: Investigating the Associations Between Diabetes-Related Distress, Burnout, and Job Satisfaction

The present study investigates the association between diabetes-related distress (DD) and work outcomes (burnout and job satisfaction) among employed people with type 1 diabetes. Employed adults with type 1 diabetes (N = 297) completed an online survey. Measures assessed emotional, social, food- and treatment-related DD, burnout, and job satisfaction, as well as the type of insulin treatment. We conducted multiple regression analyses to test our hypotheses. Emotional DD was significantly and positively associated with burnout. Social DD was significantly and negatively associated with job satisfaction. The type of treatment (insulin pen versus insulin pump) had no significant effect on the outcomes. This study sets the stage for research on the interactions between working conditions, work outcomes and illness symptoms, and problems of people with type 1 diabetes, and, generally, employees with chronic illnesses. The findings have implications for individual health and illness management, burnout prevention, and occupational health measures.

Personal Resources and Organizational Outcomes: Sex as a Moderator of the Complex Relationships Between Self-Esteem, Heart Rate Variability, and Work-Related Exhaustion

Global self-esteem represents a protective personal resource lowering the risk of psychological distress. Research conducted in the work setting has confirmed the psychosocial benefits of high self-esteem. However, research linking self-esteem to neurobiological adaptability appears quite scarce. In this study, we propose a theoretical model in which self-esteem predicts work-related exhaustion indirectly, through the mediation of heart rate variability (HRV) and negative affect at work. Moreover, we explore the relationship between self-esteem and HRV. From one side, one would expect a positive link between self-esteem and HRV, signaling higher autonomic adaptability. However, recent studies have shown that in women, such associations become more complex, with even reversed patterns as compared with that in men. Thus, we included sex as a moderator of the relationship between HRV and self-esteem. The model was tested on a sample of 110 individuals working in the relational professions (54% males; M _age = 42.6, SD = 13.73), observed for an entire workday. Results confirmed the protective role of self-esteem against the experience of negative affect and (indirectly) work-related exhaustion. Symptoms of exhaustion at work were also negatively predicted by HRV, and both HRV and negative affect acted as mediators of the relationship between self-esteem and work-related exhaustion. Notably, sex differences emerged in the association between global self-esteem and cardiac vagal tone at work: in women, self-esteem was negatively related to HRV, which in turn led to higher work-related exhaustion, whereas in men, no evidence of this indirect effect appeared. Burnout prevention programs should not ignore important sex differences in how individuals respond to work-related stress.

Heart Rate Variability in Different Levels of Burnout-Cross-Sectional Study of Different Occupational Groups Heart Rate Variability and Burnout

OBJECTIVES

The aim of this study was a subjective and objective stress analysis of occupational groups.

METHODS

The study examined 414 employees with patients or children contact on work. The age ranged from 22 to 63 years. Subjective stress was measured using the Maslach Burnout Inventory and objective stress with heart rate variability (HRV).

RESULTS

Twenty-one percent of subjects showed a high level of exhaustion, 12.9% a high level of cynicism and low performance. There were significant group differences between cynicism levels in meanNN (P = .008) and meanHR (P = .002). There were no significant differences in HRV for exhaustion and professional efficacy.

CONCLUSIONS

The health-impairing manifestations of the three dimensions of the burnout syndrome are not associated with the lower HRV. However, healthy subjects from a "screening" study who had not been clinically diagnosed with burnout were examined here.

High Job Burnout Predicts Low Heart Rate Variability in the Working Population after a First Episode of Acute Coronary Syndrome

(1) Background: Job burnout may affect the prognosis of patients with acute coronary syndrome (ACS) through mechanisms involving heart rate variability (HRV). However, no study has yet examined those potential associations. Hence, we conducted the present study to investigate this issue. (2) Method: Participants included patients who presented with a first episode of ACS and who were employed. The Copenhagen Burnout Inventory (CBI) was used to assess job burnout. Twenty-four-hour ambulatory electrocardiography recorded HRV on four occasions, i.e., during the hospitalization and follow-ups at one, six, and 12 months, respectively. (3) Results: A total of 120 participants who at least completed three Holter examinations throughout the study were enrolled in the final analysis. Job burnout scores at baseline were inversely associated with LnSDNN, LnTP, LnHF, LnLF, LnULF, and LnVLF during the consequent one-year follow-up. Each 1 SD increase in job burnout scores predicted a decline ranging from 0.10 to 0.47 in the parameters described above (all p < 0.05), and all relationships were independent of numerous confounders, including anxiety and depression. (4) Conclusion: High job burnout predicted reduced HRV parameters during the one-year period post-ACS in the working population.

