Healthcare workers in Saudi Arabia perceive stress differently according to gender but not in cortisol levels: an immunoassay study

Authors

  • Ricardo J. M. Governo Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
  • Danah A. Alyusuf Department of Clinical Pharmacy, Jubail General Hospital, King Abdullah, Al Jubail, Saudi Arabia
  • Paul R. Gard School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, UK

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20194468

Keywords:

Cortisol, Stress, Enzyme-linked immunosorbent assay, Healthcare, Hair

Abstract

Background: Working in the healthcare sector is generally regarded as stress inductive, which hampers performance, yet one demanding constant accuracy. This dichotomy has led to numerous investigations on the impact from perceived stress on hospital workers but focused primarily on employing psychological methods to determine perceived stress. This study sought to employ an arguably more objective measure of chronic stress on female healthcare professionals in Saudi Arabia, by assaying the concentration of hair cortisol (HCC) in parallel with stress questionnaires.

Methods: Pharmacists, nurses and lab workers participated in providing hair samples. Cortisol levels were subsequently quantified using immunoassay methods. Investigations considered the variables of age, gender, and smoking, hair coloring or bleaching or working in shifts on both stress perception and HCC.

Results: On average chronic stress was perceived comparably between the different healthcare professions and not differ significantly against the female control group. However, chronic stress differed significantly between genders within the healthcare profession. In contrast, HCC levels showed no direct relation to stress perception with respect to either gender or profession. HCC did, however, show steady decreases with respect to age, as an indirect measure of experience, that contrasted against the identical scores for stress perception. Finally, night shifts, smoking or hair colouring did not produce a significant change on HCC in the healthcare cohorts.

Conclusions: Women in the healthcare profession perceive stress higher irrespective of profession compared to men. Also show a pattern of decreasing levels of cortisol with increasing age despite reporting similar stress perception against younger participants.

Author Biographies

Ricardo J. M. Governo, Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, UK

Lecturer of Anatomy

Department of Medical Education

Brighton and Sussex Medical School

Danah A. Alyusuf, Department of Clinical Pharmacy, Jubail General Hospital, King Abdullah, Al Jubail, Saudi Arabia

Lecturer in Anatomy

Department of Medical Education

Brighton and Sussex Medical School

References

Marmot M, Theorell T. Social class and cardiovascular disease: the contribution of work. Int J Health Serv Adm Eval. 1988;18(4):659-74.

Schnall P, Belkic K, Landsbergis P, Baker D. Why the workplace and cardiovascular disease?. Occup Med. 2000;15(1):1-6.

Johnson AC. Developmental pathways to attention-deficit/hyperactivity disorder and disruptive behaviour disorders: investigating the impact of stress response on executive functioning. Clin Psychol Rev. 2015;36:1-12.

Lee H-H, Lo SH, Chen BY, Lin YH, Chu D, Cheng TJ, et al. Increased nigh duty loading of physicians caused elevated blood pressure and sympathetic tones in a dose dependant manner. Int Arch Occup Environ Health. 2016;89(3):413-23.

Karabay ME, Akyuz B, Elci M. Effects of family-work conflict, locus of control, self-confidence and extraversion personality on employee work stress. Procedia Soc Behav Sci. 2016;235:269-80.

Godin I, Kittel F, Coppieters Y, Siegrist J. A prospective study of cumulative job stress in relation to mental health. BMC Public Health. 2005;5(1):67.

Lea VM, Corlett SA, Rodgers RM. Workload and its impact on community pharmacists' job satisfaction and stress: a review of the literature. Int J Pharm Pract. 2012;20(4):259-71.

Viehmann A, Kersting C, Thielmann A, Weltermann, B. Prevalence of chronic stress in general practitioners and practice assistants: Personal, practice and regional characteristics. PloS One. 2017;12(5):e0176658.

Boyle TA, Bishop A, Morrison B, Murphy A, Barker J, Ashcroft DM, et al. Pharmacist work stress and learning from quality related events. Res Social Adm Pharm. 2016;12(5):772-83.

Russell E, Koren G, Rieder M, Van Uum, S. Hair cortisol as a biological marker of chronic stress: current status, future directions and unanswered questions. Psychoneuroendocrinol. 2012;37(5):589-601.

Stalder T, Steudte S, Alexander N, Miller R, Gao W, Dettenborn L, et al. Cortisol in hair, body mass index and stress-related measures. Biol Psychol. 2012;90(3):218-23.

