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

Ahola, 2005, The relationship between job-related burnout and depressive disorders—results from the Finnish health 2000 study, J Affect Disord, 88, 55, 10.1016/j.jad.2005.06.004 Alt SR, Turner JD, Klok MD et al. (2010). Differential expression of glucocorticoid receptor transcripts in major depressive disorder is not epigenetically programmed. Psychoneuroendocrinology 35: 544–556. https://doi.org/10.1016/j.psyneuen.2009.09.001. American Psychiatric Association, 2013 Appels, 1991, Burnout as a risk factor for coronary heart disease, Behav Med, 17, 53, 10.1080/08964289.1991.9935158 Bellingrath, 2008, Cortisol dysregulation in school teachers in relation to burnout, vital exhaustion, and effort-reward-imbalance, Biol Psychol, 78, 104, 10.1016/j.biopsycho.2008.01.006 Bianchi, 2015, Burnout–depression overlap: a review, Clin Psychol Rev, 36, 28, 10.1016/j.cpr.2015.01.004 Cadegiani, 2016, Adrenal fatigue does not exist: a systematic review, BMC Endocr Disord, 16, 48, 10.1186/s12902-016-0128-4 Chida, 2008, Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations, Psychol Bull, 134, 829, 10.1037/a0013342 Clow, 2004, The awakening cortisol response: methodological issues and significance, Stress, 7, 29, 10.1080/10253890410001667205 Cohen, 2017, Meta-analysis of relation of vital exhaustion to cardiovascular disease events, Am J Cardiol, 119, 1211, 10.1016/j.amjcard.2017.01.009 Dahlgren, 2009, Day-to-day variation in saliva cortisol—relation with sleep, stress and self-rated health, Biol Psychol, 82, 149, 10.1016/j.biopsycho.2009.07.001 Danhof-Pont, 2011, Biomarkers in burnout: a systematic review, J Psychosom Res, 70, 505, 10.1016/j.jpsychores.2010.10.012 Dedovic, 2009, The brain and the stress axis: the neural correlates of cortisol regulation in response to stress, NeuroImage, 47, 864, 10.1016/j.neuroimage.2009.05.074 de Kloet, 2005, Stress and the brain: from adaptation to disease, Nat Rev Neurosci, 6, 463, 10.1038/nrn1683 de Looff, 2018, Associations of sympathetic and parasympathetic activity in job stress and burnout: a systematic review, PLoS One, 13, e0205741, 10.1371/journal.pone.0205741 De Vente, 2003, Physiological differences between burnout patients and healthy controls: blood pressure, heart rate, and cortisol responses, Occup Environ Med, 60, i54, 10.1136/oem.60.suppl_1.i54 de Vente, 2015, Burnout is associated with reduced parasympathetic activity and reduced HPA axis responsiveness, predominantly in males, Biomed Res Int, 2015, 13, 10.1155/2015/431725 Deneva, 2019, Burnout syndrome in physicians-psychological assessment and biomarker research, Medicina (Kaunas), 55, 209, 10.3390/medicina55050209 Ekstedt, 2004, Microarousals during sleep are associated with increased levels of lipids, cortisol, and blood pressure, Psychosom Med, 66, 925, 10.1097/01.psy.0000145821.25453.f7 Elder, 2014, The cortisol awakening response—applications and implications for sleep medicine, Sleep Med Rev, 18, 215, 10.1016/j.smrv.2013.05.001 Evans, 1993, The nature of burnout: a study of the three-factor model of burnout in human service and non-human service samples, J Occup Organ Psychol, 66, 29, 10.1111/j.2044-8325.1993.tb00514.x Fitzsimons, 2016, Circadian and ultradian glucocorticoid rhythmicity: implications for the effects of glucocorticoids on neural stem cells and adult hippocampal neurogenesis, Front Neuroendocrinol, 41, 44, 10.1016/j.yfrne.2016.05.001 Freudenberger, 1974, Staff burn-out, J Soc Issues, 30, 154, 10.1111/j.1540-4560.1974.tb00706.x Fries, 2005, A new view on hypocortisolism, Psychoneuroendocrinology, 