Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus-pituitary-adrenal (HPA) axis responses to a low-dose ACTH1-24 (Synacthen) and dexamethasone-CRH test in healthy school teachers

Effort-reward and overcommitment at work and psychiatric symptoms in healthcare professionals: The mediation role of allostatic load

Background

Despite decades of advancement to support interventions for managing work-related stress, mental health issues have significantly escalated among healthcare professionals. Effort-reward imbalance (ERI) and overcommitment in the workplace are linked to several psychiatric disorders. However, the underlying biological mechanisms remain unclear. This study investigated whether ERI and overcommitment among healthcare professionals were linked to Allostatic Load (AL) and whether AL mediates the relationship between ERI, overcommitment and mental health issues.

Methods

One hundred forty-two nursing workers (n = 142; 90.1 % female, mean age: 39.5 ± 9.6) were randomly recruited from a university hospital in Sao Paulo, Brazil, and applied the ERI scale that assesses work effort, reward, and overcommitment. The Perceived Stress Scale (PSS), The Beck Depression Inventory (BDI), and the Self-Report Questionnaire for psychiatric symptoms (SRQ-20) evaluated the mental health outcomes. Ten neuroendocrine, metabolic, immunologic and cardiovascular biomarkers were analyzed, and values were transformed into an AL index using clinical reference cutoffs.

Results

Linear regression adjusted for covariates showed that higher scores for overcommitment were associated with higher AL indexes, which in turn were associated with higher SRQ-20, but not with PSS and DBI scores. As expected, higher scores for effort, lower for reward, and higher ERI were associated with higher scores for PSS, SRQ-20, and DBI, but not with AL index. Direct effect estimates showed that overcommitment was directly associated with higher SRQ-20 scores, and indirectly via AL.

Conclusion

Our study reveals that overcommitment, rather than ERI, was linked to increased AL in healthcare workers. Additionally, AL mediates the relationship between overcommitment and higher psychiatric symptoms, highlighting a key mechanism by which work stress can lead to mental health problems. Individual's responses to high work demands need to be considered when designing predictive models and interventions for mental health issues.

Job load, job stress, and job exhaustion among Chinese junior middle school teachers: Job satisfaction as a mediator and teacher’s role as a moderator

Job exhaustion is not uncommon among Chinese middle school teachers, but the key antecedents of job exhaustion and the underlying mechanisms in this historically underrepresented population remain poorly understood. This study examined the association between job demand and exhaustion, and tested the mediating role of job satisfaction and the moderating role of teachers’ role (i.e., homeroom versus subject) in this association. The two-wave, China Education Panel Survey data from 701 Chinese junior middle school teachers (M_age = 30.05 years old, SD_age = 7.86; 78.75% females) were used. Primary hypotheses were tested using structural equation modelling. Results indicated that job load rather than job stress at Wave 1 was positively associated with job exhaustion at Wave 2 indirectly through its negative association with job satisfaction at Wave 2 only among subject teachers; in contrast, for homeroom teachers, job satisfaction at Wave 2 was the only factor that was identified to be negatively associated with job exhaustion at Wave 2. Notably, all significant associations emerged after controlling for a number of covariates, including job exhaustion at Wave 1. Such findings shed initial light on the complexity inherent within the phenomena of middle school teachers’ occupational health in a Chinese cultural context. Reducing teachers’ work load associated with long working hours and promoting teachers’ job satisfaction may be effective ways to relieve and prevent job exhaustion, especially for Chinese subject teachers.

Psychological Stress = Physiological Stress?

Abstract. The present study analyzed experimentally the association between the experience of psychological stress and the physiological stress response of prospective teachers. The experienced stress was assessed by self-reported data. Cortisol concentrations via saliva samples reflected the physiological response. The results show no difference between the stress and the control group in the experience of psychological stress. However, the stress group had significantly increased cortisol concentrations compared to the control group. The study could not show any correlation between the two stress parameters. The results suggest that a stress response should be validated based not only on the experience of psychological stress but also on the physiological stress response. This is particularly crucial in light of the fact that the majority of studies concerning stress in teachers are limited to experiences of psychological stress so far. Due to this, the results may provide a first important contribution to a more comprehensive stress assessment for teachers.

