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The role of stress in absenteeism: cortisol responsiveness among patients on long-term sick leave.

Jacobsen HB, Bjørngaard JH, Hara KW, Borchgrevink PC, Woodhouse A, Landrø NI, Harris A, Stiles TC - PLoS ONE (2014)

Bottom Line: Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups.The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave.The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.

View Article: PubMed Central - PubMed

Affiliation: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.

ABSTRACT

Objective: This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal.

Methods: Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.

Results: Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups.

Conclusions: The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.

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Related in: MedlinePlus

Fitted random effects models of subgroup analyses on participant characteristics.Characteristics were dichotomized as “Yes” or “No” based on established cut-offs (fatigue, pain, anxiety, depression and/or sleep problems) or occurrence/non-occurrence (smoking, SCID-diagnosis and/or medication). The gray bar represents the TSST-G exposure phase, and error bars represent 95% confidence intervals.
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pone-0096048-g003: Fitted random effects models of subgroup analyses on participant characteristics.Characteristics were dichotomized as “Yes” or “No” based on established cut-offs (fatigue, pain, anxiety, depression and/or sleep problems) or occurrence/non-occurrence (smoking, SCID-diagnosis and/or medication). The gray bar represents the TSST-G exposure phase, and error bars represent 95% confidence intervals.

Mentions: In figure 3, TSST-G curves from participants were dichotomized as “Yes” or “No” based on established cut-offs (fatigue, pain, anxiety, depression and/or sleep problems) or occurrence/non-occurrence (smoking, SCID-diagnosis and/or medication). There was weak evidence for any statistical interaction between the exposure effect on cortisol response and self-reported caseness of chronic fatigue, depression, anxiety, chronic pain, sleep problems, antidepressant/synthetic hormone medication, one or more SCID Axis-I diagnoses, age, sex or BMI (p>0.05). There was evidence of statistical interaction between the exposure effect on cortisol response and smoking (p = 0.003). There was a tendency towards a higher initial cortisol level and a weaker exposure effect in smokers (Figure 3).


The role of stress in absenteeism: cortisol responsiveness among patients on long-term sick leave.

Jacobsen HB, Bjørngaard JH, Hara KW, Borchgrevink PC, Woodhouse A, Landrø NI, Harris A, Stiles TC - PLoS ONE (2014)

Fitted random effects models of subgroup analyses on participant characteristics.Characteristics were dichotomized as “Yes” or “No” based on established cut-offs (fatigue, pain, anxiety, depression and/or sleep problems) or occurrence/non-occurrence (smoking, SCID-diagnosis and/or medication). The gray bar represents the TSST-G exposure phase, and error bars represent 95% confidence intervals.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4008526&req=5

pone-0096048-g003: Fitted random effects models of subgroup analyses on participant characteristics.Characteristics were dichotomized as “Yes” or “No” based on established cut-offs (fatigue, pain, anxiety, depression and/or sleep problems) or occurrence/non-occurrence (smoking, SCID-diagnosis and/or medication). The gray bar represents the TSST-G exposure phase, and error bars represent 95% confidence intervals.
Mentions: In figure 3, TSST-G curves from participants were dichotomized as “Yes” or “No” based on established cut-offs (fatigue, pain, anxiety, depression and/or sleep problems) or occurrence/non-occurrence (smoking, SCID-diagnosis and/or medication). There was weak evidence for any statistical interaction between the exposure effect on cortisol response and self-reported caseness of chronic fatigue, depression, anxiety, chronic pain, sleep problems, antidepressant/synthetic hormone medication, one or more SCID Axis-I diagnoses, age, sex or BMI (p>0.05). There was evidence of statistical interaction between the exposure effect on cortisol response and smoking (p = 0.003). There was a tendency towards a higher initial cortisol level and a weaker exposure effect in smokers (Figure 3).

Bottom Line: Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups.The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave.The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.

View Article: PubMed Central - PubMed

Affiliation: Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.

ABSTRACT

Objective: This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal.

Methods: Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.

Results: Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups.

Conclusions: The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.

Show MeSH
Related in: MedlinePlus