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Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals

Published online by Cambridge University Press:  24 April 2017

José Carlos Fernández-Sánchez
Affiliation:
Programa de Doctorado en Medicina Clínica y Salud Pública, University of Granada, and San Rafael University Hospital, Granada, Spain
José Manuel Pérez-Mármol*
Affiliation:
Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
Antonia Blásquez
Affiliation:
Area de Bioquimica Clinica, Hospital Alejandro Otero, Granada, Spain
Ana María Santos-Ruiz
Affiliation:
Department of Health Psychology, Faculty of Health Sciences, University of Alicante, Alicante, Spain
María Isabel Peralta-Ramírez
Affiliation:
Department of Clinical Psychology, University of Granada, Granada, Spain Mind, Brain and Behavior Research Center, Granada, Spain
*
Address correspondence and reprint requests to: José Manuel Pérez Mármol, Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain. E-mail: josemapm@ugr.es.

Abstract

Objective:

A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population.

Method:

A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory–Human Services Survey (MBI–HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL–90–R Symptoms Inventory.

Results:

There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI–HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15–30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it.

Significance of results:

A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

Aydemir, O. & Icelli, I. (2013). Burnout: Risk factors. In Burnout for Experts: Prevention in the Context of Living and Working. Bahrer-Kohler, S. (ed.), pp. 119143. New York: Springer Science.CrossRefGoogle Scholar
Bakker, A.B., Van der Zee, K.I., Lewig, K.A., et al. (2006). The relationship between the Big Five personality factors and burnout: A study among volunteer counselors. The Journal of Social Psychology, 146(1), 3150.CrossRefGoogle ScholarPubMed
Bauer, J., Stamm, A., Virnich, K., et al. (2006). Correlation between burnout syndrome and psychological and psychosomatic symptoms among teachers. International Archives of Occupational and Environmental Health, 79(3), 199204. Epub ahead of print Oct 29, 2005.CrossRefGoogle ScholarPubMed
Bellingrath, S., Weigl, T. & Kudielka, B.M. (2008). Cortisol dysregulation in school teachers in relation to burnout, vital exhaustion, and effort–reward–imbalance. Biological Psychology, 78(1), 104113. Epub ahead of print Feb 2.CrossRefGoogle ScholarPubMed
Bría, M., Baban, A. & Dumitrascu, D.L. (2012). Systematic review of burnout risk factors among European healthcare professionals. Cognition, Brain, Behavior: An Interdisciplinary Journal, 16(3), 423452. Available from https://www.researchgate.net/publication/236230229_Systematic_Review_of_Burnout_Risk_Factors_among_European_Healthcare_Professionals.Google Scholar
Chan, A.O., Chan, Y.H., Chuang, K.P., et al. (2015). Addressing physician quality of life: Understanding the relationship between burnout, work engagement, compassion fatigue and satisfaction. Journal of Hospital Administration, 4(6), 46. Available from https://www.researchgate.net/publication/283194498_Addressing_physician_quality_of_life_understanding_the_relationship_between_burnout_work_engagement_compassion_fatigue_and_satisfactionCrossRefGoogle Scholar
Clark, J.E., Aitken, S., Watson, N., et al. (2016). Training oncology and palliative care clinical nurse specialists in psychological skills: Evaluation of a pilot study. Palliative & Supportive Care, 13(3), 537542. Epub ahead of print Jun 13, 2013.CrossRefGoogle Scholar
Clow, A., Hucklebridge, F., Stalder, T., et al. (2010). The cortisol awakening response: More than a measure of HPA axis function. Neuroscience and Biobehavioral Reviews, 35(1), 97103. Epub ahead of print Dec 22, 2009.CrossRefGoogle ScholarPubMed
Cohen, S., Kamarak, T. & Mermeistein, R. (1983). Perceived Stress Scale—PSS. Journal of Health and Social Behavior, 24, 285396. Available from https://das.nh.gov/wellness/Docs/Percieved%20Stress%20Scale.pdf.Google Scholar