The biology of burnout: Causes and consequences

OBJECTIVES

Burnout is a state of exhaustion resulting from prolonged and excessive workplace stress. We sought to examine biological underpinnings of burnout, focussing on mechanisms and physical consequences.

METHODS

We searched the literature on burnout and evaluated studies examining biological parameters in patient populations (i.e. 'clinical' burnout) as well as in individuals from the general population judged as having some degree of burnout evaluated using a dimensional approach.

RESULTS

Findings suggest that burnout is associated with sustained activation of the autonomic nervous system and dysfunction of the sympathetic adrenal medullary axis, with alterations in cortisol levels. Limited studies have also shown altered immune function and changes in other endocrine systems. Consequences of burnout include increased allostatic load, structural and functional brain changes, excito-toxicity, systemic inflammation, immunosuppression, metabolic syndrome, cardiovascular disease and premature death. Limitations of studies include variability in study populations, low specificity of burnout measures, and mostly cross-sectional studies precluding examination of changes across the course of burnout.

CONCLUSIONS

Further examination of biological mechanisms of burnout would benefit from more homogeneous clinical samples, challenge tests and prospective studies. This would assist in differentiation from conditions such as depression and aid with development of specific treatment targets for burnout.

A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself

Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individual’s clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.

The hypothalamo-pituitary-adrenal axis and the autonomic nervous system in burnout

Burnout constitutes a serious health concern in the modern working environment. It is a stress-related condition that has developed as a result of a prolonged psychosocial stress exposure causing a persistent mismatch between demands and resources. The main symptom is emotional exhaustion, but physical fatigue, diminished professional efficacy, cynicism, and cognitive impairments are also associated with this condition. Burnout has been used both as a psychologic term in occupational settings and as a clinical diagnosis in patient populations, and there is currently no universally accepted definition and diagnostic criteria of burnout. It has been hypothesized that the two main stress response systems, the autonomic nervous system (ANS) and the hypothalamus-pituitary-adrenal axis (HPA axis), are involved in the pathogenesis of burnout. A common hypothesis is that in the early stages of chronic stress, the HPA axis and sympathetic ANS activity tend to be higher, while it will decrease with a longer duration of chronic stress to ultimately reach a state of hypoactivity in clinical burnout. The current research in this field shows many contradictory results. Thus there is no compelling evidence of either ANS or HPA dysfunction in burnout. However, there is partial support for the hypothesis of HPA and sympathetic hyperactivity in early stages, and HPA hyporeactivity and low vagal activity in more severe burnout cases, but high-quality studies investigating the causal links are still lacking.

Involuntary vs. Voluntary Flexible Work: Insights for Scholars and Stakeholders

Building on insights from the early stages of our research partnership with a U.S. Fortune 500 organization, we came to differentiate between voluntary and involuntary schedule variability and remote work. This differentiation underscores the complexity behind flexible schedules and remote work, especially among white-collar, salaried professionals. We collected survey data among the partner firm's information technology (IT) workforce to evaluate whether these forms of flexibility had different implications for workers, as part of the larger Work, Family, and Health Network Study. We find that a significant minority of these employees report working variable schedules and working at home involuntarily. Additionally, involuntary variable schedules are associated with greater work-to-family conflict, stress, burnout, turnover intentions, and lower job satisfaction in models that adjust for personal characteristics, type of job, work hours, family demands, and other factors. Voluntary remote work, in contrast, is protective and more common in this professional sample. Employees working at least 20% of their hours at home and reporting moderate or high choice over where they work have lower stress and intentions to leave the firm (as well as higher job satisfaction in some models). These findings point to the importance of both stakeholders and scholars distinguishing between voluntary and involuntary forms of flexibility, even in a relatively advantaged professional and technical workforce.

