The role of stress in absenteeism: cortisol responsiveness among patients on long-term sick leave.
OBJECTIVE
This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal.


METHODS
Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.


RESULTS
Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups.


CONCLUSIONS
The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.
Henrik B
HB
Jacobsen
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway; Forensic Department and Research Centre Brøset, St. Olav's University Hospital, Trondheim, Norway.
Johan Håkon
JH
Bjørngaard
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.
Karen W
KW
Hara
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.
Petter C
PC
Borchgrevink
Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
Astrid
A
Woodhouse
National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway; Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway.
Nils Inge
NI
Landrø
Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.
Anette
A
Harris
Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway; National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
Tore C
TC
Stiles
D000041:Absenteeism; D000328:Adult; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D057566:Self Report; D018582:Sick Leave; D013315:Stress, Psychological / Q000378:metabolism* / Q000503:physiopathology / Q000523:psychology
D006854:Hydrocortisone