The association between study conditions and hair cortisol in medical students in Germany - a cross-sectional study

Did childhood adversity increase the vulnerability of university students to the negative mental health impact of the COVID-19 pandemic?

OBJECTIVE

To examine a potential synergistic effect of history of childhood adversity and COVID-19 pandemic exposure on the association with mental health concerns in undergraduate students. Participants: We used U-Flourish Survey data from 2019 (pre-pandemic) and 2020 (during-pandemic) first-year cohorts (n = 3,149) identified at entry to a major Canadian University.

METHODS

Interactions between childhood adversity (physical and sexual abuse, and peer bullying) and COVID-19 pandemic exposure regarding mental health concern (depressive and anxiety symptoms, suicidality, and non-suicidal self-harm) were examined on an additive scale.

RESULTS

We found a positive additive interaction between physical abuse and pandemic exposure in relation to suicidality (combined effect was greater than additive effect (risk difference 0.54 vs. 0.36)). Conversely, less than additive interactions between peer bullying and pandemic regarding depression and anxiety were observed.

CONCLUSIONS

Childhood adversities have diverse reactions to adult stressor depending on the nature of the childhood adversity and the mental health outcomes.

Over-commitment positively predicts hair cortisol concentrations only in nurses with high need for recovery

PURPOSE

In the contemporary workplace, enduring fatigue has become a standard for employees. This investigation assesses whether such working conditions exacerbate the depletion of employees' personal resources. The need for recovery serves as an indicator of the necessity to mitigate post-work fatigue. A high need for recovery signifies that employees must commence a new workday while already fatigued.

METHODS

This research recruited two cohorts of nurses, categorized by a high need for recovery and a low need for recovery, to examine the correlation between work effort and hair cortisol concentrations in each group.

RESULTS

Hair cortisol concentrations serve as a biological marker of cumulative cortisol secretion over a specific time frame, reflecting overall personal resource expenditure during this interval. Findings revealed a notable positive correlation between intrinsic work effort (over-commitment) and hair cortisol levels exclusively among nurses with a high need for recovery.

CONCLUSION

These outcomes imply that active effort amidst fatigue may lead to excessive strain. This insight enriches the classic 'effort-recovery' model by illustrating how an employee' s personal volition can influence the accumulation of fatigue.

Hair cortisol concentration and its association with acute stress responses and recovery in a sample of medical students in Germany

INTRODUCTION

Experiencing acute and chronic stress can contribute to adverse health outcomes. Responses to acute stress differ between individuals (i.e., stress reactivity) and the experience of chronic stress has been discussed to be associated with acute stress responses and stress recovery. This study thus aims to investigate whether hair cortisol concentration (HCC), being an indicator for hypothalamus-pituitary-adrenal (HPA) axis activity over a prolonged period of time, is associated with acute stress responses and recovery in a sample of medical students.

MATERIAL AND METHODS

From July 2020 to July 2021, medical students (n = 54) underwent a virtual-reality Trier Social Stress Test in which their blood pressure and heart rate variability (HRV) were measured, and hair samples were taken to determine HCC. Piecewise linear growth analyses were used to investigate whether HCC (categorized into low, medium and high levels) is associated with acute stress responses and recovery regarding blood pressure and HRV.

RESULTS

Significant interaction effects in piecewise linear growth analyses showed that participants with higher levels of HCC had lower systolic and diastolic blood pressure responses compared to participants with medium levels of HCC. No significant interaction effects were observed for HRV responses or for recovery measures.

CONCLUSIONS

The study suggests that higher levels of HCC are associated with a lower cardiovascular response in terms of blood pressure to an acute stressor in medical students. Therefore, long-term HPA-axis activity may contribute to different magnitudes of acute stress responses in the autonomic nervous system. As the shown lower blood pressure responses to acute stress in individuals with increased long-term HPA-axis activity may represent inadequate stress responses, these should be further studied in order to find out more about their interaction and potential subsequent disease risks.

Prospective associations of technostress at work, burnout symptoms, hair cortisol, and chronic low-grade inflammation

BACKGROUND

Working conditions in the age of digitalization harbor risks for chronic stress and burnout. However, real-world investigations into biological effects of technostress, that is stress in the context of digital technology use, are sparse. This study prospectively assessed associations between technostress, general work stress, burnout symptoms, hair cortisol, and chronic low-grade inflammation.

METHODS

Hospital employees (N = 238, 182 females, Mage = 28.5 years) participated in a prospective cohort study with two follow-ups six months apart (T2, T3). Participants answered standardized questionnaires on general job strain (job demand-control ratio), technostressors (work interruptions, multitasking, information overload), burnout symptoms (exhaustion, mental distance), and relevant confounders. Moreover, they provided capillary blood samples for C-reactive protein (CRP) and hair strands for hair cortisol concentration (HCC) analysis. Structural equation modelling was performed.

RESULTS

The factorial structure of survey measures was confirmed. Burnout symptoms (MT2 = 2.17, MT3 = 2.33) and HCC (MT2 = 4.79, MT3 = 9.56; pg/mg) increased over time, CRP did not (MT2 = 1.15, MT3 = 1.21; mg/L). Adjusted path models showed that technostress was negatively associated with HCC (β = -0.16, p =.003), but not with burnout and CRP. General work stress in contrast, was not significantly associated with burnout, HCC or CRP. Furthermore, there were reciprocal effects of CRP on HCC (β = 0.28, p =.001) and of HCC on CRP (β = -0.10, p ≤.001). Associations were robust in additional analyses including further confounders.

CONCLUSION

This is the first study on prospective effects of technostress on employees' endocrine and inflammatory systems. Results suggest differential effects of technostress on the hypothalamic-pituitary-adrenocortical axis activity. Given its key role for long-term health, the findings have important implications for occupational health and safety in digitalized work environments.

Comparison of the Perceived Stress Reactivity Scale with physiological and self-reported stress responses during ecological momentary assessment and during participation in a virtual reality version of the Trier Social Stress Test

Valid approaches to conveniently measure stress reactivity are needed due to the growing evidence of its health-impairing effects. This study examined whether the Perceived Stress Reactivity Scale (PSRS) predicts cardiovascular and psychological responses to psychosocial stressors during daily life and during a virtual reality (VR) Trier Social Stress Test (TSST). Medical students answered a standardized baseline questionnaire to assess perceived stress reactivity by the PSRS. The PSRS asks participants to rate the intensity of their typical affective responses to common stressors during daily life. They were further asked to participate in a VR-TSST and in an ecological momentary assessment (EMA) over a period of three consecutive workdays during daily life. Blood pressure and self-reported stress were repeatedly, heart rate variability (HRV) continuously measured during the VR-TSST and EMA. Furthermore, participants repeatedly assessed task demands, task control and social conflict during the EMA. Data was analysed using multilevel analysis and multiple linear regression. Results indicate that the PSRS moderates associations between blood pressure (but not HRV) and demands and control during daily life. Furthermore, the PSRS directly predicted self-reported stress, but did not moderate associations between self-reported stress and demands, control and social conflict. The PSRS did not predict physiological and self-reported stress responses to the VR-TSST. This study partly confirmed convergent validity of the PSRS to stress reactivity in daily life. Furthermore, the lack of association between the PSRS and stress responses to the VR-TSST calls for future studies to search for reliable and valid ways to assess stress reactivity.