MECHANISMS IN ENDOCRINOLOGY: Endocrine and immunological aspects of burnout: a narrative review

Burnout has several different definitions, and attempts have been made to discriminate between burnout as a psychological construct and burnout as a clinical entity. A large body of research has focused on elucidating the biological link between stress exposure and burnout and/or finding a clinically usable biomarker for burnout. The objective of this narrative review is to summarize the main endocrine and immune findings in relation to burnout. The literature has primarily focused on dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis. However, albeit the large body of studies, it cannot be concluded that clear effects are seen on HPA axis function in people with burnout. The HPA axis and anabolic acute reactivity to stress might be affected in clinical burnout. Plausible, effects of chronic stress might rather be seen when measuring responses to acute stress rather than resting state hormonal levels. Studies on other hormones, including thyroid hormones, prolactin and growth hormone in burnout subjects are inconclusive. It is important to note that this field is faced with many methodological challenges, one being the diurnal and pulsatile nature of many of the hormones of interest, including cortisol, which is not always considered. Another challenge is the heterogeneity regarding definitions and measurements of stress and burnout. Existing studies on burnout and immune function are heterogeneous regarding the results and no firm conclusion can be made if clinically relevant immune changes are present in burnout subjects. An overall conclusion is that existing research cannot confirm any homogenous reliable endocrinological or immunological changes related to burnout.

How to measure glucocorticoid receptor's sensitivity in patients with stress-related psychiatric disorders

Stress is a state of derailed homeostasis and a main environmental risk factor for psychiatric diseases. Chronic or uncontrollable stress may lead to a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a common feature of stress-related psychiatric disorders. One of the key mechanisms underlying a disturbed HPA axis is an impaired function of the glucocorticoid receptor (GR) with an enhanced or reduced feedback sensitivity for glucocorticoids and subsequently altered concentrations of peripheral cortisol. GR function is regulated by a multiprotein complex including the different expression of the hsp90 co-chaperone FK 506 binding protein 51 (FKBP5) that may be genetically determined or acquired in response to stressful stimuli. Specific patterns of a dysregulation of the HPA axis and GR function are found in different stress-related psychiatric entities e.g. major depression, job-related exhaustion or posttraumatic stress disorder. GR challenge tests like the dexamethasone-suppression test (DST), the dexamethasone-corticotropin-releasing hormone (dex-CRH) test or most recently the analysis of the dexamethasone-induced gene expression are employed to sensitively measure HPA axis activity in these disorders. They provide information for a stratification of phenotypic similar but neurobiological diverse psychiatric disorders. In this review we present a synopsis of GR challenge tests with a focus on the application of the DST, the CRH test and the dex-CRH test as well as the dexamethasone-induced gene expression in stress-related psychiatric entities.

Educators' emotion regulation strategies and their physiological indicators of chronic stress over 1 year

Studies show teaching is a highly stressful profession and that chronic work stress is associated with adverse health outcomes. This study analysed physiological markers of stress and self-reported emotion regulation strategies in a group of middle school teachers over 1 year. Chronic physiological stress was assessed with diurnal cortisol measures at three time points over 1 year (fall, spring, fall). The aim of this longitudinal study was to investigate the changes in educators' physiological level of stress. Results indicate that compared to those in the fall, cortisol awakening responses were blunted in the spring. Further, this effect was ameliorated by the summer break. Additionally, self-reported use of the emotion regulation strategy reappraisal buffered the observed blunting that occurred in the spring.

Mechanisms of Mitochondrial Redox Signaling in Psychosocial Stress-Responsive Systems: New Insights into an Old Story

SIGNIFICANCE

Psychosocial stress is associated with alterations in serum glucocorticoids and cytokines, such as interleukin-6 (IL-6) and IL-1β, which functionally interact. However, the molecular mechanisms and physiological relationship between the two systems within the context of stress exposure are not well characterized. Recent Advances: Extracellular IL-6, which stimulates the release of cortisol from the zona fasciculata of the adrenal cortex, mediates its intracellular effects by tyrosine phosphorylation of the transcription factor signal transducer and activator of transcription 3 (STAT3). Mitochondrial electron transfer reactions are involved in both STAT3-driven ATP production in oxidative respiration and adrenocortical steroid biosynthesis.

CRITICAL ISSUES

The role of STAT3 in oxidative respiration and steroidogenesis suggests that it integrates both nuclear and mitochondrial actions, thereby preserving main steps of glucocorticoid biosynthesis in the adrenal gland under psychosocial stress. This review discusses the notion that these two pathways are together simultaneously involved in protection against chronic stressors.