The hypothalamo-pituitary-adrenal axis and the autonomic nervous system in burnout

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.

Prospective associations between burnout symptomatology and hair cortisol

OBJECTIVES

Burnout is a stress-related, psychological syndrome due to high levels of job stressors. It has been found to be related to impairments of well-being, health, and job outcomes. Alterations of glucocorticoid secretion might be a mechanism explaining the linkage between burnout and reduced psychophysical functioning. Regarding hair cortisol as indicator this assumption, so far, has been only examined in cross-sectional studies. Therefore, we aimed to compare cross-sectional and prospective associations between different burnout symptoms and hair cortisol, additionally investigating potential nonlinear associations.

METHODS

The prospective study sample comprises 194 employees (95% nurses) from German geriatric care. We assessed burnout symptoms at baseline (t1) and 6 months later (t2) and collected hair samples for cortisol analyses at t2.

RESULTS

We found significant cross-sectional and prospective nonlinear (i.e., exponential) but not linear relationships between an aggregated measure of the burnout subscales emotional exhaustion, cynicism, and reduced efficacy and hair cortisol, even after adjusting for BMI and depressive mood. None of the single subscales of burnout was related to hair cortisol after adjusting for confounders.

CONCLUSIONS

Our findings further support the assumption that accumulated burnout symptoms and hypercorticolism are positively related.

Inertia of emotions and inertia of the heart: Physiological processes underlying inertia of negative emotions at work

Emotional inertia is a key feature of emotional dynamics and it refers to the degree to which a current emotional state can be predicted by a previous emotional state. In this study, using the experience sampling method, we examined the relationship between inertia of negative emotions at work and parasympathetic activity, measured by vagally-mediated heart rate variability (HRV). In line with current literature on HRV, we propose that temporal dependency of negative emotions at work may be associated to lower HRV, an important marker of the ability to flexibly adjust to a changing environment. Participants (n = 120) were prompted six times during a regular workday, while wearing a heart rate monitor. In accordance with the polyvagal theory and the model of neurovisceral integration, findings supported our hypothesis and indicated that workers with lower HRV tend to show high time persistence of negative emotions at work. Practical implications and directions for future research are discussed.

Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans

PURPOSE OF REVIEW

Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health.

RECENT FINDINGS

Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.

Is There an Optimal Autonomic State for Enhanced Flow and Executive Task Performance?

Introduction

Flow describes a state of optimal experience that can promote a positive adaptation to increasing stress. The aim of the current study is to identify the ideal autonomic state for peak cognitive performance by correlating sympathovagal balance during cognitive stress with (1) perceived flow immersion and (2) executive task performance.

Materials and Methods

Autonomic states were varied in healthy male participants (n = 48) using combinations of patterned breathing and skeletal muscle contraction that are known to induce differing levels of autonomic response. After autonomic variation, a Stroop test was performed on participants to induce a mild stress response, and autonomic arousal was assessed using heart rate variability. Subjective experience of flow was measured by standardized self-report, and executive task performance was measured by reaction time on the Stroop test.

Results

There were significant associations between autonomic state and flow engagement with an inverted U-shaped function for parasympathetic stimulation, sympathetic response, and overall sympathovagal balance. There were also significant associations between autonomic states and reaction times. Combining sympathetic and parasympathetic responses to evaluate overall sympathovagal balance, there was a significant U-shaped relationship with reaction time.

Discussion

Our results support the flow theory of human performance in which the ideal autonomic state lies at the peak of an inverted-U function, and extremes at either end lead to both suboptimal flow experience. Similarly, cognitive task performance was maximized at the bottom of the U-function. Our findings suggest that optimal performance may be associated with predominant, but not total, sympathetic response.

