Exhaustion and endocrine functioning in clinical burnout: an in-depth study using the experience sampling method

Area of Science:

• Endocrinology
• Psychiatry
• Occupational Health

Background:

• Burnout is a significant occupational health issue.
• The Hypothalamic-Pituitary-Adrenal (HPA) axis is implicated in stress response.
• Previous research on burnout and HPA axis functioning is limited by retrospective assessment bias.

Purpose of the Study:

• To investigate the relationship between HPA axis functioning and burnout symptoms.
• To utilize an electronic symptom diary to overcome retrospection bias.
• To examine within- and between-subject associations.

Main Methods:

• Forty-two clinically burned-out participants used an electronic diary for 2 weeks.
• Saliva samples were collected to assess cortisol awakening response (CAR), dehydroepiandrosterone-sulphate (DHEAS), and perform the dexamethasone suppression test (DST).
• Momentary exhaustion and daily recovery were assessed via diary, alongside retrospective burnout questionnaires.

Main Results:

• Significant relationships were found between endocrine values and momentary symptom severity assessed by diary.
• No significant associations were observed with retrospective questionnaire-assessed burnout symptoms.
• Severe burnout symptoms were linked to lower CAR, higher DHEAS, smaller cortisol/DHEAS ratios, and stronger DST suppression.

Conclusions:

• Burnout symptom severity is significantly associated with HPA axis functioning.
• The electronic diary method provides a more accurate assessment of burnout symptoms and their relation to endocrine function.
• Findings support the view that HPA axis dysregulation is a component of clinical burnout.