FUTURE DIRECTIONS

Linking the function of cytokines and main components of the hypothalamic-pituitary-adrenal (HPA) axis to molecular mechanisms of mitochondrial redox signaling will be essential for a better understanding of the relevant stress-responsive systems engaged in stress vulnerability. Antioxid. Redox Signal. 28, 760-772.

Limbic brain structures and burnout-A systematic review

More profound understanding of the relationship between the burnout and the limbic system function can provide better insight into brain structures associated with the burnout syndrome. The objective of this review is to explore all evidence of limbic brain structures associated with the burnout syndrome. In total, 13 studies were selected. Four of them applied the neuroimaging technology to investigate the sizes/volumes of the limbic brain structures of burnout patients. Six other studies were to investigate the hypothalamus-pituitary-adrenal (HPA) axis of burnout patients. Based on the results of the studies on the HPA-axis and neuroimaging of the limbic brain structures, one can see great impact of the chronic occupational stress on the limbic structures in terms of HPA dysregulation, a decrease of BDNF, impaired neurogenesis and limbic structures atrophy. It can be concluded that chronic stress inhibits the feedback control pathway in the HPA axis, causes the decrease of brain-derived neurotrophic factor (BDNF), then impaired neurogenesis and eventually neuron atrophy.

A Systematic Review and Meta-analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-Adrenal Axis Measures of Stress

OBJECTIVE

The association between effort-reward imbalance (ERI) and various health outcomes has been well documented over the past 20 years, but the mechanisms responsible for this association remain unclear. The present meta-analysis assessed the associations of ERI and overcommitment (OC) in the workplace with hypothalamic-pituitary-adrenal (HPA) axis measures.

METHODS

Electronic databases were searched with the phrase "effort*reward*imbalance," which yielded 319 studies leading to 56 full-text studies being screened. Thirty-two studies within 14 articles met inclusion criteria and were meta-analyzed using mixed and random effects models.

RESULTS

Greater ERI was associated with increased HPA axis activity (r = .09, p < .001, k = 14, N = 2541). The cortisol awakening response (r = .14, p < .001, k = 9, N = 584) and cortisol waking concentrations (r = .12, p = .01, k = 6, N = 493) were the only HPA measures associated with ERI. OC was also associated with greater HPA axis activity (r = .06, p < .01, k = 10, N = 1918). Cortisol (PM) (r = .13, p = .02, k = 3, N = 295) was the only HPA measure associated with OC.

CONCLUSIONS

ERI and OC were similarly related with HPA responsivity. However, because OC moderated the relationship between ERI and HPA axis markers, the importance of OC should not be overlooked. Because OC is likely more malleable than ERI to intervention, this may be a promising avenue for future research.

Work Stress and Altered Biomarkers: A Synthesis of Findings Based on the Effort-Reward Imbalance Model

While epidemiological studies provide statistical evidence on associations of exposures such as stressful work with elevated risks of stress-related disorders (e.g., coronary heart disease or depression), additional information on biological pathways and biomarkers underlying these associations is required. In this contribution, we summarize the current state of the art on research findings linking stressful work, in terms of an established theoretical model-effort-reward imbalance-with a broad range of biomarkers. Based on structured electronic literature search and recent available systematic reviews, our synthesis of findings indicates that associations of work stress with heart rate variability, altered blood lipids, and risk of metabolic syndrome are rather consistent and robust. Significant relationships with blood pressure, heart rate, altered immune function and inflammation, cortisol release, and haemostatic biomarkers were also observed, but due to conflicting findings additional data will be needed to reach a firm conclusion. This narrative review of empirical evidence supports the argument that the biomarkers under study can act as mediators of epidemiologically established associations of work stress, as measured by effort-reward imbalance, with incident stress-related disorders.

Adrenal fatigue does not exist: a systematic review

BACKGROUND

The term "adrenal fatigue" ("AF") has been used by some doctors, healthcare providers, and the general media to describe an alleged condition caused by chronic exposure to stressful situations. Despite this, "AF" has not been recognized by any Endocrinology society, who claim there is no hard evidence for the existence. The aim of this systematic review is to verify whether there is substantiation for "AF".