De las Cuevas, C., González de Rivera, J.L., Henry-Benítez, M., et al. (1991). Análisis factorial de la versión Española del SCL–90–R en la población general [in Spanish]. Anales de Psiquiatría, 7(3), 9396. Available from http://www.psicoter.es/pdf/91_A098_20.pdf.Google Scholar
De Vente, W., Olff, M., van Amsterdam, J.G.C., et al. (2003). Physiological differences between burnout patients and healthy controls: Blood pressure, heart rate, and cortisol responses. Occupational and Environmental Medicine, 60(Suppl. 1), 5461. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765727/.CrossRefGoogle ScholarPubMed
Derogatis, L.R. (1994). Symptom Checklist 90: Administration Scoring and Procedures Manual. Minneapolis: National Computer Systems.Google Scholar
Dréano-Hartz, S., Rhondali, W., Ledoux, M., et al. (2015). Burnout among physicians in palliative care: Impact of clinical settings. Palliative & Supportive Care, 14(4), 19. Epub ahead of print Oct 14.Google ScholarPubMed
Gil-Monte, P.R. & Peiró, J.M. (1999). Validez factorial del Maslach Burnout Inventory en una muestra multiocupacional [Factorial validity of the Maslach Burnout Inventory in a multi-occupational sample] [in Spanish]. Psicothema, 11(3), 679689. Available from http://www.psicothema.com/pdf/319.pdf.Google Scholar
Griffiths, J., Wilson, C., Ewing, G., et al. (2015). Improving communication with palliative care cancer patients at home: A pilot study of SAGE & THYME communication skills model. European Journal of Oncology Nursing, 19(5), 465472. Epub ahead of print Mar 14.CrossRefGoogle ScholarPubMed
Grossi, G., Perski, A., Ekstedt, M., et al. (2005). The morning salivary cortisol response in burnout. Journal of Psychosomatic Research, 59(2), 103111.CrossRefGoogle ScholarPubMed
Heim, C., Ehlert, U. & Hellhammer, D.H. (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25(1), 135.CrossRefGoogle ScholarPubMed
Herrera, E., Rocafort, J., De Lima, L., et al. (2007). Regional palliative care program in Extremadura: An effective public health care model in a sparsely populated region. Journal of Pain and Symptom $management, 33(5), 591598. Available from http://www.jpsmjournal.com/article/S0885-3924(07)00128-5/pdf.CrossRefGoogle Scholar
Hill, R.C., Dempster, M., Donnelly, M., et al. (2016). Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions. Palliative Medicine, 30(9), 825833.CrossRefGoogle ScholarPubMed
Holland, J.M. & Neimeyer, R.A. (2005). Reducing the risk of burnout in end-of-life care settings: The role of daily spiritual experiences and training. Palliative & Supportive Care, 3(3), 173181.CrossRefGoogle ScholarPubMed
Kamal, A.H., Bull, J.H., Wolf, S.P., et al. (2016). Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. Journal of Pain and Symptom Management, 51(4), 690696. Epub ahead of print Nov 24, 2015.CrossRefGoogle ScholarPubMed
Koh, M.Y.H., Chong, P.H., Neo, P.S.H., et al. (2015). Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study. Palliative Medicine, 29(7), 633642. Epub ahead of print Mar 31.CrossRefGoogle ScholarPubMed
Korczak, D., Wastian, M. & Schneider, M. (2012). Therapy of the burnout syndrome. GMS Health Technology Assessment, 8, 19. Epub ahead of print Jun 14. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434360/.Google ScholarPubMed
Laboratorio Cobas, S.L. (2009). Test Inmunológico in vitro para la Determinación Cuantitativa de Cortisol en Suero, Plasma, Orina y Saliva Humanos [In-Vitro Immunological Test to Determine the Quantity of Cortisol in Human Serum, Plasma, Urine, and Saliva] [in Spanish]. Madrid: Laboratorio Cobas S.L.Google Scholar
Langelaan, S., Bakker, A.B., Schaufeli, W.B., et al. (2006). Do burned-out and work-engaged employees differ in the functioning of the hypothalamic–pituitary–adrenal axis. Scandinavian Journal of Work, Environment & Health, 32(5), 339348.CrossRefGoogle ScholarPubMed
Lennartsson, A., Sjörs, A., Währborg, P., et al. (2015). Burnout and hypocortisolism: A matter of severity? A study on ACTH and cortisol responses to acute psychosocial stress. Frontiers in Psychiatry, 6(8), 18. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313581/.CrossRefGoogle ScholarPubMed