Examining reactivity patterns in burnout and other indicators of chronic stress

INTRODUCTION

Burnout symptomatology is associated with various negative health consequences; however, the mechanisms underlying these associations remain unclear. One potential pathway involves alterations in the acute stress response. The aims of the present study were to examine burnout-associated alterations in stress-reactivity patterns, during a standardized social stressor compared to a control condition, as well as to examine whether effects associated with greater burnout symptomatology were distinct from other, conceptually overlapping indicators of chronic stress (i.e. depressive symptomatology and elevated hair cortisol concentration [HCC]).

MATERIALS AND METHODS

In a randomized two-factor design a total of 70 employed males with varying burnout symptoms but without evidence of physical or psychiatric disease were exposed to the Trier Social Stress Test for Groups (TSST-G) or a non-stressful control condition. Acute stress reactivity was assessed using self-report stress measures and non-invasive biomarkers. Associations among acute stress reactivity, burnout and depressive symptoms (assessed with self-report measures), as well as HCC were analysed using repeated measure ANCOVAs and moderation analysis.

RESULTS

Burnout symptomatology was associated with elevated stress perception independent of the experimental condition. In addition, depressive symptomatology was associated with enhanced anticipatory appraisal, whereas HCC was not related to any subjective stress measure. On a physiological level, burnout and depressive symptomatology, as well as HCC were associated with a pattern of blunted cardiovascular reactivity, however the timing of this effect varied.

CONCLUSION

Our results indicate burnout-associated modulations in stress reactivity, which diverge, at least partly, from other indicators of chronic stress.

Associations between digit ratio (2D4D), mood, and autonomic stress response in healthy men

The ratio between the length of the second (index) and the fourth (ring) finger (2D4D) is a putative biomarker of prenatal testosterone (T) exposure, with higher exposure leading to a smaller ratio. 2D4D has further been linked to mental and somatic disorders. Healthy male Swiss recruits (N = 245; M_age = 20.30 years) underwent a psychosocial stress test. Mood and salivary alpha-amylase (sAA) were assessed before and after the stress test, while heart rate (HR) and heart rate variability (HRV) were measured continuously. Additionally, 2D4D (right: R2D4D; left: L2D4D) was determined and divided into quartile groups. Correlation analysis showed no associations between R/L2D4D and outcome measures. Comparing calculated quartiles for R2D4D, subjects in the lowest R2D4D quartile expressed trendwise (p < 0.10) lower positive and higher negative affect, significantly elevated sAA activity (p < 0.05), but no HR and HRV differences at baseline as compared to subjects in the upper three quartiles. With regard to acute stress, subjects in the lowest as compared to subjects in the upper three R2D4D quartiles showed a higher increase of negative affect and a stronger cardiac response (p < 0.05), but no alterations in positive affect and sAA activity. Young healthy men in the lowest R2D4D quartile revealed a more negative affect and increased physiological activity at baseline and in response to acute stress. An exposure to high levels of prenatal T might constitute a risk factor potentially increasing vulnerability to stress-related disorders in men.

A comparative clinical and radiographic study on patients with chronic facial pain with and without temporomandibular disorder presenting to an otolaryngology clinic

Objective: Facial pain associated with temporomandibular disorder (TMD) is considered a component of Costen's syndrome. However, prior to the current study, no previous clinical and radiographic studies have addressed facial pain in patients with TMD. Methods: The study included 212 patients with chronic facial pain examined in an otolaryngology clinic. These were stratified into 132 patients with TMD and 80 patients without TMD. Clinical and radiographic findings were documented in both groups. Results: Forty-eight patients in the TMD group had normal endoscopic findings and clear CT scans and had their facial pain directly attributable to TMD. Conclusion: In patients presenting with facial pain, where nasal endoscopy reveals no abnormality, TMD should be specifically addressed, especially if CT scans of the paranasal sinuses are clear.

The Longitudinal Association of Reduced Vagal Tone With Burnout

OBJECTIVE

Previous research indicates a link between burnout symptoms and reduced vagally mediated heart rate variability (HRV); however, the directionality of this relationship is still largely unknown. The objective of the present study was to examine the longitudinal relationship between HRV and burnout symptoms for 1 year, with a special focus on the emotional exhaustion (EE) burnout subdimension, which remains inadequately distinguished from overlapping with depressive symptoms.

