title: Correlation of serum cortisol levels and stress among medical doctors working in emergency departments.
abstract: OBJECTIVE
  To assess and correlate serum cortisol levels and self-perceived work-related stress among medical doctors working in emergency departments in different tertiary care hospitals of Karachi.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology, AKUH, from December 2004 to August 2005.
  
  
  METHODS
  A total of 64 doctors participated from one private and two public tertiary care hospitals of Karachi. Thirty-four doctors were from emergency departments and 30 from non-emergency departments. Serum cortisol levels were measured in the morning (between 8.00-8.30 am) and in the evening (between 8.00-8.30 pm). Cortisol was measured by Florescence Polarization Immunoassay (FPIA) technique. Two questionnaires, modified mental Professional Stress Scale (PSS) and Aga Khan University Anxiety and Depression Scale (AKUADS) were used to assess stress levels.
  
  
  RESULTS
  Emergency room physicians (ERP) were 1.2-year younger than non-emergency room physicians (NERP). Mean evening cortisol of emergency physicians was 60.72nmol/L higher than non-emergency physicians. The difference between morning and evening cortisol was marginally significant (p = 0.051). Morning diastolic blood pressure was 3mmHg higher in emergency physicians. Forty-one percent of emergency physicians and 20% of non-emergency physicians had AKUADS more than or equal to 20, the difference was borderline significant (p = 0.068). Mean value of professional stress scale for emergency physicians was significantly higher than non-emergency physicians. Evening serum cortisol concentration was significantly associated with PSS (p = 0.011). The sub-scales such as work-load (p = 0.007) and lack of resources were highly significant with evening cortisol (p = 0.005).
  
  
  CONCLUSIONS
  In this study, evening serum cortisol levels significantly correlated with work overload and lack of resources, however, there was marginally significant correlation between morning and evening serum cortisol difference. Study suggests that emergency physicians perceive more stress than non-emergency physicians. Work overload and lack of resources are major contributing factors for stress in these doctors.
authors.affiliation: Section of Chemical Pathology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi. ayaz.baig@aku.edu
authors.forename: Ayaz
authors.initials: A
authors.lastname: Baig
authors.forename: Imran
authors.initials: I
authors.lastname: Siddiqui
authors.forename: Haider
authors.initials: H
authors.lastname: Naqvi
authors.forename: Salman
authors.initials: S
authors.lastname: Sabir
authors.forename: Jawaid
authors.initials: J
authors.lastname: Jabbar
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shahid
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D004632:Emergency Medical Services; D005260:Female; D016231:Fluorescence Polarization Immunoassay; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D010820:Physicians; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000097:blood*; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone