Summary: A simple saliva test that measures cortisol at specific times of day can help identify people at risk of burnout, chronic stress and related depression.
Source: Medical University of Vienna.
Depression and stress-related disorders are a growing global burden. According to World Health Organization estimates, depression ranks among the leading causes of disease burden worldwide, and experts expect several mental disorders—including depression, Alzheimer’s disease and alcohol dependence—to remain prominent causes of ill health by 2030. Increasing rates of work-related stress and burnout are also reported in many countries, including Austria, where mental health problems have become a leading cause of disability retirement since 2010. Researchers at the Medical University of Vienna (MedUni Vienna) and the Health Insurance Agency’s Health and Prevention Center have demonstrated that a straightforward saliva test measuring cortisol can be used to identify people at heightened risk of burnout.
Cortisol is a hormone involved in the body’s stress response. It helps mobilize energy by promoting metabolic processes and suppresses excessive immune reactions and inflammation. In healthy individuals, cortisol levels typically peak shortly after waking and then decline during the day, falling to very low or undetectable levels by evening. When people experience persistent stress, however, this normal daily rhythm can become disrupted: cortisol remains measurable for much longer throughout the day, and in cases of chronic stress the normal diurnal pattern may be lost entirely.
The research team—led by Helmuth Haslacher and Alexander Pilger from the Division of Medical-Chemical Laboratory Diagnostics (KILM) at MedUni Vienna and Robert Winker from the stress clinic at the Health and Prevention Center of the KFA (Health Insurance Agency)—found that elevated cortisol late in the day or at midday can be detected from a single saliva sample. Sampling at midday or at the cortisol nadir (evening) distinguished people with high levels of work-related stress and burnout from healthy employees, offering a practical biomarker for identifying individuals at risk.
In the study, researchers compared cortisol levels and work-related stress indicators in a group of patients diagnosed with burnout and a control group of healthy employees. Psychological assessments that identified high work-related stress were reflected in higher midday and evening salivary cortisol values. Patients who received treatment at the specialized stress clinic showed clinical improvement alongside reductions in cortisol levels, supporting the marker’s potential utility for monitoring treatment progress. The investigators conclude that midday and evening cortisol measurements may serve as an efficient, non-invasive screening and monitoring tool to detect people at increased risk of burnout.
Compared with earlier approaches that required multiple early-morning saliva samples taken at short intervals after waking, a single midday or evening sample proved both more reliable and far less burdensome. The researchers report that midday and nadir samples were superior to the cortisol awakening response for assessing and monitoring burnout. Their data indicate high accuracy in identifying people at risk from a single sample, while multiple early-morning samplings showed greater variability and required more effort. Laboratory analysis of the single samples can be completed within hours, and in this study salivary cortisol measures outperformed several blood-based stress markers in identifying burnout risk.
The study’s findings point to practical implications for preventive occupational health: a simple, fast saliva test could be incorporated into routine screening in workplaces or preventive care settings to identify high-risk employees and to monitor the effectiveness of stress-reduction interventions. Follow-up studies are planned to validate the approach in larger and more diverse populations and to develop standardized biochemical testing protocols suitable for everyday clinical and preventive practice.
Source: Medical University of Vienna
Publisher: NeuroscienceNews (article organized by NeuroscienceNews)
Image source: Image adapted from a Medical University of Vienna news release.
Original research: Open-access study titled “Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring” by Alexander Pilger, Helmuth Haslacher and colleagues, published in Scientific Reports (June 2018). The publication reports that midday and evening cortisol measurements were more strongly associated with burnout and that treatment was accompanied by significant reductions in cortisol levels.
Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring
Burnout and work-related stress symptoms, including anxiety and depression, contribute to prolonged work absence and early retirement, creating a need for reliable tools to identify at-risk individuals and to monitor treatment outcomes. The study evaluated stress-specific biomarkers in a real-world cohort (burnout patients: n = 40; healthy controls: n = 26) assessed at baseline and after four months of medical and psychological treatment. At baseline, salivary cortisol levels were significantly higher in the burnout group compared to controls, with larger differences observed in midday and nadir samples than in total morning cortisol secretion. The treatment program produced significant reductions in stress, anxiety and depression scores, and many patients demonstrated clinically relevant improvement. These changes were accompanied by approximately a 30% decrease in midday cortisol and a 25% decrease in cortisol nadir, supporting the usefulness of midday and evening salivary cortisol as assessment and biomonitoring markers for burnout.