title: Burnout and cortisol: evidence for a lower cortisol awakening response in both clinical and non-clinical burnout.
abstract: OBJECTIVE
  Although the relationship between burnout and cortisol levels has been examined in previous studies, the results are mixed. By adopting a design in which we attempted to overcome important limitations of earlier research, the purpose of the present study was to improve the understanding of the biological underpinnings of burnout and to further the knowledge about the relationship between burnout and cortisol.
  
  
  METHODS
  A clinical burnout patient group (n =32), a non-clinical burnout group (n =29), and a healthy control group (n =30) were compared on burnout symptoms, physical and psychological complaints, and on cortisol levels. In order to examine a broad range of cortisol indices, including different measures of the cortisol awakening response (CAR) and several day-curve measures, salivary cortisol was collected six times a day during two consecutive non-workdays.
  
  
  RESULTS
  As expected, the clinical burnout group reported more burnout symptoms, and physical and psychological complaints than the non-clinical burnout group, which in turn reported more burnout symptoms and physical and psychological complaints than the healthy control group. With regard to cortisol levels, we found that until 30 min after awakening, the CAR of both the clinical and the non-clinical burnout group was lower compared with the healthy control group. Furthermore, there was some evidence that the decline of cortisol during the day was smaller in the non-clinical burnout group than in the healthy control group.
  
  
  CONCLUSIONS
  The results of the present study provide support for lowered cortisol in both clinical and non-clinical burnout.
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands. Electronic address: b.oosterholt@psych.ru.nl.
authors.forename: Bart G
authors.initials: BG
authors.lastname: Oosterholt
authors.affiliation: Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands.
authors.forename: Joseph H R
authors.initials: JHR
authors.lastname: Maes
authors.affiliation: Institute of Psychology, Erasmus University, Rotterdam, the Netherlands.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Van der Linden
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands; HSK Group, Arnhem, the Netherlands.
authors.forename: Marc J P M
authors.initials: MJPM
authors.lastname: Verbraak
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands.
authors.forename: Michiel A J
authors.initials: MAJ
authors.lastname: Kompier
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000175:diagnosis / Q000378:metabolism*; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000378:metabolism*; D012720:Severity of Illness Index
chemical_list: D006854:Hydrocortisone
keywords: CAR; Emotional exhaustion; Fatigue; HPA axis; Salivary cortisol; Work stress