Working conditions and salivary cortisol in young hospital physicians

Intense work demands, high responsibility and limited control are frequently reported by young physicians. Chronic activation of the hypothalamo-pituitary-adrenal (HPA) axis during repetitive stress situations might account for the increased incidence in psychiatric and other disorders in physicians. However, objective data on stress levels are scarce, making it difficult to asses the impact of work stress thereon. Aim of the study was to identify work-related factors leading to chronic activation of the HPA- axis in physicians. 334 hospital physicians in training received questionnaires covering working conditions, stressors, social and health aspects. Saliva samples were collected on 2 consecutive days (4 per day), including a morning and a late night sample. Cortisol was measured by a LIA (IBL, Hamburg). For analysis, mean morning cortisol (MC), integrated cortisol secretion (area under the curve, AUC-G) and cortisol secretion variability (AUC-I) were used. From 146 respondents (rate: 43.7%), 118 subjects (44 m, 74 f, age 30.4±2.3yrs) provided properly collected samples and were included in this study. Physicians with a shorter professional experience (mean: 2.6±0.7yrs) had significantly higher MC levels (p=0.007), AUC-G (p=0.049) and higher AUC-I (p=0.004) than those with a longer experience. Among the factors related to working conditions, responsibility for severely ill patients and immediate action were significantly correlated to the AUC-G (r=0.322, p<0.001). Perceived quality of medical training correlated positively to MC (r=0.18) and negatively to AUC-I (r=-0.20). In regression analysis, professional experience and quality of medical training predicted morning cortisol levels (R2=12.4). In conclusion, chronic stress reflected by high morning and mean daily cortisol levels, seems to be frequent among young physicians during training. Cortisol levels decrease with professional experience, but increase with quality of medical training and high responsibility. Specific aspects of professional practice lead to activation of the HPA axis in physicians.