Burnout and Hypocortisolism – A Matter of Severity? A Study on ACTH and Cortisol Responses to Acute Psychosocial Stress

Abstract

Background: Common consequences of long-term psychosocial stress are fatigue and burnout. It has been suggested that burnout could be associated with hypocortisolism, thus, inability to produce sufficient amounts of cortisol. This study aimed to investigate whether patients with clinical burnout exhibit aberrant ACTH and cortisol responses under acute psychosocial stress compared with healthy individuals.Methods: Nineteen patients (9 men and 10 women) and 37 healthy subjects (20 men and 17 women), underwent the Trier Social Stress Test. Blood samples and saliva samples were collected before, after, and during the stress test for measurements of plasma ACTH, serum cortisol, and salivary cortisol. Several statistical analyses were conducted to compare the responses between patients and controls. In addition, in order to investigate the possibility that burnout patients with more severe symptoms would respond differently, sub-groups of patients reporting higher and lower burnout scores were compared.Results: In both patients and healthy controls, we observed elevated levels of ACTH and cortisol after exposure to the stressor. There were no differences in responses of ACTH, serum cortisol, or salivary cortisol between patients and controls. Patients reporting higher burnout scores had lower salivary cortisol responses than controls, indicating that patients with more severe burnout symptoms may be suffering from hypocortisolism. In addition, patients with more severe burnout symptoms tended to have smaller ACTH responses than the other patients. However, there was no corresponding difference in serum cortisol.Conclusion: This study indicates that hypocortisolism is not present in a clinical burnout patient group as a whole but may be present in the patients with more severe burnout symptoms.

Investigating the Role of Salivary Cortisol on Vocal Symptoms

“…Research results show an association between the magnitude of the morning rise and the level of life stressors (Pruessner, Hellhammer & Kirschbaum, 1999;Wüst et al, 2000a). In line with the Allostatic Load Model, results showed that severe chronic stress or burnout was associated with lack off or attenuated peak in the morning cortisol levels (Lennartsson et al, 2015).…”

“…Kristenson et al (2011) report that the correlation between cortisol levels on consecutive days has been reported to be r = 0.5 in a number of studies, which is why mean levels over two or three days often are used to give more reliable results. Furthermore, since stress (acute stress or moderate duration of chronic stress) is associated with elevated morning cortisol levels (for example Clow, Thorn, Evans & Hucklebridge, 2004) whereas burnout is associated with hypocortisolism (Lennartsson et al, 2015), a more detailed questionnaire regarding exhaustion or levels of stress might have provided the means to perform a more detailed analysis of the associations between cortisol levels, exhaustion and occurrence of vocal symptoms.…”

Cynicism as subscale of burnout

“…Various burnout measuring scales exist, which, but for exhaustion, differ in subscales characteristics. General agreement exists on exhaustion as primary characteristic of burnout, and credible indications exist for physiological correlates that could explain the pathophysiological symptoms of this energy-depleted state of exhaustion [10,11]. However, the same cannot necessarily be said for other characteristics included as subscales.…”

“…For example, while chronic stress initially results in hypercortisolemia, it may eventually lead to hypocortisolemia [9] -a fact that can, and have indeed, 3 lead to opposite findings in the search for biological correlates of burnout. At present there is enough evidence to accept deficiencies in HPA axis and ANS to be biological correlates of severe burnout [8,10,11]. In view of the role of the HPA axis (cortisol) and the ANS in energy availability, coupled to associations of hypocortisolism and ANS insufficiency with fatigue [8,9]), it seems feasible to accept inadequacies in these main stress axes [8,10,11] as correlates of the burnout-associated exhaustion.…”

“…At present there is enough evidence to accept deficiencies in HPA axis and ANS to be biological correlates of severe burnout [8,10,11]. In view of the role of the HPA axis (cortisol) and the ANS in energy availability, coupled to associations of hypocortisolism and ANS insufficiency with fatigue [8,9]), it seems feasible to accept inadequacies in these main stress axes [8,10,11] as correlates of the burnout-associated exhaustion. In addition, due to the loss of glucocorticoid regulation of the immune system, hypocortisolaemia can lead to an increase in pro-inflammatory cytokines [12].…”