Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel

Abstract

Background The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked. Methods 467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors. Results As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% ( IQR = 3% - 59%, p <0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model’s predictability. Conclusion Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.

Increases in stress hormone levels in a UK population during the COVID-19 pandemic: A prospective cohort study

“…Here we show evidence that these psychobiological perturbations were also evident amongst a general population sample. Furthermore, our study, and that by Racjani et al (2021) and Marcil et al (2022) , report comparable changes in cortisol/cortisone during the pandemic: with Rajcani et al, reporting an increase of 22% on pre-pandemic levels in health care professionals, Marcil et al reporting an increase of 27%, while our data show a 23% increase in hair cortisone.…”

“…Several issues are worthy of further discussion. First, the present work replicates and extends early findings on the experiences of health care workers during the pandemic which has shown an increase in cortisol levels when compared with pre-pandemic levels and positive associations between stress and cortisol in these populations ( Ibar et al, 2021 , Rajcani et al, 2021 , Marcil et al, 2022 ). Here we show evidence that these psychobiological perturbations were also evident amongst a general population sample.…”

“…Recent observational studies have also reported a relationship between cortisol and mental health during the COVID-19 pandemic. For example, Rajcani et al (2021) and Marcil et al (2021) reported that cortisol measured in hair during the COVID-19 pandemic increased by 22-27% among healthcare workers ( Rajcani et al, 2021 , Marcil et al, 2022 ). Ibar et al (2021) found that health workers with burnout also had significantly higher hair cortisol levels during the pandemic.…”

Stress and the hypothalamic–pituitary–adrenal axis: How can the COVID‐19 pandemic inform our understanding and treatment of acute insomnia?

“…For instance, it has been shown that cortisol levels in healthcare workers were higher during the peak of the first wave of the pandemic relative to immediately before, and that those individuals who worked in higher‐risk environments demonstrated increased cortisol levels compared with low‐risk workers (Rajcani et al, 2021). Separate studies, conducted during the pandemic, have shown that the relative change in cortisol levels can predict subsequent burnout in healthcare workers, and that the CAR is associated with the emotional response to the pandemic (Baliyan et al, 2021; Marcil et al, 2022); importantly, one demonstrated that hair cortisol levels increased from pre‐pandemic to post‐pandemic onset (Marcil et al, 2022). Overall, this provides further support to demonstrate that the simultaneous measurement of stress and HPA axis activity is relevant to the pathogenesis of acute insomnia.…”

The Psychoneuroimmunological Model of Moral Distress and Health in Healthcare Workers: Toward Individual and System-Level Solutions

“…Findings from a recent study found increased hair cortisol concentrations levels in HCWs who, during the current pandemic, experienced high distress due to an increased risk of exposure to the virus, fear of risk to their own and their family's health, greater workloads, and ethical and moral dilemmas during triage and patient care [ 92 ]. Additionally, changes in hair cortisol concentrations levels among HCWs three months after the outbreak of the COVID-19 pandemic predicted future burnout among HCWs [ 93 ]. Similar findings were reported for female nurses during the first wave of the COVID-19 pandemic: they had higher hair cortisol concentrations levels in the hair during the first wave relative to prior to the pandemic.…”