METHODS

Here we present HRV and behavioral data from 167 individuals (mean [SD] age = 43.43 [11.78] years; 30.5% male) who attended two biomarker samplings (T1 and T2) of the Dresden Burnout Study approximately 12 months apart.

RESULTS

In hierarchical linear regression analyses, T1 HRV significantly inversely predicted T2 overall burnout symptoms (β = -.16; p = .03) and EE (β = -.23; p = .02), adjusting for age, sex, body mass index, adverse health behaviors, and depressive symptoms. Importantly, only high EE at T1 (β = -.22; p = .04), and not the T1 Maslach Burnout Inventor total score, predicted reductions in HRV from T1 to T2.

CONCLUSIONS

We report for the first time longitudinal evidence that HRV is associated with changes in burnout symptoms, independently of depressive symptoms. Results suggest vagal dysfunction being predictive and specific for burnout symptoms, making HRV a promising starting point for the explanation of biophysiological mechanisms underlying burnout symptoms and cardiovascular diseases. The finding of only EE at T1 being predictive for changes in HRV underscores the importance of exhaustion for modulations in autonomic regulation.

Stressful life events predict one-year change of leukocyte composition in peripheral blood

A plethora of cross-sectional studies suggest that psychological stress resulting from experiencing stressful life events (SLE) can result in an altered immune response. Potential maladaptive immune changes may outlast the event and affect the organism long after stress cessation. As a consequence, an increased vulnerability for immune-mediated pathologies (e.g. arthritis, diabetes) may develop over the life span. The objective of the present study was to monitor the longitudinal kinetics of peripheral white blood cells (WBCs; neutrophils, lymphocytes, and monocytes) in response to SLE. Here we present blood, hair, and behavioural measures obtained in the Dresden Burnout Study, at first visit (T1; N = 446) and one year later (T2; N = 173). Cumulative impact of SLE was assessed at T1 with the Life Stressor Checklist (LSC-R). Results indicate a significant increase in neutrophils (+2.8% per each 10 LSC-R points) between T1 and T2 in association with reported SLE. The change in neutrophils tended to correlate with the change in hair cortisol (Coheńs f = 0.6). We propose that SLE trigger immunological alterations that persist across time and thereby promote a continuous effect on WBC distribution. Such an effect might advance subclinical inflammatory processes, reduce an individualś immune defence, and promote a link between psychological stress and physical disease.

Reduced self-regulation mirrors the distorting effects of burnout symptomatology on task difficulty perception during an inhibition task

Burnout, a pathological consequence of chronic work stress, shows an increasing incidence rate in industrialized countries. Previous findings indicate that burnout may be linked to a detachment of the negative association between subjectively appraised task demand and cognitive performance, which is typically seen in healthy individuals. The present study sought to confirm this relationship and to investigate whether this dissociation is mirrored in a biological marker of self-regulation, i.e., resting vagally mediated heart rate variability (HRV). A heterogeneous sample (N = 65) of working adults (M age = 43.3, SD = 10; 23.1 % male) with varying degrees of burnout symptomatology completed three cognitive tasks (2-back, number-letter, and go/nogo) to assess different domains of executive functioning (updating, set-shifting, and inhibition), and respective demand ratings. Additionally, vagally mediated HRV at rest, operationalized as the root-mean square differences of successive R-R intervals (RMSSD), was recorded. Burnout symptomatology moderated the association between subjective task difficulty and performance parameters of the go/nogo task, such that higher burnout scores were associated with reductions in the naturally occurring negative association between self-rated task demand and response inhibition. Intriguingly, this pattern was mirrored when replacing burnout with HRV. These findings suggest that burnout symptomatology, and individual differences in self-regulatory capacities (indexed by resting HRV), may alter one's capacity for accurate task evaluation, a mechanism which could potentially underlie the dissociation between self-rated cognitive function and actual performance among individuals experiencing burnout.

The Dresden Burnout Study: Protocol of a prospective cohort study for the bio-psychological investigation of burnout

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.