30, 1010, 10.1016/j.psyneuen.2005.04.006 Glise, 2012, Course of mental symptoms in patients with stress-related exhaustion: does sex or age make a difference?, BMC Psychiatry, 12, 18, 10.1186/1471-244X-12-18 Glise, 2014, Prevalence and course of somatic symptoms in patients with stress-related exhaustion: does sex or age matter, BMC Psychiatry, 14, 118, 10.1186/1471-244X-14-118 Grossi, 2003, Physiological correlates of burnout among women, J Psychosom Res, 55, 309, 10.1016/S0022-3999(02)00633-5 Grossi, 2005, The morning salivary cortisol response in burnout, J Psychosom Res, 59, 103, 10.1016/j.jpsychores.2005.02.009 Grossi, 2015, Stress-related exhaustion disorder - clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout, Scand J Psychol, 56, 626, 10.1111/sjop.12251 Gustafsson, 2017, Athlete burnout: review and recommendations, Curr Opin Psychol, 16, 109, 10.1016/j.copsyc.2017.05.002 Hasselberg, 2014, Self-reported stressors among patients with exhaustion disorder: an exploratory study of patient records, BMC Psychiatry, 14, 66, 10.1186/1471-244X-14-66 Heim, 2000, The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders, Psychoneuroendocrinology, 25, 1, 10.1016/S0306-4530(99)00035-9 Jonsdottir, 2019, Endocrine and immunological aspects of burnout: a narrative review, Eur J Endocrinol, 180, R147, 10.1530/EJE-18-0741 Jönsson, 2015, Exhaustion-related changes in cardiovascular and cortisol reactivity to acute psychosocial stress, Physiol Behav, 151, 327, 10.1016/j.physbeh.2015.07.020 Juruena, 2018, Atypical depression and non-atypical depression: is HPA axis function a biomarker? A systematic review, J Affect Disord, 233, 45, 10.1016/j.jad.2017.09.052 Kalafatakis, 2018, Ultradian rhythmicity of plasma cortisol is necessary for normal emotional and cognitive responses in man, Proc Natl Acad Sci U S A, 115, E4091, 10.1073/pnas.1714239115 Kalimi, 1994, Anti-glucocorticoid effects of dehydroepiandrosterone (DHEA), Mol Cell Biochem, 131, 99, 10.1007/BF00925945 Kanthak, 2017, Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion, Scand J Work Environ Health, 43, 475, 10.5271/sjweh.3647 Kirschbaum, 1993, The ‘trier social stress test’—a tool for investigating psychobiological stress responses in a laboratory setting, Neuropsychobiology, 28, 76, 10.1159/000119004 Kivimaki, 2015, Work stress as a risk factor for cardiovascular disease, Curr Cardiol Rep, 17, 630, 10.1007/s11886-015-0630-8 Klarić, 2010, Caregiver burden and burnout in partners of war veterans with post-traumatic stress disorder, Coll Antropol, 34, 15 Kleijweg, 2013, The clinical utility of the Maslach burnout inventory in a clinical population, Psychol Assess, 25, 435, 10.1037/a0031334 Kleijweg, 2013, Comparing the predictive utility of two screening tools for mental disorder among probationers, Psychol Assess, 25, 435, 10.1037/a0031334 Kristensen, 2005, The Copenhagen burnout inventory: a new tool for the assessment of burnout, Work Stress, 19, 192, 10.1080/02678370500297720 Kudielka, 2010, Human models in acute and chronic stress: assessing determinants of individual hypothalamus–pituitary–adrenal axis activity and reactivity, Stress, 13, 1, 10.3109/10253890902874913 Langelaan, 2006, Do burned-out and work-engaged employees differ in the functioning of the hypothalamic-pituitary-adrenal axis?, Scand J Work Environ Health, 32, 339, 10.5271/sjweh.1029 Langelaan, 2007, Is burnout related to allostatic load?, Int J Behav Med, 14, 213, 10.1007/BF03002995 Lennartsson, 2015, Indication of attenuated DHEA-s response during acute psychosocial stress in patients with clinical