METHODS

A systematic search was performed at PUBMED, MEDLINE (Ebsco) and Cochrane databases, from the beginning of the data until April 22nd, 2016. Searched key words were: "adrenal" + "fatigue", "adrenal" + "burnout", "adrenal" + "exhaustion", "hypoadrenia", "burnout" + "cortisol", "fatigue" + "cortisol", "clinical" + "burnout", "cortisol" + "vitalility", "adrenal" + "vitality", and "cortisol" + "exhaustion". Eligibility criteria were: (1) articles written in English, (2) cortisol profile and fatigue or energy status as the primary outcome, (3) performed tests for evaluating the adrenal axis, (4) absence of influence of corticosteroid therapy, and (5) absence of confounding diseases. Type of questionnaire to distinct fatigued subjects, population studied, tests performed of selected studies were analyzed.

RESULTS

From 3,470 articles found, 58 studies fulfilled the criteria: 33 were carried in healthy individuals, and 25 in symptomatic patients. The most assessed exams were "Direct Awakening Cortisol" (n = 29), "Cortisol Awakening Response" (n = 27) and "Salivary Cortisol Rhythm" (n = 26).

DISCUSSION

We found an almost systematic finding of conflicting results derived from most of the studies methods utilized, regardless of the validation and the quality of performed tests. Some limitations of the review include: (1) heterogeneity of the study design; (2) the descriptive nature of most studies; (3) the poor quality assessment of fatigue; (4) the use of an unsubstantiated methodology in terms of cortisol assessment (not endorsed by endocrinologists); (5) false premises leading to an incorrect sequence of research direction; and, (6) inappropriate/invalid conclusions regarding causality and association between different information.

CONCLUSION

This systematic review proves that there is no substantiation that "adrenal fatigue" is an actual medical condition. Therefore, adrenal fatigue is still a myth.

Relationship Between Job Burnout and Neuroendocrine Indicators in Soldiers in the Xinjiang Arid Desert: A Cross-Sectional Study

The purpose of this study was to explore the relationship between job burnout and neuroendocrine indicators in soldiers living in a harsh environment. Three hundred soldiers stationed in the arid desert and 600 in an urban area were recruited. They filled in the Chinese Maslach Burnout Inventory questionnaire. One hundred soldiers were randomly selected from each group to measure their levels of noradrenaline, serotonin, heat shock protein (HSP)-70, adrenocorticotropic hormone, and serum cortisol. Job burnout was more common in soldiers from urban areas than those from rural areas. Job burnout was significantly higher among soldiers stationed in the arid desert than those in urban areas. For soldiers in the arid desert, the levels of HSP-70, serum cortisol, and adrenocorticotropic hormone were significantly higher than in soldiers in urban areas. Correlation analyses showed that the degree of job burnout was weakly negatively correlated with the level of HSP-70. Being an only child, HSP-70 levels, cortisol levels, and ACTH levels were independently associated with job burnout in soldiers stationed in the arid desert. A higher level of job burnout in soldiers stationed in arid desert and a corresponding change in neuroendocrine indicators indicated a correlation between occupational stress and neurotransmitters.

Preparation for teacher collaboration in inclusive classrooms - stress reduction for special education students via acceptance and commitment training: A controlled study

Background

The education system in Germany is beginning to witness a sea change, lately, owing to the country’s ratification of the United Nation’s Convention on the Rights of Persons with Disabilities. The enactment is aiming at making provision for special education teachers to share the same teaching platform and institution with other teachers for teaching children from all backgrounds, irrespective of their needs. While promoting the benefits of collaborative teaching, this provision would also effectively establish role demarcation among teachers. However, the level of participation and adaptiveness displayed by individual teachers would play a major role in determining the success or failure of the intended collaborative framework.

