Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability.

PURPOSE: Exhaustion symptoms are known to be associated with cardiovascular disease (CVD) risk; however, the underlying mechanisms remain unclear. Autonomic imbalance, as indicated by reductions in vagally-mediated heart rate variability (vmHRV), appears to be a valid candidate for such a biological link, as it has been associated with both exhaustion symptoms and CVD risk and mortality. METHODS: The present study examined a potential mediation of vmHRV on the association between exhaustion symptoms and self-reported CVD risk factors as well as the age dependency of this mediation in a large, heterogeneous sample of the Dresden Burnout Study (N = 388; 72.9% females; Mage = 42.61, SD = 11.67). RESULTS: Results indicate that exhaustion symptoms were indirectly associated with CVD risk factors through vmHRV even after adjusting for well-known confounders (i.e., sex, body mass index, depressive symptoms). Moreover, this pattern was significant only among middle-aged (i.e., 54.27 years) and older individuals. CONCLUSIONS: Our findings add to growing evidence that autonomic imbalance may be a key biological link between exhaustion symptoms and CVD risk in middle-aged and older individuals. Implications for public health are discussed.

Depressive symptoms are negatively associated with hair N-arachidonoylethanolamine (anandamide) levels: A cross-lagged panel analysis of four annual assessment waves examining hair endocannabinoids and cortisol.

BACKGROUND: The endocannabinoid system (ECS) is increasingly being recognized as key regulatory system coupled with the glucocorticoid system implicated in the pathophysiology of major depressive disorder (MDD). However, prior studies examining the ECS in MDD have been inconclusive, of small sample size or of cross-sectional nature limiting interpretation of causal inferences or time-dependent effects. METHODS: In a prospective community-based cohort study including 128 individuals (women: 108), depressive symptoms (PHQ-9) as well as hair cortisol and endocannabinoids were measured annually over four years (T1-T4). Cortisol, N-arachidonoylethanolamine (AEA), and 2-arachidonoyl-sn-glycerol/1-arachidonoyl-sn-glycerol (2-AG/1-AG) were extracted from 3 cm hair segments reflecting cumulative concentrations of the last three months prior sampling. RESULTS: Cross-sectional group comparisons at baseline revealed reduced AEA and cortisol levels in the group with a positive MDD screening compared to individuals with low depressive symptomatology (both p < .05). Cross-lagged panel models showed that AEA levels at T2 were negatively associated with depressive symptoms at T3 (p < .05). Also, depressive symptoms at T3 were negatively associated with AEA levels at T4 (p < .01). The direction of association was reversed for 2-AG/1-AG, as 2-AG/1-AG levels at T1 were positively associated with depressive symptoms at T2 (p < .01). CONCLUSIONS: While cross-sectional analyses suggest higher depressive symptomatology to be associated with reduced AEA and cortisol release, longitudinal analyses reveal that primarily AEA levels are negatively associated with depressive symptoms. These longitudinal associations elucidate time-dependent relationships between depressive symptomatology and the ECS and further highlight AEA as potential treatment target in MDD.

Determining the direction of prediction of the association between parasympathetic dysregulation and exhaustion symptoms.

Stress-related exhaustion symptoms have a high prevalence which is only likely to increase further in the near future. Understanding the physiological underpinnings of exhaustion has important implications for accurate diagnosis and the development of effective prevention and intervention programs. Given its integrative role in stress-regulation, the parasympathetic branch of the autonomic nervous systems has been a valid starting point in the exploration of the physiological mechanisms behind exhaustion. The aim of the present study was to examine the directionality and specificity of the association between exhaustion symptoms and vagally-mediated heart rate variability (vmHRV), a relatively pure measure of parasympathetic tone. Exhaustion symptoms and vmHRV were measured at four annually assessment waves (2015-2018) of the Dresden Burnout Study. A total sample of N = 378 participants who attended at least two of the four annual biomarker measurements were included in the present analyses. Cross-lagged multi-level panel modelling adjusting for various covariates (e.g., age, sex, BMI) revealed that vmHRV was meaningfully predictive of exhaustion symptoms and not vice versa. In addition, these effects were specific for exhaustion symptoms as no effect was shown for the other burnout sub-dimensions, or for depressive symptoms. Our findings indicate a clear link between exhaustion symptoms and vmHRV which may hold great potential for both enhancing the diagnosis and treatment of exhaustion symptoms.

The moderating effect of cortisol and dehydroepiandrosterone on the relation between sleep and depression or burnout.

