Exhaustion measured by the SF-36 vitality scale is associated with a flattened diurnal cortisol profile (original) (raw)
Related papers
Socialmedicinsk Tidskrift, 2012
The interest in exhaustion has increased rapidly during the last few decades in many developed countries. In Sweden, prevalence of exhaustion increased by 50 percent on average between 1989 and 2005, and recent data reveals that exhaustion still remains at this higher level. Scientifically, exhaustion is not clearly defined. Chronic stress is acknowledged to give rise to exhaustion, but specific mechanisms involved have generally been overlooked in stress research. The relatively new concept of "hypocortisolism" in this context, referring to low levels of circulating cortisol, and observed in disorders featuring exhaustion, should be of interest. Hypocortisolism has also been suggested to comprise a mechanism for development of stress-related disease that challenges the previous general view of stress pathophysiology. The main objective of this thesis was to evaluate whether exhaustion as concept may be helpful in elucidating stress mechanisms. The four included Papers explored the discriminant validity of exhaustion in relation to depression and anxiety; HPA activity in exhaustion; associations with psychosocial work stressors; and significance for onset of a "stress-related disease", i.e. cardiac disease. Two study populations were used. For Papers I, III, and IV, analyses were performed on data from the Malmö Shoulder and Neck Study (N = 12,607); prospective data on coronary heart disease for Paper IV was obtained through data linkage. For Paper II, a working population sample (N = 78) was analysed. Exhaustion was assessed by means of the (inverted) SF-36 vitality measure. In Paper I, exhaustion emerged separately from depression and anxiety in factor analysis, supporting the conceptual integrity of exhaustion. In Paper II, HPA dysregulation in terms of a flattened diurnal cortisol rhythm (due to lower morning cortisol) was found in exhaustion. In Paper III, relationships with work-related stressors were demonstrated. Finally, in Paper IV, the contribution of exhaustion, independent from depression and anxiety, in development of coronary heart disease was indicated in men. The findings point to a unique and potentially important role of exhaustion in stress theory. It may, however, be important to focus gender in search of relevant concepts and mechanisms for development of stress-related disease. The search for preventive measures should be essential in future research.
Salivary cortisol patterns in vital exhaustion
Journal of Psychosomatic Research, 2000
Objective: The syndrome of vital exhaustion (VE), a risk indicator for myocardial infarction, is characterized by excessive fatigue, irritability, and demoralization. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis is a potential pathogenic mechanism in fatigue syndromes, but little is known about HPA function in syndromal VE. Method: We assessed basal free cortisol levels and responses to a speech task and to morning awakening by collecting multiple saliva samples over 2 days from 29 VE men and 30 controls. Results: VE subjects reported higher perceived stress, poorer sleep, and greater fatigue than controls. Basal cortisol levels were lower in VE subjects, especially in the evening, and were negatively associated with fatigue. Overall cortisol responses to the speech task were similar in VE and control groups, although VE subjects were less likely to show large (!2.76 nmol/l) responses. The cortisol response to awakening was associated with concurrent fatigue and poor sleep quality. Conclusion: These findings suggest a subtle HPA hypoactivity in VE, which may arise through chronic stress and associated sleep disturbances. D (N.A. Nicolson).
Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion
BMJ Open, 2012
Objectives: Studies on hypothalamusepituitarye 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.
Stress, 2006
Stress-related exhaustion is an increasingly focused phenomenon, although scientifically not yet fully conceptualised. This is perhaps partly due to the fact that the distinction between exhaustion and other already established concepts, such as depression, is not clear. This study explores whether exhaustion can be differentiated from depression and anxiety, by means of introducing the SF-36 vitality scale as a strategy for the measurement of exhaustion. The Malmö Shoulder and Neck Study cohort, in this study including 12,607 middle-aged men and women, was utilized. Depression and anxiety were assessed by the general health questionnaire (GHQ). Factor analysis was performed in order to potentially discriminate between the included measures. Factor analysis showed that all four exhaustion items of the (inverted) SF-36 vitality scale loaded on a single factor, separate from the GHQ depression and anxiety factors. These results support the notion that exhaustion can be distinguished from depression and anxiety, providing an empirical foundation for defining exhaustion as a unique concept. Furthermore, since SF-36 has been widely used in clinical and epidemiological studies, the benefits of using the SF-36 vitality scale in the assessment of exhaustion could be substantial.
A field (researcher's) guide to cortisol: tracking HPA axis functioning in everyday life
Health Psychology Review, 2008
Researchers have been incorporating ambulatory cortisol sampling into studies of everyday life for over a decade. Such work provides an important supplement to acute laboratory stress paradigms and provides a novel perspective on the interrelationships between stress, psychological resources, and health. However, the results of many field studies have been inconclusive and more studies have been undertaken than published. We describe some of the challenges facing naturalistic cortisol researchers, including lack of power, methodological and analytical problems, and patterns of confusing or conflictual results. We then summarize key findings of published naturalistic cortisol studies to date, grouped by type of cortisol outcome (morning awakening response, diurnal slope, area under the curve, and associations between momentary experiences and cortisol). We propose research questions relevant to everyday stress researchers and suggest next steps for researchers who are interested in incorporating naturalistic cortisol sampling into future studies.
Background: Salivary cortisol is a useful biomarker in stress research, as a valid measure for HPA axis activity, whose deregulation is one of the ways that psychosocial risk factors at work, result to the creation of illness. Aim: The aim of this review was to summarize current literature of salivary cortisol as measures of work stress in healthy workers, so as to investigate the association between work stress and cortisol secretion as well as to identify specific work characteristics, that affect the cortisol secretion. Methods: We identified articles through PubMed using search terms related to salivary cortisol, HPA axis, work stress. Results: Many studies have shown that altered level of cortisol, appears to be associated with work related stress factors. Work shift, working hours, the nature of work, organizational characteristic of work (effort reward imbalance, high demand-low control, over-commitment, conflicts between home and work demands, and workload) as well as bulling at work, sociodemographic characteristics, financial strain, physical risk factors and social support at work are found to affect Cortisol levels. Though the relationship between the cortisol secretion and some of the above work stressors was found to be contradictory. Discussion: From the present study it is obvious that the researches present an inconsistency regarding the impact of work stressors on cortisol levels. It has been identified that increased cortisol levels in populations reporting increased distress couldn’t replicate this association. Among the reasons identified to be behind these inconsistent findings are the differences in the prevalence of potential confounders, differences in analytical approach and the duration of stressful stimulus. Conclusion: The detailed knowledge about factors that play pivotal role in measures of the cortisol secretion is very important, as the biomarkers have been demonstrated that can characterize and quantify the biological impact of psychological stress. Targeted prevention policy and evidence based interventions in workplace might include the identification of sources of occupational stress and this is the first that can affect cortisol secretion.