burnout, J Psychosom Res, 79, 107, 10.1016/j.jpsychores.2015.05.011 Lennartsson, 2015, Burnout and hypocortisolism—a matter of severity? A study on ACTH and cortisol responses to acute psychosocial stress, Front Psych, 6, 8 Lennartsson, 2015, Low levels of dehydroepiandrosterone sulfate in younger burnout patients, PLoS One, 10 Lennartsson, 2016, Low heart rate variability in patients with clinical burnout, Int J Psychophysiol, 110, 171, 10.1016/j.ijpsycho.2016.08.005 Lennartsson, 2016, Changes in DHEA-s levels during the first year of treatment in patients with clinical burnout are related to health development, Biol Psychol, 120, 28, 10.1016/j.biopsycho.2016.08.003 Lightman, 2020, Dynamics of ACTH and cortisol secretion and implications for disease, Endocr Rev, 41, 470, 10.1210/endrev/bnaa002 Lindström, 2010, Increased prevalence of burnout symptoms in parents of chronically ill children, Acta Paediatr, 99, 427, 10.1111/j.1651-2227.2009.01586.x Maninger, 2009, Neurobiological and neuropsychiatric effects of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS), Front Neuroendocrinol, 30, 65, 10.1016/j.yfrne.2008.11.002 Marchand, 2014, Workers’ psychological distress, depression, and burnout symptoms: associations with diurnal cortisol profiles, Scand J Work Environ Health, 40, 305, 10.5271/sjweh.3417 Maslach, 1976, Burned-out, Hum Behav, 5, 16 Maslach, 2001, Job burnout, Annu Rev Psychol, 52, 397, 10.1146/annurev.psych.52.1.397 May, 2014, School burnout and cardiovascular functioning in young adult males: a hemodynamic perspective, Stress, 17, 79, 10.3109/10253890.2013.872618 May, 2015, School burnout: increased sympathetic vasomotor tone and attenuated ambulatory diurnal blood pressure variability in young adult women, Stress, 18, 11, 10.3109/10253890.2014.969703 May, 2018, School burnout and heart rate variability: risk of cardiovascular disease and hypertension in young adult females, Stress, 21, 211, 10.1080/10253890.2018.1433161 McEwen, 1998, Stress, adaptation, and disease: allostasis and allostatic load, Ann N Y Acad Sci, 840, 33, 10.1111/j.1749-6632.1998.tb09546.x McEwen, 2000, Allostasis and allostatic load: implications for neuropsychopharmacology, Neuropsychopharmacology, 22, 108, 10.1016/S0893-133X(99)00129-3 McEwen, 2019, What is the confusion with cortisol?, Chronic Stress, 3, 10.1177/2470547019833647 Melamed, 1992, Burnout and risk factors for cardiovascular diseases, Behav Med, 18, 53, 10.1080/08964289.1992.9935172 Melamed, 1999, Chronic burnout, somatic arousal and elevated salivary cortisol levels, J Psychosom Res, 46, 591, 10.1016/S0022-3999(99)00007-0 Melamed, 2006, Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions, Psychol Bull, 132, 327, 10.1037/0033-2909.132.3.327 Melamed, 2006, Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons, Psychosom Med, 68, 863, 10.1097/01.psy.0000242860.24009.f0 Miller, 2007, If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans, Psychol Bull, 133, 25, 10.1037/0033-2909.133.1.25 Moch, 2003, Longitudinal changes in pituitary-adrenal hormones in South African women with burnout, Endocrine, 21, 267, 10.1385/ENDO:21:3:267 Mommersteeg, 2006, Immune and endocrine function in burnout syndrome, Psychosom Med, 68, 879, 10.1097/01.psy.0000239247.47581.0c Mommersteeg, 2006, Cortisol deviations in people with burnout before and after psychotherapy: a pilot study, Health Psychol, 25, 243, 10.1037/0278-6133.25.2.243 Mommersteeg, 2006, Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test, Psychoneuroendocrinology, 31, 216, 10.1016/j.psyneuen.2005.07.003 Mommersteeg, 2006, A longitudinal