PostHeaderIcon Your Spit May Hold the Key to Predicting Burnout

February 22, 2011


From Wednesday’s Globe and Mail

New test can show ’stress hormone’ cortisol levels, and help doctors avoid misdiagnosis

Go ahead: Spit if you feel frustrated about your job. What your saliva reveals could alert doctors to whether you’re at risk of burnout at work, according to new Canadian research.

And testing saliva could also help people with symptoms of burnout avoid being put on medication that might actually make the condition worse, said Robert-Paul Juster, a doctoral student at McGill University in Montreal who helped design the research.

A clue that someone is suffering burnout is lowered levels of cortisol, often referred to as the “stress hormone” because it is secreted when we feel anxious or agitated. But if we are under continual stress, our bodies can shut down production of the hormone rather than try to keep up with the constant demand.

“We wanted to … find a simple way to find low levels of the hormone showing up in people who have not yet had problems, and how that may predict risk of burnout,” Mr. Juster said.

Normally, cortisol tends to spike in the morning as people wake up, which is the body’s way of revving up after a night’s sleep. Levels usually decline during the day. “But we find that people with high stress don’t have that boost of cortisol in the morning,” Mr. Juster said. “They report feeling exhausted in the morning, even though they’ve had a full night’s sleep.”

Burnout, clinical depression, or anxiety-related issues in the workplace affect at least 10 per cent of North Americans and Europeans, according to estimates prepared by the International Labour Organization.

The Montreal research included a random sample of 30 middle-aged workers in a variety of professions. They took samples of their saliva at home and at work a total of five times a day; using a questionnaire, they also rated their stress levels and any physical symptoms they were experiencing.

About half of the participants reported facing a high level of stress and physical symptoms such as fatigue and irritability in their workplace. In their saliva tests, this showed up as either lower or higher than average levels of cortisol.

The difference is significant, because although burnout and depression have similar symptoms, burnout typically reduces cortisol levels in the body, while depression increases levels of cortisol, noted the study’s supervisor, Sonia Lupien, of the Centre for Studies on Human Stress of Louis-H. Lafontaine Hospital in Montreal, who is an associate professor of psychiatry at the Université de Montréal.

If a person goes to see a psychiatrist complaining of fatigue and irritability, and is feeling cynical and not highly motivated, the doctor might think that the person is depressed and prescribe antidepressants, which have the effect of lowering cortisol levels, Dr. Lupien explained. But if the person is already suffering from low cortisol levels, the medication could reduce the levels even more and potentially put him or her at higher risk of spiralling into burnout.

The saliva test requires laboratory analysis, so it is not as simple as monitoring insulin levels with a glucose strip. “But [the test] is as simple as spitting in a tube and putting it in a refrigerator, and the questionnaire takes five minutes to complete,” Mr. Juster said.

“Saliva will tell you things that the blood samples won’t tell you. Because you can easily take the tests through the day, it will give a dynamic of how the stress hormone varies through the day,” he said.

The researchers are now planning a larger follow-up study aiming to find specific levels of cortisol that point to a high risk of imminent burnout. This could help employees realize they need to amend their lives to reduce their stress, and help doctors steer patients at risk into stress reduction programs, Mr. Juster suggested.

“As it stands now, there are no norms for cortisol; the only values are for risk of pituitary tumours.

“What we’re suggesting is in the future, is that it would be important for physicians and psychiatrists to do a series of cortisol tests to find risks. If you are starting to see you have really high or really low levels, that is a warning of potential burnout and also risk of mental health issues in general,” Mr. Juster said.

The research is to appear in a coming issue of the journal Psychoneuroendocrinology.

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