School burnout and heart rate variability: risk of cardiovascular disease and hypertension in young adult females

Emerging research documents the relationship between school burnout and some indicators of increased cardiovascular risk. Indicators of cardiovascular functioning assessed via ambulatory blood pressure and heart rate variability (HRV) have not been thoroughly explored in this research domain. Therefore, the current study examined relationships between school burnout and indicators of cardiac functioning via 24 h ambulatory blood pressure (BP) and electrocardiogram monitoring in a sample of young adult female undergraduates (N = 88). Two hypotheses were tested: (1) that independent of related negative affective symptomology (depression and anxiety), increased school burnout would be related to greater systolic and diastolic BP, higher low frequency (LF) HRV and lower very low frequency (VLF) HRV, and (2) that lower VLF would be related to greater school burnout independently of LF HRV. Hierarchical multiple regression analyzes showed that school burnout was significantly related to elevated ambulatory BP (systolic and diastolic) and HRV markers of increased cardiac sympathovagal tone. These findings support the hypotheses and suggest that school burnout might be implicated in the development of pre-hypertension or early cardiovascular disease. Study limitations and the need for future longitudinal research are discussed.

Heart rate variability and salivary cortisol in very preterm children during school age

The autonomic nervous system (ANS) plays a major role in the human stress response and reflects physical and psychological adaptability to a changing environment. Long-term exposure to early life stressors may alter the function of the ANS. The present study examines differences in the ANS between children born very preterm and full-term as well as the association between the ANS and the hypothalamic-pituitary-adrenal (HPA) axis, the other main branch of the human stress system. Fifty-four healthy children born very preterm (<32nd gestational week) and 67 full-term children aged 7-12 years provided data for the present study. Polysomnography (PSG) assessments were obtained during a night at the children's home in lying position at rest (wake) and during different sleep stages (stage 2 sleep, slow wave sleep, rapid-eye-movement sleep). Autonomic function was assessed by use of heart rate variability, specifically low frequency power (LF), high frequency power (HF), total spectral power (Tot Pow), and the LF/HF ratio. HPA axis activity was measured using salivary cortisol the next morning at awakening, 10, 20, and 30min later. Children born very preterm had lower LF/HF ratio during wake and stage 2 sleep compared to full-term children. Moreover, higher LF, Tot Pow, and LF/HF ratio during wake, stage 2 sleep, and REM sleep were related to more post-awakening cortisol secretion. The present study provides evidence on long-term ANS alterations after very preterm birth. Moreover, findings suggest a relation between the ANS and the HPA axis and therefore support the notion of mutual feedback between the two human stress systems.

High-Tech Acupuncture for Prevention of Lifestyle Diseases-A Sino-Austrian Cooperation Research Protocol on Heart Rate Variability

BACKGROUND

Acupuncture can not only be used for well-known diseases, but also for so-called modern lifestyle-related diseases. Using innovative methods like e.g. new analyses of heart rate variability (HRV), it is also possible to investigate diseases like burnout syndrome, ie., qi deficiency in Chinese medicine (CM).

OBJECTIVE

The main object of this research protocol is to perform research on the relationship of burnout syndrome and heart rate (HR) and HRV.

METHODS

A total of 175 patients with burnout syndrome (qi deficiency syndrome) in five groups and 35 healthy volunteers will be investigated. Based on random numbers generated by computer and concealed in opaque envelops, the patients will be assigned to four acupuncture groups using Zusanli (ST 36) acupuncture stimulation, Guanyuan (CV4) acupuncture stimulation, both points, and both points with Streitberger device respectively, and a moxibustion group using both points mentioned above, with 35 cases in each group. Altogether four different experiments are planned. Experiment 1 includes 70 subjects and is a comparison between a burnout group and a control group (healthy volunteers). The evaluation parameters are different scores and indices of HR and HRV. Experiment 2 includes 140 subjects and compares the efficacy of different acupuncture points. In experiment 3 (105 subjects), acupuncture and moxibustion should be compared to healthy volunteers. Experiment 4 (70 subjects) investigates the long-term therapeutic effects of acupuncture and moxibustion on the scores of qi deficiency and HR/HRV in qi deficiency patients. In both the acupuncture and moxibustion groups, a total of 10 treatments will be performed.

CONCLUSIONS

The joint research aims at the scientific evaluation of CM, mainly in the field of HRV. This parameter could be a very good indicator of the state of health and can be inflfluenced by different acupuncture methods, as shown in the past.