Acute and chronic stress increase salivary cortisol: a study in the real-life setting of a national examination undertaken by medical graduates

Abstract

Spanish medical graduates who apply for a medical specialty training position (MIR) must take an examination that will shape their future personal and professional lives. Preparation for the test represents an important stressor that persists for several months. The aim of this study was to elucidate the stress pattern of this group and evaluate possible changes in the circadian rhythm of cortisol release in medical graduates preparing for this test. A repeated-measures longitudinal study was performed, measuring the salivary cortisol concentrations in 36 medical graduates (13 males and 23 females; mean age of 24.2 years) on five sampling days. Five cortisol samples were collected from 07:00 to 21:00 h in order to monitor changes in the circadian rhythm. On all sampling days (except on the day of the official examination), anxiety and psychological stress were evaluated with the Spanish versions of the State-Trait Anxiety Inventory (STAI) and the Perceived Stress Scale (PSS). During the study period, participants showed higher levels of anxiety than the Spanish reference population as well as a progressive increase in self-perceived stress. A significant increase in salivary cortisol concentration was observed in both chronic (study and examination preparation) and acute (examinations) situations. Our results suggest that the cortisol awakening response (CAR) may be a good indicator of anticipatory stress but is unaffected by long-term examination preparation. Comparison of results between the official examination day and the mock examination days yielded evidence that learning may modulate the behavior of the hypothalamic-pituitary-adrenal axis.

Copeptin as a stress marker prior and after a written examination – the CoEXAM study

“…Second, serum cortisol levels measured prior to the examination are elevated as a consequence of the anticipation of the examination and predicted subsequent successful completion of the exams. It has already been shown in different stress models (Trier stress test, theoretical driving lesson, national medical examination and first jump of a parachutist) that cortisol is influenced by psychological stress (Dickerson & Kemeny, 2004;Dugue et al, 1993Dugue et al, , 2001Gonzalez-Cabrera et al, 2014). Our study demonstrates that psychological stress induced by a written examination not only leads to a rise of serum or salivary cortisol levels but also to a rise in copeptin levels.…”

“…Psychological stress also increases cortisol during ambulatory settings, e.g. during a theoretical driving license examination (Dugue et al, 2001), one hour prior to an oral academic examination (Lacey et al, 2000) and in Spanish medical graduates taking an examination to apply for their medical specialty training position (Gonzalez-Cabrera et al, 2014). To our knowledge, only preliminary findings from a very small study are available about a possible correlation between salivary cortisol levels and examination success (Ng et al, 2003).…”

Longitudinal and immediate effect of Kundalini Yoga on salivary levels of cortisol and activity of alpha-amylase and its effect on perceived stress

“…[40] These factors were not controlled or used as criteria of exclusion because our sample size was very limited. Due to the fact that the evidence is ambiguous with respect to the influence of age and gender in the salivary concentrations of stress markers,[41] the effects of oral contraceptives on cortisol levels[4243] and the increase in cortisol secretion due to nicotine consumption,[40] it is suggested to approach these factors in the future studies.…”

Comparison of Psychiatric Symptoms and Attitudes of Coping with Stress in Somatization Disorder and Fibromyalgia and Osteoarthritis and Their Relatives

“…8,9 When a given situation is perceived as stress, a series of physiological mechanisms is activated. These mechanisms occur with noradrenaline and cortisol secretion as a result of activation of the sympathetic and adrenomedullary system with hypothalamicpituitary-adrenal axis 10 . Stress causes distress in people.…”