study on cortisol and complaint reduction in burnout, Psychoneuroendocrinology, 31, 793, 10.1016/j.psyneuen.2006.03.003 Morgan, 2002, The impact of burnout on human physiology and on operational performance: a prospective study of soldiers enrolled in the combat diver qualification course, Yale J Biol Med, 75, 199 Onen Sertoz, 2008, The role of BDNF and HPA axis in the neurobiology of burnout syndrome, Prog Neuro-Psychopharmacol Biol Psychiatry, 32, 1459, 10.1016/j.pnpbp.2008.05.001 Oosterholt, 2015, Burnout and cortisol: evidence for a lower cortisol awakening response in both clinical and non-clinical burnout, J Psychosom Res, 78, 445, 10.1016/j.jpsychores.2014.11.003 Oosterholt, 2016, Getting better, but not well: a 1.5 year follow-up of cognitive performance and cortisol levels in clinical and non-clinical burnout, Biol Psychol, 117, 89, 10.1016/j.biopsycho.2016.02.009 Orosz, 2017, A biological perspective on differences and similarities between burnout and depression, Neurosci Biobehav Rev, 73, 112, 10.1016/j.neubiorev.2016.12.005 Österberg, 2009, Cognitive performance in patients with burnout, in relation to diurnal salivary cortisol, Stress, 12, 70, 10.1080/10253890802049699 Österberg, 2012, A follow-up of cognitive performance and diurnal salivary cortisol changes in former burnout patients, Stress, 15, 589, 10.3109/10253890.2011.648972 Paine, 1982 Parent-Lamarche, 2018, Work stress, personality traits, and cortisol secretion: testing a model for job burnout, Work, 60, 485, 10.3233/WOR-182755 Penz, 2018, Hair cortisol as a biological marker for burnout symptomatology, Psychoneuroendocrinology, 87, 218, 10.1016/j.psyneuen.2017.07.485 Pilger, 2018, Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring, Sci Rep, 8, 9151, 10.1038/s41598-018-27386-1 Pines, 1993, Burnout: an existential perspective Pruessner, 1999, Burnout, perceived stress, and cortisol responses to awakening, Psychosom Med, 61, 197, 10.1097/00006842-199903000-00012 Qi, 2013, Aberrant stress hormone receptor balance in the human prefrontal cortex and hypothalamic paraventricular nucleus of depressed patients, Psychoneuroendocrinology, 38, 863, 10.1016/j.psyneuen.2012.09.014 Rohleder, 2009, Determinants of salivary α-amylase in humans and methodological considerations, Psychoneuroendocrinology, 34, 469, 10.1016/j.psyneuen.2008.12.004 Rothe, 2020, Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: a systematic review, Neurosci Biobehav Rev, 114, 232, 10.1016/j.neubiorev.2020.02.024 Rydmark, 2006, Neuroendocrine, cognitive and structural imaging characteristics of women on longterm sickleave with job stress-induced depression, Biol Psychiatry, 60, 867, 10.1016/j.biopsych.2006.04.029 Salvagioni, 2017, Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies, PLoS One, 12, 10.1371/journal.pone.0185781 Schaufeli, 2005, The conceptualization and measurement of burnout: common ground and worlds apart the views expressed in work & stress commentaries are those of the author(s), and do not necessarily represent those of any other person or organization, or of the journal, Work Stress, 19, 256, 10.1080/02678370500385913 Schaufeli, 2001, On the clinical validity of the Maslach burnout inventory and the burnout measure, Psychol Health, 16, 565, 10.1080/08870440108405527 Schaufeli, 2009, Burnout: 35 years of research and practice, Career Dev Int, 14, 204, 10.1108/13620430910966406 Schutte, 2000, The factorial validity of the Maslach burnout Inventory-general survey (MBI-GS) across occupational groups and nations, J Occup Organ Psychol, 73, 53, 10.1348/096317900166877 Shaffer, 2017, An