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
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
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DOI：
10.3109/10253890.2012.683465
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发表时间：
2013-01
期刊：
影响因子：
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通讯作者：
Maren Wolfram;S. Bellingrath;Nicolas Feuerhahn;B. Kudielka
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文献类型：
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作者：
Maren Wolfram;S. Bellingrath;Nicolas Feuerhahn;B. Kudielka
在流行病学研究中积累了长期工作压力对健康有害影响的证据。最近的研究表明，改变下丘脑-垂体-肾上腺（HPA）轴的调节作为一个可能的生物学途径之间的联系压力和疾病。然而，调节异常的方向仍不清楚，报告HPA高或低反应性。为了解开HPA轴不同功能水平的潜在影响，我们在53名健康教师中使用两种药物刺激试验检查了反应（31名女性，22名男性;平均年龄：49.3岁;年龄范围：30-64岁）：低剂量促肾上腺皮质激素（ACTH 1 -24，Synacthen）试验检测肾上腺皮质敏感性及地塞米松-促肾上腺皮质激素释放激素（DEX-CRH）联合应用检查垂体和肾上腺皮质反应性的试验。在-1、+15、+30、+45、+60、+90、+120 min时采集血液和唾液样本。情绪耗竭（EE）是倦怠的核心维度，采用Maslach倦怠量表进行测量。根据Siegrist的努力-回报-不平衡模型评估过度承诺（OC）。我们发现EE和Synacthen后较高的血浆皮质醇谱之间存在显著相关性（p = 0.045）。相比之下，OC与DEX-CRH后ACTH（p = 0.045）、血浆皮质醇（p = 0.005）和唾液皮质醇（p = 0.023）浓度降低显著相关。结果支持的概念，改变HPA轴调节在长期工作压力的教师，根据个人的压力条件和HPA轴的测试功能水平的高反应性和低反应性的差异模式。
Evidence for a detrimental impact of chronic work stress on health has accumulated in epidemiological research. Recent studies indicate altered hypothalamus–pituitary–adrenal (HPA) axis regulation as a possible biological pathway underlying the link between stress and disease. However, the direction of dysregulation remains unclear, with reported HPA hyper- or hyporeactivity. To disentangle potential effects on different functional levels in the HPA axis, we examined responses using two pharmacological stimulation tests in 53 healthy teachers (31 females, 22 males; mean age: 49.3 years; age range: 30–64 years): a low-dose adrenocorticotrophic hormone (ACTH1–24, Synacthen) test was used to assess adrenal cortex sensitivity and the combined dexamethasone–corticotropin releasing hormone (DEX–CRH) test to examine pituitary and adrenal cortex reactivity. Blood and saliva samples were collected at − 1,+15,+30,+45,+60,+90,+120 min. Emotional exhaustion (EE), the core dimension of burnout, was measured with the Maslach Burnout Inventory. Overcommitment (OC) was assessed according to Siegrist's effort–reward–imbalance model. We found a significant association between EE and higher plasma cortisol profiles after Synacthen (p = 0.045). By contrast, OC was significantly associated with attenuated ACTH (p = 0.045), plasma cortisol (p = 0.005), and salivary cortisol (p = 0.023) concentrations following DEX–CRH. Results support the notion of altered HPA axis regulation in chronically work-stressed teachers, with differential patterns of hyper- and hyporeactivity depending on individual stress condition and the tested functional level of the HPA axis.