Burnout and cortisol: Evidence for a lower cortisol awakening response in both clinical and non-clinical burnout

Oosterholt, Bart G.; Maes, J.H.R.; Linden, Dimitri van der; Verbraak, Marc; Kompier, Michiel A. J.

doi:10.1016/j.jpsychores.2014.11.003

Cited by 59 publications

(53 citation statements)

References 36 publications

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“…ChTx related to worse fatigue. Initial tests performed during, w/ or w/o ChTx.Schmidt [69] (part 2)2016265Breast CancerFAQDAC, CAR, SCR, NSC↑AUC, ↑CAR, ↑NSC, ↑SCR, Nl DACSecond test of the study, performed after 14 weeks of procedures.Sjors [25]2015220H/BSMBQDAC, CAR↓CAR, ↑DACResults normalized after adjustment of anti-depressive use; SCR results not providedOosterholt [28]201591H/BMaslachDAC, CAR, SCR, AUC, CAR 60 minNl SCR, ↓CAR, Nl AUC, Nl CAR 60 min, ↓DACControl of variations did not change resultsDe Vente [22]201595H/BAcute Psychosocial Stressor diagnosisMSC, MSTNl MSC, Nl MSTMST: Nl (women), reduced (men); MSC: Nl (men), reduced (women). Mental arithmetic and public speech stressors also performedLennartsson [24]201556H/BDCSRD; exclusion w/ SEQDHEA-S; ACTH; ACTH and DHEA-S post-TSST (TSST stress test performed)↓DHEA-S, ↓post-TSST DHEA-S, Nl ACTH, Nl post-TSST ACTHTao [23]2015171H/BMaslachMSC, ACTH↑ACTH, ↑MSCJonsson [29]201551H/BSMBQMSC, MSTNl MSC, ↓MSTLennartsson [27]201556H/BDCSRD and SMBQMSC, MST, ACTH, ACTH post-TSST (TSST stress test performed)Nl MSC, Nl MST, Nl ACTH, Nl post-TSST ACTHSevere BO: lower ACTH, cortisol response to TSST vs controls, whereas low BO: higher ACTH, cortisol responses vs controlsSchmaling [26]201562HealthyADASAUC, SCR↓AUC, ↓SCR31 couples studied, one of which had chronic fatigue (but not CFS)Sveinsdottir [68]20151150Chronic LombalgiaCFQDAC, CAR, SCR, NSCNl DAC, Nl CAR, Nl NSC, Nl SCR**Colocar como SAUDÁVEL – porque é só lombalgia (increased CAR in Low back pain)Powell [67]201576Multiple SclerosisCFQDAC, CAR, SCR…”

Section: Resultsmentioning

confidence: 99%

Adrenal fatigue does not exist: a systematic review

Cadegiani

Kater

2016

BMC Endocr Disord

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BackgroundThe term “adrenal fatigue” (“AF”) has been used by some doctors, healthcare providers, and the general media to describe an alleged condition caused by chronic exposure to stressful situations. Despite this, “AF” has not been recognized by any Endocrinology society, who claim there is no hard evidence for the existence. The aim of this systematic review is to verify whether there is substantiation for “AF”.MethodsA systematic search was performed at PUBMED, MEDLINE (Ebsco) and Cochrane databases, from the beginning of the data until April 22nd, 2016. Searched key words were: “adrenal” + “fatigue”, “adrenal” + “burnout”, “adrenal” + “exhaustion”, “hypoadrenia”, “burnout” + “cortisol”, “fatigue” + “cortisol”, “clinical” + “burnout”, “cortisol” + “vitalility”, “adrenal” + “vitality”, and “cortisol” + “exhaustion”. Eligibility criteria were: (1) articles written in English, (2) cortisol profile and fatigue or energy status as the primary outcome, (3) performed tests for evaluating the adrenal axis, (4) absence of influence of corticosteroid therapy, and (5) absence of confounding diseases. Type of questionnaire to distinct fatigued subjects, population studied, tests performed of selected studies were analyzed.ResultsFrom 3,470 articles found, 58 studies fulfilled the criteria: 33 were carried in healthy individuals, and 25 in symptomatic patients. The most assessed exams were “Direct Awakening Cortisol” (n = 29), “Cortisol Awakening Response” (n = 27) and “Salivary Cortisol Rhythm” (n = 26).DiscussionWe found an almost systematic finding of conflicting results derived from most of the studies methods utilized, regardless of the validation and the quality of performed tests. Some limitations of the review include: (1) heterogeneity of the study design; (2) the descriptive nature of most studies; (3) the poor quality assessment of fatigue; (4) the use of an unsubstantiated methodology in terms of cortisol assessment (not endorsed by endocrinologists); (5) false premises leading to an incorrect sequence of research direction; and, (6) inappropriate/invalid conclusions regarding causality and association between different information.ConclusionThis systematic review proves that there is no substantiation that “adrenal fatigue” is an actual medical condition. Therefore, adrenal fatigue is still a myth.

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Section: Resultsmentioning

confidence: 99%

Adrenal fatigue does not exist: a systematic review

Cadegiani

Kater

2016

BMC Endocr Disord

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“…Indeed, prior work has shown that a greater CAR is associated with attenuated distress responses to stress (Powell and Schlotz, 2012). Under burnout conditions, however, the HPA axis exhibits hypocortisolism, characterized by a blunted CAR (Chida and Steptoe, 2009; Oosterholt et al, 2015). Given that poorer sleep can be a stressor itself and lead to greater feelings of fatigue, family demands in the context of poorer sleep may become excessively burdensome, thereby leading to a state of hypocortisolism similar to that observed in burnt out individuals.…”

Section: Discussionmentioning

confidence: 99%

Daily family stress and HPA axis functioning during adolescence: The moderating role of sleep

Chiang

Tsai

Park

et al. 2016

Psychoneuroendocrinology

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The present study examined the moderating role of sleep in the association between family demands and conflict and hypothalamic-pituitary-adrenal (HPA) axis functioning in a sample of ethnically diverse adolescents (n = 316). Adolescents completed daily diary reports of family demands and conflict for 15 days, and wore actigraph watches during the first 8 nights to assess sleep. Participants also provided five saliva samples for 3 consecutive days to assess diurnal cortisol rhythms. Regression analyses indicated that sleep latency and efficiency moderated the link between family demands and the cortisol awakening response. Specifically, family demands were related to a smaller cortisol awakening response only among adolescents with longer sleep latency and lower sleep efficiency. These results suggest that certain aspects of HPA axis functioning may be sensitive to family demands primarily in the context of longer sleep latency and lower sleep efficiency.

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“…In general, cortisol, the prevailing hormone in the glucocorticoid group (Stachowicz and Lebiedzi nska 2016) can be influenced by factors like age (Aardal and Holm 1995), gender (Nater et al 2007;Marin et al 2011) and mental fatigue (Leproult, Buxton, and Cauter 1997). Cortisol level is commonly used to estimate stress (Almela et al 2011;Bakke et al 2004;Goldfarb et al 2017) and characterised by a steady drop in the afternoon hours (Nater et al 2007;Leproult, Buxton, and Cauter 1997;Oosterholt et al 2015). Although these daytime-related decrements in cortisol level occurred in our study too, the statistically less pronounced drop for the intervention period follow-up suggests that there might be an effect from the sit/stand intervention.…”

Section: Stress Responsementioning

confidence: 99%