The Psychophysiology of the burnout syndrome: cortisol sampling in burned out subjects

Burnout symptoms of emotional exhaustion, depersonalisation and reduced personal accomplishment are the result of chronic stress. Specifically the hypothalamus pituitary adrenal (HPA)-axis is involved in long-term stress adaptation. Upon stimulation the HPA-axis releases cortisol from the adrenal medulla. Cortisol maintains the stress response and at the same time prevents overshoot of the stress response. The HPA-axis is interconnected with other regulatory systems involved in maintaining the energy balance, mood states, cognition, immunity, feeding and reproduction. A disrupted HPA-axis, with either hypo- or hyperfunctioning, could therefore act upon these systems, causing a whole array of different symptoms found in burnout individuals. The main goal of our study is to establish the occurrence of HPA-axis disregulation in burned out subjects. Burned out subjects are included before receiving treatment in a Dutch private health clinic. To date 40 burnout subjects (30 M) and 25 controls (18 M) have been included. The HPA-axis and burnout related questionnaires are sampled at the onset of treatment (T1), immediately after treatment (T2) and at follow up (T3) 6 months later. At each time point basic cortisol levels are measured non-invasively via cotton role saliva sampling. Daily sampling on two consecutive days includes the early morning rise (acute increase after awakening) and 3 further samples across the day. The dexamethason suppression test (0,5 mg o.d.) provides information on the negative feedback efficiency of the HPA-axis. A preceding pilot study on 22 burnout subjects (7 M, age 45 SD 8) and 21 controls (7 M, age 50 SD 7) has shown that the cortisol EMR level is lower for burnout subjects compared with the control group. The Early Morning Rise, and the day curve are not different. The burnout subjects also score sign. higher on the following questionnaires: SCl-90; general complaints, MBI; burnout, CIS-20; fatigue, BDI; depression, GSKS; sleep, CFQ; cognitive functioning. However a correlation between the cortisol data and the psychological complaints was not found. The first data of T1 sampling in the ongoing study will be shown.