Burnout, perceived stress, and cortisol responses to awakening

OBJECTIVE: The effects of burnout and perceived stress on early morning free cortisol levels after awakening were investigated in a group of teachers. Previous studies revealed that cortisol levels show a significant increase after awakening, with high intraindividual stability. METHODS: Sixty-six teachers from local public schools (42 women and 24 men, mean age 42+/-5 years) were asked to sample saliva for cortisol analysis on 3 consecutive days. On each day, cortisol levels were measured at the time of awakening and 15, 30, and 60 minutes thereafter. On the night before the third day, subjects took 0.5 mg dexamethasone orally for testing glucocorticoid feedback inhibition. Burnout and perceived stress were measured by three different questionnaires. RESULTS: Perceived stress correlated with increases of cortisol levels during the first hour after awakening after dexamethasone pretreatment. In addition, teachers scoring high on burnout showed lower overall cortisol secretion on all sampling days, and a higher suppression of cortisol secretion after dexamethasone administration. In the subgroup of teachers with both high levels of perceived stress and high levels of burnout, a lower overall cortisol secretion was observed on the first 2 days, with stronger increases during the first hour after awakening after dexamethasone suppression. This subgroup also showed the lowest self-esteem, the highest external locus of control, and the highest number of somatic complaints. CONCLUSIONS: These results demonstrate differential effects of burnout and perceived stress on hypothalamic-pituitary-adrenal axis regulation.     

The relationship of social support to perceived control and subjective mental health in adolescents

This study investigated the link between social support and positive constructs, specifically, psychological well-being and the perceived ability to obtain and savor positive life events. Eighty-two high school students were surveyed. Social support was significantly related to positive dimensions of subjective mental health (happiness, gratification, and self-confidence), but not to its negative components (vulnerability, strain, and uncertainty), and was also significantly related to respondents' perceived ability to obtain and savor positive life events, but not to their perceived ability to avoid or cope with negative events. Future theory and research should examine the link between social support and positive constructs such as psychological well-being and positive life experience.     

The influence of morningness-eveningness on anxiety and cardiovascular responses to stress

The relationship between cardiovascular responses to stress and health outcomes is inconsistent. In this study, the effects of morningness-eveningness and time of day upon cardiovascular activity at rest and in response to stress were examined. Sixty morning-types and evening-types completed two testing sessions (one morning, one afternoon) that comprised a battery of three stress tasks and a measure of anxiety. The results failed to support a time of day effect upon cardiovascular activity, but there was evidence of an interaction between time of day and morningness-eveningness upon heart rate (HR) and rate pressure product (RPP; HRxSBP). Evening-types exhibited higher HR and RPP in the afternoon, both at rest and during stress. A time of day effect was shown for mood, with anxiety levels higher in the morning than the afternoon. These results are discussed in terms of their health and methodological implications.     

The effects of social stress and cortisol responses on the preconscious selective attention to social threat

The purpose of the present study was to investigate the effects of social stress and stress-induced cortisol on the preconscious selective attention to social threat. Twenty healthy participants were administered a masked emotional Stroop task (comparing color-naming latencies for angry, neutral and happy faces) in conditions of rest and social stress. Stress was induced by means of the Trier social stress test. Based on the stress-induced increase in cortisol levels, participants were allocated post hoc (median-split) to a high and low responders group. In contrast to low responders, high responders showed a negative or avoidant attentional bias to threat (i.e. shorter latencies for angry than neutral faces) in the rest condition. Most importantly, although low responders became avoidant, the high responders became vigilant to the angry faces after stress induction. There were no such effects for happy faces. Our findings are in line with previous studies in both animals and humans, that associate high glucocorticoid stress-responsiveness with diminished avoidance and prolonged freezing reactions during stress.     

