Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion.
Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion.
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倦怠和抑郁症中的自主性失调：疲惫的核心作用的证据。
DOI：
10.5271/sjweh.3647
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发表时间：
2017-09-01
期刊：
影响因子：
--
通讯作者：
Kirschbaum C
中科院分区：
文献类型：
--
作者：
Kanthak MK;Stalder T;Hill LK;Thayer JF;Penz M;Kirschbaum C
考虑到自主神经系统（ANS）在压力调节中的重要作用，令人惊讶的是，人们对ANS在职业倦怠中的作用知之甚少，职业倦怠是长期暴露于工作压力后产生的一种情况。目前的研究试图调查ANS调节，以迷走神经介导的心率变异性（HRV）为指标，与倦怠症状相关，以(i)区分倦怠的三个维度[情绪耗竭（EE），玩世不恭，个人成就感降低]之间的关联，以及（ii）调查与抑郁症状相关的重叠。在德累斯顿职业倦怠研究（Dresden Burnout Study）的大型人群样本中进行了迷走神经介导的HRV评估（即，连续差异均方根，RMSSD） [N=410，平均年龄42.2，标准差（SD） 11.2岁；33.4%的男性)。在情绪唤醒状态（静脉穿刺、平卧）、335秒平卧恢复期和335秒坐位休息状态下，评估90秒迷走神经介导的HRV。多元线性回归分析结果显示，即使在考虑了既定的ANS调节因子（如年龄、体重指数）后，EE与静脉穿刺期间的RMSSD （β= - 0.11， P=0.03）和坐位休息（β= - 0.09， P=0.04）呈负相关。在倦怠的其他维度中没有观察到这种模式。抑郁症状的探索性分析进一步揭示RMSSD与倦怠相关症状呈显著负相关，但与抑郁的核心标准（如抑郁情绪）无显著负相关。这项研究提供了精疲力竭和迷走神经功能下降之间的联系的证据，无论是在倦怠和抑郁中，这表明ANS调节可能不是疾病特异性的，而是两种情况共有的潜在特征的心理生理相关。
Given the important role of the autonomic nervous system (ANS) in stress regulation, astonishingly little is known about ANS functioning in burnout, a condition arising after prolonged exposure to work-related stress. The current study sought to investigate ANS modulation, as indexed by vagally-mediated heart rate variability (HRV), in relation to burnout symptomatology to (i) distinguish associations between the three dimensions of burnout [emotional exhaustion (EE), cynicism, reduced personal accomplishment] and (ii) investigate overlap in associations with depressive symptomatology. Assessments of vagally-mediated HRV (ie, root mean square of successive differences, RMSSD) were conducted in a large population-based sample from the Dresden Burnout Study [N=410, mean age 42.2, standard deviation (SD) 11.2 years; 33.4% male]. Vagally-mediated HRV was assessed for 90 seconds during an emotionally-arousing situation (venipuncture, recumbent), a 335-second recumbent recovery period, and a 335-second seated resting condition. Results from multiple linear regression analyses revealed that EE was negatively related to RMSSD during venipuncture (β= −0.11, P=0.03) and the seated rest (β= −0.09, P=0.04) even after accounting for established ANS modulators (eg, age, body mass index). This pattern was not observed for the other dimensions of burnout. Exploratory analyses of depressive symptomatology further revealed that RMSSD was significantly and inversely associated with burnout-related symptoms but not with the core criteria of depression (eg, depressed mood). This study presents evidence for a link between exhaustion and reduced vagal function, both in burnout and depression, suggesting that ANS modulations may not be disorder-specific but rather a psychophysiological correlate of an underlying feature shared by both conditions.
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