overview of heart rate variability metrics and norms, Front Public Health, 5, 00258, 10.3389/fpubh.2017.00258 Shirom, 1989, Burnout in work organization Shirom, 2003, Job-related burnout: a review Sjörs, 2015, No alterations in diurnal cortisol profiles before and during the treatment in patients with stress-related exhaustion, Int J Occup Med Environ Health, 28, 120, 10.13075/ijomeh.1896.00208 Sjörs, 2012, Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion, BMJ Open, 2, 10.1136/bmjopen-2012-001091 Söderström, 2006, Weekday and weekend patterns of diurnal cortisol, activation and fatigue among people scoring high for burnout, Scand J Work Environ Health, 2, 35 Stalder, 2012, Analysis of cortisol in hair–state of the art and future directions, Brain Behav Immun, 26, 1019, 10.1016/j.bbi.2012.02.002 Stalder, 2016, Assessment of the cortisol awakening response: expert consensus guidelines, Psychoneuroendocrinology, 63, 414, 10.1016/j.psyneuen.2015.10.010 Stalder, 2017, Stress-related and basic determinants of hair cortisol in humans: a meta-analysis, Psychoneuroendocrinology, 77, 261, 10.1016/j.psyneuen.2016.12.017 Sterling, 1988, Allostasis: a new paradigm to explain arousal pathology Teisala, 2014, Associations of physical activity, fitness, and body composition with heart rate variability-based indicators of stress and recovery on workdays: a cross-sectional study, J Occup Med Toxicol, 9, 16, 10.1186/1745-6673-9-16 Thayer, 2007, The role of vagal function in the risk for cardiovascular disease and mortality, Biol Psychol, 74, 224, 10.1016/j.biopsycho.2005.11.013 Thayer, 2010, The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors, Int J Cardiol, 141, 122, 10.1016/j.ijcard.2009.09.543 Toker, 2012, Burnout and risk of coronary heart disease: a prospective study of 8838 employees, Psychosom Med, 74, 840, 10.1097/PSY.0b013e31826c3174 Traunmüller, 2019, Psychophysiological concomitants of burnout: evidence for different subtypes, J Psychosom Res, 118, 41, 10.1016/j.jpsychores.2019.01.009 Wahlberg, 2009, Suppressed neuroendocrine stress response in depressed women on job-stress-related long-term sick leave: a stable marker potentially suggestive of preexisting vulnerability, Biol Psychiatry, 65, 742, 10.1016/j.biopsych.2008.10.035 Wang Q, Joels M, Swaab DF et al. (2012). Hippocampal GR expression is increased in elderly depressed females. Neuropharmacology 62: 527–533. https://doi.org/10.1016/j.neuropharm.2011.09.014. Epub 2011 Sep 19. PMID: 21945289. Wang, 2013, Glucocorticoid receptor protein expression in human hippocampus; stability with age, Neurobiol Aging, 34, 1662, 10.1016/j.neurobiolaging.2012.11.019 Wang, 2019, Mediating effects of hair cortisol on the mutual association of job burnout and insomnia: a retrospective exploratory study, J Psychiatr Res, 117, 62, 10.1016/j.jpsychires.2019.07.001 Wekenborg, 2019, The longitudinal association of reduced vagal tone with burnout, Psychosom Med, 81, 791, 10.1097/PSY.0000000000000750 Wekenborg, 2019, Examining reactivity patterns in burnout and other indicators of chronic stress, Psychoneuroendocrinology, 106, 195, 10.1016/j.psyneuen.2019.04.002 Wingenfeld, 2009, Elevated diurnal salivary cortisol in nurses is associated with burnout but not with vital exhaustion, Psychoneuroendocrinology, 34, 1144, 10.1016/j.psyneuen.2009.02.015 Wolfram, 2013, 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, Stress, 16, 54, 10.3109/10253890.2012.683465 Zanstra, 2006, Vagal and sympathetic activity in burnouts during a mentally demanding workday, Psychosom Med, 68, 583, 10.1097/01.psy.0000228012.38884.49