Ethnicity moderates the influence of perceived social status on subjective sleep quality

It has long been recognized that socioeconomic status (SES) influences health and health-related behaviors, and it has been suggested that the adverse impact of low SES on health may be partly mediated by poor sleep quality. The relation between sleep and objective and subjective measures of SES has only been explored in a preliminary manner, providing indirect evidence that associations between SES and health might be explained, in part, by disrupted sleep. However, it remains unclear whether low SES directly affects sleep quality or whether the SES-sleep quality relation varies as a function of ethnicity given robust ethnic disparities across SES-related factors. This study examined the relation between perceived social status (i.e., individuals' perception of their socioeconomic standing) and subjective sleep quality among 149 college students, and examined the moderating effect of ethnicity to determine whether the magnitude or direction of association differed among Caucasian, Asian, and African Americans. Using hierarchical regressions and a dummy-coded ethnicity variable, results demonstrated significant moderation (ΔR? = 0.04, p = .02), such that both Asian (p = .04) and African Americans (p = .02) were significantly different from Caucasian Americans. Lower perceived social status was related to greater impairment in sleep quality for Asian Americans (β = -.37, p < .01) and African Americans (β = -.51, p < .01), but not Caucasian Americans (β = -.02, p = .87). These findings provide initial support for the negative impact of low perceived social status on sleep quality for specific subgroups of ethnic minorities.     

The relationships among objective and subjective environmental stress levels and serum uric acid: the moderating effect of perceived control

This study was designed to investigate the effects of objective and subjective stress levels and perceived control on serum uric acid (SUA). Respondents were 2,504 male and 1,176 female manufacturing employees. Objective job-related stress was assessed by the Ergonomic Stress Level (ESL) inventory (S. Melamed, D. Yekutieli, P. Froom, E. Kristal-Boneh, & J. Ribak, 1999). As expected, ESL was positively associated with SUA, but among male respondents only. The measure of subjective stress, environmental annoyance, was negatively related with SUA for male respondents, thus not confirming the hypothesis. Perceived control was not found to have a direct effect on SUA, after controlling for the ESL measure. For male respondents only, perceived control moderated the relationship between ESL and SUA: This relationship was negative for those reporting above-average control and positive for those reporting below-average control.     

Effects of locus of control on perceived hospital environment

Re-examined how psychiatric patients' perception of their treatment setting was related to locus of control, unconfounded by variations in treatment setting, differences in pathology, or length of hospitalization. Forty male patients were drawn from the general psychiatric population of Norwich Hospital. They were administered the Rotter I-E Scale, Ward Atmosphere and Ward Initiative Scales. In contrast to reports found in the literature, the results of the study indicated that internally oriented patients preferred a well-ordered, organized treatment setting in which therapeutic objectives and treatment procedures were defined clearly. A most important determinant of the perception of the treatment setting appeared to be the Internals' personal involvement in the therapeutic functioning of the unit. Externals felt that the level of personal participation in the operation of the unit should be minimal and that treatment plans and procedures should be formulated by professional staff and not by their peers.     

Adult attachment representations predict cortisol and oxytocin responses to stress

There are many factors contributing to individual variations in the response to stressful experiences. The present study evaluated the patterns of stress responses according to attachment representations in 28 adults from a community sample, plus 46 subjects expected to be particularly sensitive to stress, having been exposed during childhood and/or adolescence to traumatizing events such as abuse or potentially lethal illnesses. Subjects were given the Adult Attachment Interview, which provides attachment classifications, and the Trier Social Stress Test (TSST), involving an experimental psychosocial challenge. Subjective responses to the TSST, as well as saliva samples (assayed for cortisol) and blood plasma samples (assayed for ACTH and oxytocin) were collected before, during and after the stress procedure. The stress responses presented specific patterns according to attachment classifications. Subjects with an autonomous attachment classification reported relatively low subjective stress, they presented a moderate response of the hypothalamic-pituitary-adrenal (HPA) axis (ACTH and cortisol), and a high level of oxytocin. Subjects with a dismissing classification reported a moderate subjective stress, they presented an elevated response of the HPA axis, and moderate levels of oxytocin. Subjects with a preoccupied classification presented moderate levels of subjective stress, and of HPA response, and a relatively low level of oxytocin. Finally, subjects with an unresolved classification reported elevated subjective stress; they presented a suppressed HPA response, and moderate levels of oxytocin. These data support the notion that attachment representations may affect stress responses, and suggest a specific role of oxytocin in both the attachment system and the stress system.     