Marchand, A., Durand, P., Juster, R.P., et al. (2014 a). Workers' psychological distress, depression, and burnout symptoms: Associations with diurnal cortisol profiles. Scandinavian Journal of Work, Environment & Health, 40(3), 305314. Epub ahead of print Jan 27.CrossRefGoogle ScholarPubMed
Marchand, A., Juster, R., Durand, P., et al. (2014 b). Burnout symptom sub-types and cortisol profiles: What's burning most? Psychoneuroendocrinology, 40, 2736.CrossRefGoogle Scholar
Maslach, C. & Jackson, S.E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99113. Available from http://onlinelibrary.wiley.com/doi/10.1002/job.4030020205/pdf.CrossRefGoogle Scholar
Maslach, C. & Jackson, S.E. (1986). Maslach Burnout Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Melamed, S., Ugarten, U., Shirom, A., et al. (1999). Chronic burnout, somatic arousal and elevated salivary cortisol levels. Journal of Psychosomatic Research, 46(6), 591598.CrossRefGoogle ScholarPubMed
Menezes, V.A., Fernández Calvo, B., Hernández Martín, L., et al. (2006). Resiliencia y el modelo Burnout–Engagement en cuidadores formales de ancianos [Resilience and Burnout–Engagement model in formal caregivers for the elderly] [in Spanish]. Psicothema, 18(4), 791796. Available from http://www.psicothema.com/pdf/3310.pdf.Google Scholar
Michael, N., Callaghan, C.O., Brooker, J.E., et al. (2016). Introducing a model incorporating early integration of specialist palliative care: A qualitative research study of staff's perspectives. Palliative Medicine, 30(3), 303312. Epub ahead of print Jul 29, 2015.CrossRefGoogle ScholarPubMed
Mingote, J.C., Moreno, B. & Gálvez, M. (2004). Desgaste profesional y salud de los profesionales médicos: Revisión y propuestas de prevención [Professional exhaustion and health of medical professionals: Revision and prevention suggestions] [in Spanish]. Medicina Clinica, 123(7), 265270. Available from http://www.elsevier.es/es-revista-medicina-clinica-2-articulo-desgaste-profesional-salud-los-profesionales-13065203.CrossRefGoogle Scholar
Ministry of Health Social Services and Equality (2014). Palliative Care Strategy of the National Health System: 2010–2014 Update. Madrid: Ministry of Health Social Services and Equality. Available from http://www.msps.es/organizacion/sns/planCalidadSNS/docs/paliativos/PalliativeCareStrategySpanishHS.pdf.Google Scholar
Mommersteeg, P.M., Keijsers, G.P., Heijnen, C.J., et al. (2006 a). Cortisol deviations in people with burnout before and after psychotherapy: A pilot study. Health Psychology, 25(2), 243248.CrossRefGoogle ScholarPubMed
Mommersteeg, P.M., Heijnen, C.J., Verbraak, M.J. et al. (2006 b). A longitudinal study on cortisol and complaint reduction in burnout. Psychoneuroendocrinology, 31(7), 793804. Epub ahead of print May 15.CrossRefGoogle ScholarPubMed
Montross-Thomas, L.P., Scheiber, C., Meier, E.A., et al. (2016). Personally meaningful rituals: A way to increase compassion and decrease burnout among hospice staff and volunteers. Journal of Palliative Medicine, 19(10), 10431050. Epub ahead of print Jun 23.CrossRefGoogle ScholarPubMed
Moorey, S. (2013). I know they are distressed. What do I do now? Psycho-Oncology, 22(9), 19461952. Epub ahead of print Jul 1.Google ScholarPubMed
Moya-Albiol, L., Serrano, M.A., González-Bono, E., et al. (2005). Respuesta psicofisiológica de estrés en una jornada laboral [Psychophysiological response of stress during a work day] [in Spanish]. Psicothema, 17(2), 205211. Available from http://www.psicothema.com/pdf/3089.pdf.Google Scholar
O'Connor, T.M., O'Halloran, D.J. & Shanahan, F. (2000). The stress response and the hypothalamic–pituitary–adrenal axis: From molecule to melancholia. Quarterly Journal of Medicine, 93(6), 323333.CrossRefGoogle ScholarPubMed
Oosterholt, B.G., Maes, J.H.R., Linden, D., et al. (2015). Burnout and cortisol: Evidence for a lower cortisol awakening response in both clinical and non-clinical burnout. Journal of Psychosomatic Research, 78(5), 445451. Epub ahead of print Nov 8, 2014.CrossRefGoogle ScholarPubMed
Ostacoli, L., Cavallo, M., Zuffranieri, M., et al. (2010). Comparison of experienced burnout symptoms in specialist oncology nurses working in hospital oncology units or in hospices. Palliative & Supportive Care, 8(4), 427432. Epub ahead of print Sep 28.CrossRefGoogle ScholarPubMed
