Exhaustion-related changes in cardiovascular and cortisol reactivity to acute psychosocial stress.
Peter Jönsson, Kai Österberg, Mattias Wallergård, Åse Marie Hansen, Anne Helene Garde, Gerd Johansson, Björn Karlson
Author Information
Peter Jönsson: Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden; School of Education and Environment, Centre for Psychology, Kristianstad University, SE-29188 Kristianstad, Sweden. Electronic address: peter.jonsson@hkr.se.
Kai Österberg: Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden; Department of Psychology, Lund University, SE-22100 Lund, Sweden.
Åse Marie Hansen: Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark; National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100 Copenhagen, Denmark.
Anne Helene Garde: Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark.
Björn Karlson: Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, SE-22185 Lund, Sweden; Department of Psychology, Lund University, SE-22100 Lund, Sweden.
Prior findings indicate that individuals scoring high on vital exhaustion show a dysfunctional stress response (DSR), that is, reduced cortisol reactivity and habituation to psychosocial stressors. The main aim of the present study was to examine whether a DSR may be a vulnerability factor in exhaustion disorder (ED). We examined whether a DSR is present during the early stages of ED, and still is present after recovery. Three groups were studied: 1. Former EDpatients (n=14); 2. persons who during the past 6 month had experienced stress at work and had a Shirom-Melamed Burnout Questionnaire (SMBQ) score over 3.75, considered to indicate a pre-stage of ED (n=17); 3. persons who had not experienced stress at work during the past 6 months and had a SMBQ score below 2.75 (n=20). The participants were exposed twice to a virtual version of the Trier Social Stress Test (V-TSST), during which salivary cortisol samples were collected. In addition, high frequency heart rate variability (HF-HRV), heart rate (HR), t-wave amplitude (TWA), and α-amylase were assessed to examine stress reactivity and habituation in the autonomic nervous system (ANS). The initial analyses showed clear hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) activations in both V-TSST sessions, together with habituation of cortisol and heart rate in the second session, but without any significant group differences. However, the former EDpatients showed considerable variation in self-reported signs of exhaustion (SMBQ). This led us to assign former EDpatients with lower ratings into the low SMBQ group (LOWS) and those with higher ratings to the high SMBQ group (HIGHS). When repeating the analyses a different picture emerged; the HIGHS showed a lower cortisol response to the V-TSST than did the LOWS. Both groups' cortisol response habituated to the second V-TSST session. The ANS responses did not differ between the two groups. Thus, persons in a pre-stage of ED and unrecovered former EDpatients showed signs of DSR, in contrast to healthy controls and recovered former EDpatients. The results may be interpreted as indicating that DSR in the HPA axis is present early on in the stress process, but subsides after successful recovery.