Collaboration also becomes challenging due to the level of stress involved in the teaching profession. The fact that only 65 % of teachers in Germany reach retirement age while still in service, primarily due to psychiatric illness, has posed questions on adopting the collaborative framework for teachers from diverse backgrounds. In other words, it can be stated that the process of collaborating with teachers from different professional backgrounds and with varying levels of skills will potentially lead to further stress. The stress-related psychological states, developed through the collaborative processes, might affect the biological stress-response systems of the participating teachers. With stress-response contributing directly to the pathogenesis of stress-related diseases and disorders in the long term, it would be important to contain the ripple effect of collaborative framework that the enactment intends to establish between SEN (special educational needs) teachers and others.

Methods

In addition to impacting the long-term health of teachers, the collaborative framework is also suggestive of having similar effects on students studying special education (SEN students). A study was conducted to examine the stress levels associated with the collaborative framework. An expression in terms of two (group affiliation) × 2 (measurement time) between subjects design was implemented to examine the effects of an Acceptance and Commitment Training on the subjective tension of a sample (N = 68) of SEN students. The sample was split into an intervention and a control group (IG and CG). The effects of the training on collaborative competence were examined using the Chi-square test. Questionnaire and role plays were used to assess the collaborative competence and the subjective tension.

Results

The participants had significant stress levels and displayed an uncooperative attitude during the initial assessment. However, these results reversed after the Acceptance and Commitment Training. Significant decrease in stress levels and improved cooperation were evident among the participants in the intervention group, as opposed to the participants of the control group.

Conclusions

The findings of this study show that the Acceptance and Commitment Training is an appropriate medium to establish and develop collaboration skills, and an effective technique to reduce high levels of subjective stress. Furthermore, the training evaluation and feedback indicate that it is well-accepted by all participants. The training is also endorsed as a practically relevant medium to help SEN students collaborate and combat stress.

Mind and body: how the health of the body impacts on neuropsychiatry

It has long been established in traditional forms of medicine and in anecdotal knowledge that the health of the body and the mind are inextricably linked. Strong and continually developing evidence now suggests a link between disorders which involve Hypothalamic-Pituitary-Adrenal axis (HPA) dysregulation and the risk of developing psychiatric disease. For instance, adverse or excessive responses to stressful experiences are built into the diagnostic criteria for several psychiatric disorders, including depression and anxiety disorders. Interestingly, peripheral disorders such as metabolic disorders and cardiovascular diseases are also associated with HPA changes. Furthermore, many other systemic disorders associated with a higher incidence of psychiatric disease involve a significant inflammatory component. In fact, inflammatory and endocrine pathways seem to interact in both the periphery and the central nervous system (CNS) to potentiate states of psychiatric dysfunction. This review synthesizes clinical and animal data looking at interactions between peripheral and central factors, developing an understanding at the molecular and cellular level of how processes in the entire body can impact on mental state and psychiatric health.

Higher-status occupations and breast cancer: a life-course stress approach

Using the 1957-2011 data from 3682 White non-Hispanic women (297 incident breast cancer cases) in the Wisconsin Longitudinal Study, United States, we explore the effect of occupation in 1975 (at age 36) on breast cancer incidence up to age 72. Our study is motivated by the paradoxical association between higher-status occupations and elevated breast cancer risk, which presents a challenge to the consistent health advantage of higher social class. We found that women in professional occupations had 72122% and women in managerial occupations had 57-89% higher risk of a breast cancer diagnosis than housewives and women in lower-status occupations. We explored an estrogen-related pathway (reproductive history, health behaviors, and life-course estrogen cycle) as well as a social stress pathway (occupational experiences) as potential explanations for the effect of higher-status occupations. The elevated risk of breast cancer among professional women was partly explained by estrogen-related variables but remained large and statistically significant. The association between managerial occupations and breast cancer incidence was fully explained by job authority defined as control over others' work. Exercising job authority was related to higher breast cancer risk (HR = 1.57, 95% CI: 1.12, 2.18), especially with longer duration of holding the professional/managerial job. We suggest that the assertion of job authority by women in the 1970s involved stressful interpersonal experiences that may have promoted breast cancer development via prolonged dysregulation of the glucocorticoid system and exposure of the breast tissue to adverse effects of chronically elevated cortisol. Our study emphasizes complex biosocial pathways through which women's gendered occupational experiences become embodied and drive forward physiological repercussions.