For poor sleep quality (SQ) as well as major depressive disorder (MDD) and burnout, a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been identified. Although poor SQ is often reported as an early symptom of MDD or burnout, it is not clear whether HPA axis-related hormones can influence the association between SQ and MDD or burnout. This manuscript addresses this question by examining HPA axis-related hormones as potential moderators influencing the association between SQ and MDD or burnout. In the fourth annual examination wave of the Dresden Burnout Study, we measured general SQ (including sleep duration and efficiency), depressive and burnout symptoms, and obtained hair samples for quantification of long-term integrated steroid concentrations (cortisol [hC], cortisone [hCn], dehydroepiandrosterone [hDHEA]) from 462 participants (67% female). Data on SQ, depressive and burnout symptoms were available from 342 participants from the preceding examination wave (average time span between examinations 13.2 months). Cross-sectional analyses showed that the negative association between sleep duration and depressive symptoms was buffered by higher levels of hC, and hCn, whereas the negative association between sleep duration and burnout symptoms was buffered by higher levels of hDHEA. The negative association between sleep efficiency and burnout symptoms was intensified by higher levels of hC and hC/hCn ratio and the negative association between general SQ and burnout symptoms was intensified by higher levels of hC/hCn ratio. With regard to longitudinal data, a significant interaction effect between sleep duration and hC/hCn ratio could be detected for burnout symptoms. Our results suggest opposed moderation effects of hair glucocorticoids on the association between SQ and depressive or burnout symptoms. This points toward opposed glucocorticoid receptor functioning in depression and burnout. To fully elucidate the negative consequences of poor SQ on MDD and burnout, the complex underlying mechanisms of action including HPA axis-related hormones need to be investigated in MDD and burnout separately.

The Influence of Workload and Work Flexibility on Work-Life Conflict and the Role of Emotional Exhaustion.

The purpose of this study is to examine the relationship between contextual work-related factors in terms of job demands (workload-WL) and job resources (work flexibility-WF), work-life conflict (WLC) and the burnout dimension emotional exhaustion (EE) in a large population-based sample. Building on the job demands resources model (JDRM), we have developed the hypothesis that WL has an indirect effect on EE that is mediated by WLC. We conducted a secondary analysis using data from the Dresden Burnout Study (DBS, N = 4246, mean age (SD) = 42.7 years (10.5); 36.4% male). Results from structural equation modelling revealed that EE is positively associated with WL (ß = 0.15, p = 0.001) and negatively associated with WF (ß = -0.13, p = 0.001), also after accounting for potential confounding variables (demography, depressive symptoms, and lifetime diagnosis of burnout). Both effects are mediated by WLC (ß = 0.18; p = 0.001 and ß = 0.08; p = 0.001, respectively) highlighting the important role of WLC in employee health. In summary, WF may help to reduce burnout symptoms in employees, whereas WL may increase them. Study results suggest that both associations depend on WLC levels.

Sleep disturbances in major depressive and burnout syndrome: A longitudinal analysis.

Sleep quality (SQ) is considered to be a critical variable in major depressive syndrome (MD) as well as in burnout syndrome (B). Thus far, no study examined the differential influence of these syndromes on SQ. MD and B have been assessed in 4,415 participants at baseline and in 1,396 participants at follow-up based on the Patient Health Questionnaire-9 (PHQ-9) and the Maslach Burnout Inventory-General Survey (MBI-GS). The Pittsburgh Sleep Quality Index was used to measure SQ. Based on the PHQ-9 and MBI-GS at baseline assessment, participants were divided into four groups: a control group, a MD group, a B group, and a comorbid group suffering from MD and B. Multiple regression analyses showed that all groups demonstrate significantly worse SQ than the control group, while individuals with MD showed a lower SQ compared to individuals with B. The comorbid group showed the lowest SQ. Longitudinal analyses showed a significant bidirectional association between major depressive symptoms and SQ, whereas burnout symptoms were predictive for SQ but not vice versa. The study indicates differences between MD and B with regard to SQ, suggesting worse SQ in more severely burdened groups. Major depressive symptoms are bidirectionally linked to SQ, whereas burnout symptoms are only suggested a risk factor for impaired SQ.

Effort-reward imbalance at work is associated with hair cortisol concentrations: Prospective evidence from the Dresden Burnout Study.

Chronic stress experienced at work is considered a major health challenge for modern societies. In fact there is ample evidence that deleterious work environments, based on high efforts in relation to few rewards, substantially augment the risk for a number of highly prevalent diseases (e.g. ischemic heart disease, stroke). One potential pathway mediating these associations involves the stress-related activation of the hypothalamus-pituitary-adrenocortical (HPA) axis with proceeding alterations in the secretion of its main effector hormone cortisol. In this study we assessed a prospective, two-year effect of effort-reward imbalance (ERI) on cortisol secretion, based on a sub sample (N = 150; mean ±â€¯SD age: 42.4 ±â€¯11.1; 84.0% female) of the ongoing Dresden Burnout Study (DBS). The provided ERI measures were collected as part of the online baseline and first follow up assessment. Further, cortisol secretion patterns over prolonged periods of time were evaluated in three consecutive years of laboratory baseline and follow up visits. Our findings suggest prospective associations between ERI and cortisol, indicating a blunted cortisol secretion in response to long-term work stress (p < 0.001). Given the regulatory properties of cortisol on various central and peripheral target tissues (e.g. cardiovascular system, liver, adipose tissue), a long-term decrease of cortisol availability can be hypothesized to cause multiple health-challenging consequences. Based on our findings, providing work environments where high efforts are always linked with high rewards have to be considered an important issue for employees health.