Examining reactivity patterns in burnout and other indicators of chronic stress

Abstract

Introduction: Burnout symptomatology is associated with various negative health consequences; however, the mechanisms underlying these associations remain unclear. One potential pathway involves alterations in the acute stress response. The aims of the present study were to examine burnout-associated alterations in stress-reactivity patterns, during a standardized social stressor compared to a control condition, as well as to examine whether effects associated with greater burnout symptomatology were distinct from other, conceptually overlapping indicators of chronic stress (i.e. depressive symptomatology and elevated hair cortisol concentration [HCC]).

Materials and methods: In a randomized two-factor design a total of 70 employed males with varying burnout symptoms but without evidence of physical or psychiatric disease were exposed to the Trier Social Stress Test for Groups (TSST-G) or a non-stressful control condition. Acute stress reactivity was assessed using self-report stress measures and non-invasive biomarkers. Associations among acute stress reactivity, burnout and depressive symptoms (assessed with self-report measures), as well as HCC were analysed using repeated measure ANCOVAs and moderation analysis.

Results: Burnout symptomatology was associated with elevated stress perception independent of the experimental condition. In addition, depressive symptomatology was associated with enhanced anticipatory appraisal, whereas HCC was not related to any subjective stress measure. On a physiological level, burnout and depressive symptomatology, as well as HCC were associated with a pattern of blunted cardiovascular reactivity, however the timing of this effect varied.

Conclusion: Our results indicate burnout-associated modulations in stress reactivity, which diverge, at least partly, from other indicators of chronic stress.

Keywords: Burnout; Chronic stress; Depression; Hair cortisol; Stress reactivity; TSST.

Fig. 1.

Sequence of events and timeline for both, TSST-G and control condition. Preparation = preparation of job interview (TSST-G) vs. reading of a popular scientific test (control); SIP1= social interaction paradigm, set 1 (data not reported here); SIP2 = social interaction paradigm, set 2 (data not reported here); tsstl = mock job interview (TSST-G) vs. reading in a low voice (control); tsst2 = serial subtraction (TSST-G) vs. enumerating series of numbers in low voice (control). Figure adapted from von Dawans et al. (2011).

Fig. 2.

Manipulation check. Mean levels of (A) six VAS ratings, (B) salivary cortisol, (C) salivary alpha amylase, (D) heart rate, and (E) vagally-mediated heart rate variability before, during and after a standardized psychosocial stressor in a group format (Trier Social Stress Test for Groups; TSST-G) and a control condition (Control). Error bars are SE. vmHRV = vagally-mediated heart rate variability.

Fig. 3.

Simple slopes of condition predicting heart rate, respectively heart rate variability during (1) preparation for high, mean and low levels of (A) burnout symptoms, and (B) depressive symptoms; during (2) speaking task (tsst1), and (3) number task (tsst2) for (C) hair cortisol concentration. High levels represent M + 1SD, mean levels represent M, low levels represent M-1SD. HCC = hair cortisol concentration; MBI-GS = Maslach Burnout Inventory - General Survey sum-score, burnout symptoms; PHQ-9 = Patient Health Questionnaire sum-score, depressive symptoms; vmHRV = vagally-mediated heart rate variability.