Parola, V., Coelho, A., Cardoso, D., et al. (2016). The prevalence of burnout in health professionals working in palliative care. JBI Database of Systematic Reviews and Implementation Reports, 14(3), 4550.CrossRefGoogle ScholarPubMed
Pedrero-Pérez, E.J., Puerta-García, C. & Logares-Roibas, A. (2004). Estudio del burnout en profesionales de drogodependencias [Study on burnout in drug-addiction professionals] [in Spanish]. Trastornos Adictivos, 6(1), 515. Available from http://www.elsevier.es/es-revista-trastornos-adictivos-182-articulo-estudio-del-burnout-profesionales-drogodependencias-13056395.CrossRefGoogle Scholar
Pereira, S.M., Fonseca, A.M. & Carvalho, A.S. (2011). Burnout in palliative care: A systematic review. Nursing Ethics, 18(3), 317326.CrossRefGoogle ScholarPubMed
Pessin, H., Fenn, N., Hendriksen, E., et al. (2015). Existential distress among healthcare providers caring for patients at the end of life. Current Opinion in Supportive and Palliative Care, 9(1), 7786.CrossRefGoogle ScholarPubMed
Pruessner, J.C., Hellhammer, D.H. & Kirschbaum, C. (1999). Burnout, perceived stress, and cortisol responses to awakening. Psychosomatic Medicine, 61(2), 197204.CrossRefGoogle ScholarPubMed
Pruessner, J.C., Kirschbaum, C., Meinlschmid, G., et al. (2003). Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology, 28(7), 916931.CrossRefGoogle ScholarPubMed
Remor, E. (2006). Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). The Spanish Journal of Psychology, 9(1), 8693. Available from http://www.psy.cmu.edu/~scohen/Remor_2006_article_EurSpanPSS.pdf.CrossRefGoogle Scholar
Remor, E. & Carrobles, A. (2001). Versión española de la escala de estrés percibido (PSS–14): Estudio psicométrico en una muestra VIH+ [Spanish version of the Perceived Stress Scale (PSS–14): A psychometric study in an HIV+ sample] [in Spanish]. Ansiedad y Estrés, 7(2), 195201.Google Scholar
Sansó, N., Galiana, L., Oliver, A., et al. (2015). Palliative care professionals' inner life: Exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. Journal of Pain and Symptom Management, 50(2), 200207. Epub ahead of print Feb 18.CrossRefGoogle ScholarPubMed
Sato, K., Inoue, Y., Umeda, M., et al. (2014). A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses. Japanese Journal of Clinical Oncology, 44(8), 718728. Available from https://academic.oup.com/jjco/article-lookup/doi/10.1093/jjco/hyu075.CrossRefGoogle ScholarPubMed
Sherman, A.C., Edwards, D., Simonton, S., et al. (2006). Caregiver stress and burnout in an oncology unit. Palliative & Supportive Care, 4(1), 6580.CrossRefGoogle Scholar
Slocum-Gori, S., Hemsworth, D., Chan, W.W., et al. (2011). Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce. Palliative Medicine, 27(2), 172178. Epub ahead of print Dec 16.CrossRefGoogle ScholarPubMed
Sonnentag, S. (2006). Burnout and functioning of the hypothalamus–pituitary–adrenal axis: There are no simple answers. Scandinavian Journal of Work, Environment & Health, 32(5), 333337.CrossRefGoogle ScholarPubMed
Trufelli, D.C., Bensi, C.G., Garcia, J.B., et al. (2008). Burnout in cancer professionals: A systematic review and meta-analysis. European Journal of Cancer Care, 17(6), 524531. Epub ahead of print Sep 1.Google ScholarPubMed
Wingenfeld, K., Schulz, M., Damkroeger, A., et al. (2009). Elevated diurnal salivary cortisol in nurses is associated with burnout but not with vital exhaustion. Psychoneuroendocrinology, 34(8), 11441151.CrossRefGoogle Scholar
Wüst, S., Federenko, I., Hellhammer, D.H., et al. (2000). Genetic factors, perceived chronic stress, and the free cortisol response to awakening. Psychoneuroendocrinology, 25(7), 707720. Available from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.463.9195&rep=rep1&type=pdf.CrossRefGoogle ScholarPubMed
Yoshida, S. & Miyashita, M. (2015). Strategies for development of palliative care from the perspectives of general population and health care professionals: A Japanese outreach palliative care trial of integrated regional model study. American Journal of Hospice and Palliative Medicine, 32(6), 604610. Epub ahead of print Jun 5, 2014.CrossRefGoogle ScholarPubMed
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