Burnout, perceived stress, and cortisol responses to awakening

Objective: The effects of burnout and perceived stress on early morning fre e cortisol levels after awakening were investigated in a group of teachers. Previous studies revealed that cortisol levels show a significant increase after awakening, with high intraindividual stability. Methods: Sixty-six t eachers from local public schools (42 women and 24 men, mean age 42 +/- 5 y ears) were asked to sample saliva for cortisol analysis on 3 consecutive da ys. On each day, cortisol levels were measured at the time of awakening and 15, 30, and 60 minutes thereafter. On the night before the third day, subj ects took 0.5 mg dexamethasone orally for testing glucocorticoid feedback i nhibition. Burnout and perceived stress were measured by three different qu estionnaires. Results: Perceived stress correlated with increases of cortis ol levels during the first hour after awakening after dexamethasone pretrea tment. In addition, teachers scoring high on burnout showed lower overall c ortisol secretion on all sampling days, and a higher suppression of cortiso l secretion after dexamethasone administration. In the subgroup of teachers with both high levels of perceived stress and high levels of burnout, a lo wer overall cortisol secretion was observed on the first 2 days, with stron ger increases during the first hour after awakening after dexamethasone sup pression. This subgroup also showed the lowest self-esteem, the highest ext ernal locus of control, and the highest number of somatic complaints. Concl usions: These results demonstrate differential effects of burnout and perce ived stress on hypothalamic-pituitary-adrenal axis regulation.