A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers

Juster, Robert‐Paul; Sindi, Shireen; Marin, Marie‐France; Perna, Andrea; Hashemi, Alireza; Pruessner, Jens C.; Lupien, Sonia J.

doi:10.1016/j.psyneuen.2010.11.001

Cited by 161 publications

(126 citation statements)

References 62 publications

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“…a reduced CAR in anxiety disorder and stress-related allostatic load: Hek et al, 2013;Juster et al, 2011) it points to a lack of a relationship between trait well-being and average CAR in healthy participants. Some studies have demonstrated the CAR to be associated with vulnerability to future disorder in healthy participants (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Juster et al, 2011;Lovell et al, 2011;Wahbeh et al, 2008;Wuest et al, 2000a). Inconsistent results may be due to a scarcity of studies able to guarantee with some confidence adherence to the saliva sampling protocol in the domestic setting as it is known that non-adherence affects accuracy of PACS assessment (DeSantis et al, 2010;Dockray et al, 2008;Okun et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…For example poorer verbal memory, prospective memory, processing speed and executive function have been observed (e.g. a reduced CAR in anxiety disorder and stress-related allostatic load: Hek et al, 2013;Juster et al, 2011). Furthermore, experimental manipulation of a flatter CAR resulted in impaired memory retrieval in healthy young participants (Aas et al, 2011;Evans et al, 2011;Evans et al, 2012) and recently day differences in the CAR have been shown to predict day differences in synaptic plasticity in the brain of healthy young participants (Rimmele et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, opposite or null relationships have often been reported (e.g. Evans et al, 2007;Juster et al, 2011;Lovell et al, 2011;Stalder et al, 2010b;Steptoe et al, 2007;Steptoe et al, 2008;Thorn et al, 2006;Wahbeh et al, 2008;Wuest et al, 2000a). It is now recognized as essential to distinguish the CAR and AUCg measures of PACS.…”

Section: Introductionmentioning

confidence: 99%

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Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy

Thorn

Hucklebridge

Evans

et al. 2015

Psychoneuroendocrinology

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Indices of post awakening cortisol secretion (PACS), include the rise in cortisol (cortisol awakening response: CAR) and overall cortisol concentrations (e.g. area under the curve with reference to ground: AUCg) in the first 30-45 minutes. Both are commonly investigated in relation to psychosocial variables. Although sampling within the domestic setting is ecologically valid, participant non-adherence to the required timing protocol results in erroneous measurement of PACS and this may explain discrepancies in the literature linking these measures to trait well-being (TWB). We have previously shown that delays of little over 5 min (between awakening and the start of sampling) to result in erroneous CAR estimates. In this study, we report for the first time on the negative impact of sample timing inaccuracy (verified by electronic-monitoring) on the efficacy to detect significant relationships between PACS and TWB when measured in the domestic setting.Healthy females (N=49, 20.5±2.8 years) selected for differences in TWB collected saliva samples (S1-4) on 4 days at 0, 15, 30, 45 minutes post awakening, to determine PACS. Adherence to the sampling protocol was objectively monitored using a combination of electronic estimates of awakening (actigraphy) and sampling times (track caps).Relationships between PACS and TWB were found to depend on sample timing accuracy. Lower TWB was associated with higher post awakening cortisol AUCg in proportion to the mean sample timing accuracy (p<.005). There was no association between TWB and the CAR even taking into account sample timing accuracy. These results highlight the importance of careful electronic monitoring of participant adherence for measurement of PACS in the domestic setting. Mean sample timing inaccuracy, mainly associated with delays of >5 min between awakening and Smyth et al 3 collection of sample 1 (median = 8 min delay), negatively impacts on the sensitivity of analysis to detect associations between PACS and TWB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy

Thorn

Hucklebridge

Evans

et al. 2015

Psychoneuroendocrinology

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“…Burnout takes a steep toll on physicians and has negative effects on patients and health care systems. 1 Research advances detailing the detrimental effects of chronic stress, including impaired immune function, inflammation, elevation of cardiovascular risk factors, and depression, [2][3][4][5][6][7][8][9] are directly relevant to pediatric practitioners and create a need for organized efforts to address physician health and well-being in the pediatric community. The purpose of this report is to provide an update on the issue of physician health and wellness with regard to how they relate to pediatricians.…”

Section: Introductionmentioning

confidence: 99%

Physician Health and Wellness

McClafferty¹,

Brown²,

Vohra³

et al. 2014

Pediatrics

135

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Physician health and wellness is a critical issue gaining national attention because of the high prevalence of physician burnout. Pediatricians and pediatric trainees experience burnout at levels equivalent to other medical specialties, highlighting a need for more effective efforts to promote health and well-being in the pediatric community. This report will provide an overview of physician burnout, an update on work in the field of preventive physician health and wellness, and a discussion of emerging initiatives that have potential to promote health at all levels of pediatric training.Pediatricians are uniquely positioned to lead this movement nationally, in part because of the emphasis placed on wellness in the Pediatric Milestone Project, a joint collaboration between the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Updated core competencies calling for a balanced approach to health, including focus on nutrition, exercise, mindfulness, and effective stress management, signal a paradigm shift and send the message that it is time for pediatricians to cultivate a culture of wellness better aligned with their responsibilities as role models and congruent with advances in pediatric training.Rather than reviewing programs in place to address substance abuse and other serious conditions in distressed physicians, this article focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Examples of positive progress and several programs designed to promote physician health and wellness are reviewed. Areas where more research is needed are highlighted. Pediatrics 2014;134:830-835 INTRODUCTIONPhysician health and wellness is an issue garnering national interest because of the high prevalence of burnout in medical practitioners and trainees. Burnout takes a steep toll on physicians and has negative effects on patients and health care systems. 1 Research advances detailing the detrimental effects of chronic stress, including impaired immune function, inflammation, elevation of cardiovascular risk factors, and depression, 2-9 are directly relevant to pediatric practitioners and create a need for organized efforts to address physician health and well-being in the pediatric community. The purpose of this report is to provide an update on the issue of physician health and wellness with regard to how they relate to pediatricians. Rather than reviewing programs already in place to address substance abuse and other serious conditions in distressed physicians, this report focuses on forward progress in the field, with an emphasis on the need for prevention and anticipation of predictable stressors related to burnout in medical training and practice. Although specific recommendations are beyond the parameters of this report, examples of positive progress and national programs to promote physician health and wellness will be reviewed. BURNOUT: THE ANTITHESIS ...

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Stress, Recovery, Sleep, and Burnout

Toker

Melamed

2017

The Handbook of Stress and Health

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A clinical allostatic load index is associated with burnout symptoms and hypocortisolemic profiles in healthy workers

Cited by 161 publications

References 62 publications

Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy

Post awakening salivary cortisol secretion and trait well-being: The importance of sample timing accuracy

Physician Health and Wellness

Stress, Recovery, Sleep, and Burnout

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