Work stress and metabolic and hemostatic risk factors

A high level of work stress has been associated with cardiovascular disease. However, the pathophysiological mechanisms underlying this association remain unclear. This study examined the effect of work stress on a cluster of metabolic and hemostatic risk factors. Blood was collected three times, on the first, third, and fifth day of a work week, from 124 middle-aged, white-collar workers. Metabolic measures were insulin, glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol. Hemostatic measures were fibrinogen, tissue-type plasminogen activator activity, tissue-type plasminogen activator antigen, and type 1 plasminogen activator inhibitor antigen. Chronic work stress was defined according to Siegrist's model as 1) a combination of high effort and low reward at work (effort-reward imbalance) or 2) high overcommitment (an exhaustive work-related coping style). Overcommitment, but not imbalance or the imbalance-overcommitment interaction, was associated with an impaired fibrinolytic system, as reflected in decreased tissue-type plasminogen activator activity levels and increased type 1 plasminogen activator inhibitor antigen levels on all three measurement occasions. After controlling for body mass index, total cholesterol, triglycerides, high-density lipoprotein/low-density lipoprotein cholesterol ratio, glucose, and insulin, the relation between overcom-mitment and the fibrinolytic factors was attenuated but remained significant. The results suggest that individuals with an exhaustive coping style at work have an impaired fibrinolytic capacity that is possibly due to the effects of chronic stress on insulin resistanc

Effects of work stress on ambulatory blood pressure, heart rate and heart rate variability

Work stress has repeatedly been associated with an increased risk for cardiovascular disease. This study tested whether this relationship could be explained by exaggerated cardiovascular reactivity to work or impaired recovery in leisure time. Vagal tone was assessed as a possible determinant of these work stress effects. Participants included 109 male white-collar workers (age, 47.2+/-5. 3) who were monitored on 2 workdays and 1 nonworkday for ambulatory blood pressure, heart rate, and heart rate variability. Chronic work stress was defined according to Siegrist's model as (1) high imbalance, a combination of high effort and low reward at work, or (2) high overcommitment, an exhaustive work-related coping style indexing the inability to unwind. All findings were adjusted for possible differences in posture and physical activity between the work stress groups. High imbalance was associated with a higher heart rate during work and directly after work, a higher systolic blood pressure during work and leisure time, and a lower 24-hour vagal tone on all 3 measurement days. Overcommitment was not associated with an unfavorable ambulatory profile. Logistic regression analysis revealed that heart rate [odds ratio 1-SD increase 1.95 (95% CI, 1.02 to 3.77)] and vagal tone [odds ratio 1-SD decrease 2.67 (95% CI, 1.24 to 5.75)] were independently associated with incident mild hypertension. Surprisingly, the values during sleep were more predictive for mild hypertension than the values during work. The results from the present study suggest that the detrimental effects of work stress are partly mediated by increased heart rate reactivity to a stressful workday, an increase in systolic blood pressure level, and lower vagal ton

Een nieuwe rol voor stressfysiologie bij functionele lichamelijke klachten

The essential feature of functional somatic syndromes is the presence of symptoms without medical explanation. the syndromes have a high psychiatric co-morbidity, and stress and anxiety are assumed to play a role, at least in the maintenance of the complaints. Psychophysiological models traditionally attribute the symptoms to stress or anxiety-related disregulations in specific physiological mechanisms. In fact, however, there is no convincing empirical proof for such models. The idea of a direct coupling between self-reported symptoms and corresponding physiological disregulations thus seems hardly tenable. Therefore, we propose a reformulation of the potential role of stress physiology in diagnosing functional somatic symptoms. Physiological measures should not be used anymore to demonstrate explanatory physiological disregulations. They should instead be used to provide additional information about the state of activity of the central fear network . This alternative approach is based on the fact that self-reported and physiological manifestations of an emotional state are only loosely coupled, making both aspects complementary indicators of the brain activity involved. Physiological measures may thus provide additional information (above self-report) regarding emotional states implicated in functional complaints. A suggested application of this approach is to define sub-groups of functional somatic patients on the basis of similarities in disregulated physiological stress-response profiles. This in future may contribute to the development of more specific diagnostic tools and better tailored treatments

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