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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: Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.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.

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: Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.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.

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