Risk of hospital staff burnout can be identified with a simple saliva test

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Sadly for many nurses and midwives burnout is nothing new, with the emotional, physical and mental exhaustion caused by prolonged stress being part of their every day. Burnout can emerge for a variety of reasons – excessive workloads, a traumatic event, toxic workplace cultures or outside pressures. Nurses and midwives are susceptible to burnout and should watch out for warning signs to avoid reaching breaking point. 

The results of a new research study may provide some help, with staff at risk of burnout able to be identified with a simple saliva test that measures the hormone cortisol.

Cortisol is produced in the body to help regulate processes such as metabolism and immune response. It is an anti-stress hormone, which activates metabolic break-down processes, thereby, making energy-rich compounds available to the human body. When people are under extreme stress, this hormone persists in higher concentrations. Elevated cortisol levels have been referred to by some health experts as “public enemy number one,” due to an association with many serious health issues including lower immune function, hypertension, elevated cholesterol, weight gain, and heart disease. Cortisol excess also increases the risk of depression and mental illness. 

The hormone is predominantly produced in the early morning upon waking. In healthy people, the cortisol level then falls again over the course of the day until there is practically no measurable cortisol left by the evening.

The picture is very different for those under constant stress, with the body keeping the cortisol level within the measurable range for much longer in order to cope with the prevailing stress. If the stress then becomes “chronic”, cortisol levels remain high without any normal daily pattern.

A new study, “Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring”,  published this month in Scientific Reports (Nature Publishing Group), compared the work-related stress and cortisol levels of burnout patients with those of healthy employees. It included 40 people experiencing burnout and 26 healthy controls.

The three lead investigators, Helmuth Haslacher and Alexander Pilger from the Division of Medical-Chemical Laboratory Diagnostics (KILM) of MedUni Vienna and Robert Winker from the stress clinic at the Health and Prevention Center of the KFA (Health Insurance Agency) have now shown that elevated cortisol levels can be detected by means of a single saliva sample, taken either at midday or in the evening, so that the risk of burnout can be measured. 


 “Our current data indicate that people at risk of burnout can be identified from a single saliva sample” Study authors


While similar tests have been conducted using saliva samples that were obtained in the morning, the researchers speculated that samples obtained in the evening would be more reliable. This is because cortisol is produced naturally in the morning, but persists into the evening hours among those who are chronically stressed. The experts conducted saliva swabs between 11:30 a.m. and 12:30 p.m., and then again just before bedtime. The study revealed that all 40 participants who reported high levels of stress at work showed significantly higher levels of cortisol in both samples. 

At baseline, significantly higher levels of salivary cortisol were observed in the burnout group compared to the control group. This was even more pronounced in the midday and evening samples than for total morning cortisol secretion.

The researchers said: “it was found that people who were identified as having a high level of work-related stress using psychological methods had noticeably higher cortisol values at midday and also in the evening.” They added that they had also observed an improvement in the clinical course and cortisol levels of patients receiving treatment in a special stress clinic that was set up.

“This means that we can use these markers for preventively identifying people who are at greater risk of burnout. Our current data indicate that people at risk of burnout can be identified from a single saliva sample with almost 100% accuracy,” they said.

The researchers said that follow-up work was now needed to evaluate the findings and develop a valid biochemical testing system for use in everyday clinical practice to identify high-risk candidates for burnout.

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