Orienting responses and locus of control

Few studies have attempted to relate the locus of control (Rotter, 1966) variable to physiological activity. This paper describes the heart-rate and skin conductance responses of 40 subjects exposed to a series of auditory stimuli, in relation to their locus of control scores. It was found that those scoring relatively 'externally' on the locus of control scale gave less decelerative and more accelerative heart-rate responses and tended to give larger skin conductance responses when there was a change in stimulus characteristics, than those scoring 'internally'. These results may be interpreted to support Lazarus' (1966) suggestions that control over a situation lessens the threat perceived in that situation. They also indicate that internal subjects tend to seek information to increase their control.     

Consistent sex differences in cortisol responses to psychological stress.

In four independent studies, sex differences in cortisol responses to psychological stress were investigated in healthy adolescents and adults (total n = 153). Public speaking and mental arithmetic in front of an audience (Studies 1-3) reliably induced increases in free cortisol levels in both sexes with 2- to 4-fold increases above baseline levels. Mean cortisol responses were 1.5- to 2-fold higher in men compared with women. In Study 3, cortisol profiles were additionally investigated after human corticotropin-releasing hormone (h-CRH) and bicycle ergometry until exhaustion. Here, both sexes showed very similar adrenocortical responses. Furthermore, men showed elevated cortisol levels in anticipation of the psychological stress situation without actually having to perform the tasks (Study 4). Under this condition cortisol concentration was unchanged or decreased in women. From these data we conclude that the observed sex difference does not reflect an overall lower responsiveness of the female adrenal cortex. Although these studies do not provide conclusive data, we suggest sex differences in cognitive and/or emotional responses to distressing psychosocial situations which in turn may influence cortisol secretion.     

The impact of perceived stress and perceived control on anxiety and mood disorders in noncardiac chest pain

Chest pain without detectable heart disease, noncardiac chest pain (NCCP), is linked with anxiety and depression. Theory posits stress and perceived control may relate to NCCP. We hypothesized stress would have direct and mediated effects via perceived control on anxiety and mood disorders in NCCP. Patients (N = 113) completed questionnaires and a structured diagnostic interview. Stress and perceived control were associated with anxiety and mood disorder severity. Perceived control fully mediated the relation between stress and mood disorder severity but not anxiety disorder severity. Results are partially supportive of anxiety-based theories of NCCP.     

Differential effects of mild chronic stress on cortisol and S-IgA responses to an acute stressor

While acute stress is adaptive in the short term, chronic stress may interfere with HPA axis functioning and self-regulation that can, in turn, alter the body's immune response. Several studies suggest that acute and chronic stress consistently increase cortisol levels; however, the same cannot be said about S-IgA levels. We tested the effects of a mild chronic stress (an academic exam period), on cortisol and S-IgA responses to an acute stress. Exposure to an acute stressor significantly increases cortisol levels during periods of no-stress, but not during mild chronic stress, while S-IgA levels consistently increase during both sessions. Furthermore, we find that during the period of chronic mild stress, the perception of stress is related to increased cortisol response to an acute stressor. Combined, these findings shed light on the impact of increased background stress on acute stress responses.     

The influence of locus of control on preferences for information and decision making

Previous studies reported inconsistent relationship between the preference for information and that for decisional autonomy in medical encounters. We hypothesized that the relationship may be dependent on people's attribution beliefs on health. To test the hypothesis, demographically representative sample of Japanese population over the age of 18 (N = 3395) were invited into self-administered questionnaire survey. Preferences for information and decisional autonomy were measured by a translated version of autonomy preference index. Health attribution was measured by a scale modified from multi-dimensional health locus of control scales. After adjusting for socio-economic status, multivariable linear regression analysis revealed that information preference was positively associated with decisional preference among individuals who believed their health is less dependent on influential others. However, the reversed relationship was observed in case of individuals with attribution to others. The results suggested that individuals may use medical information for different purposes according to the types of health-related attribution beliefs.