Faresjö Å, Jullander M, Götmalm S, Theodorsson E. Higher perceived stress and poorer health reflected in elevated cortisol concentrations measured in extracts of hair from middle-aged healthy women. BMC Psychol. 2014;2(1):30.

Dettenborn L, Tietze A, Kirschbaum C, Stalder T. The assessment of cortisol in human hair: associations with sociodemographic variables and potential confounders. Stress. 2012;15(6):578-88.

Feller S, Vigl M, Bergmann MM, Boeing H, Kirschbaum C, Stalder T. Predictors of hair cortisol concentrations in older adults. Psychoneuroendocrinol. 2014;39(1):132-40.

Manenschijn L, Koper JW, Lamberts SW, van Rossum EF. Evaluation of a method to measure long term cortisol levels. Steroids. 2011;76(10-11):1032-36.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96.

Maroufizadeh S, Foroudifard F, Navid B, Ezabadi Z, Sobati B, Omani-Samani R. The Perceived Stress Scale (PSS-10) in women experiencing infertility: A reliability and validity study. Middle East Fertil Soc J. 2018;23:456-59.

Taylor JM. Psychometric analysis of the ten-item perceived stress scale. Psychol Assess. 2015;27(1):90-101.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96.

Davenport MD, Tiefenbacher S, Lutz CK, Novak MA, Meyer JS. Analysis of endogenous cortisol concentrations in the hair of rhesus macaques. Gen Comp Endocrinol. 2006;147(3):255-61.

Raul JS, Cirimele V, Ludes B, Kintz P. Detection of physiological concentrations of cortisol and cortisone in human hair. Clin Biochem. 2004;37(12):1105-11.

Gidlow CJ, Randall J, Gillman J, Silk S, Jones MV. Hair cortisol and self-reported stress in healthy, working adults. Psychoneuroendocrinol. 2016;63:163-69.

Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959-92.

Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In Spacapan S, Oskamp S (eds). The social psychology of health: Claremont Symposium on Applied Social Psychology. Newbury Park, CA: Sage; 1988: 31-67.

Maeng LY, Milad MR. Sex differences in anxiety disorders: Interactions between fear, stress, and gonadal hormones. Horm Behav. 2015;76:106-17.

Kalra S, Einarson A, Karaskov T, Van Uum S, Koren G. The relationship between stress and hair cortisol in healthy pregnant women. Clin Invest Med. 2007;30(2):e103-7.

Dettenborn L, Tietze A, Bruckner F, Kirschbaum C. Higher cortisol content in hair among long-term unemployed individuals compared to controls. Psychoneuroendocrinology. 2010;35(9):1404-9.

Schadenhofer P, Kundi M, Abrahamian H, Stummer H, Kautzky-Willer A. Influence of gender, working field and psychosocial factors on the vulnerability for burnout in mental hospital staff: results of an Austrian cross-sectional study. Scand J Caring Sci. 2018;32(1):335-45.

Uhart M, Chong RY, Oswald L, Lin PI, Wand GS. Gender differences in hypothalamic-pituitary-adrenal (HPA) axis reactivity. Psychoneuroendocrinol. 2006;31(5):642-52.

Stroud LR, Salovey P, Epel ES. Sex differences in stress responses: social rejection versus achievement stress. Biol Psychiatr. 2002;52(4):318-27.

van der Meij L, Gubbels N, Schaveling J, Almela M, van Vugt M. Hair cortisol and work stress: Importance of workload and stress model (JDCS or ERI). Psychoneuroendocrinol. 2018;89:78-85.

Aldwin CM. Does age affect the stress and coping process? Implications of age differences in perceived control. J Gerontol. 1991;46(4):P174-80.

Nader N, Chrousos GP, Kino T. Interactions of the circadian CLOCK system and the HPA axis. Trends Endocrinol Metab. 2010;21(5):277286.

Kristensen SK, Larsen SC, Olsen NJ, Fahrenkrug J, Heitmann BL. Hair dyeing, hair washing and hair cortisol concentrations among women from the healthy start study. Psychoneuroendocrinol. 2017;77:182-85.

Manenschijn L, van Kruysbergen RG, de Jong FH, Koper JW, van Rossum EF. Shift work at young age is associated with elevated long-term cortisol levels and body mass index. J Clin Endocrinol Metab. 2011;96(11):e1862-5.

Parrott AC. Nesbitt's Paradox resolved? Stress and arousal modulation during cigarette smoking. Addict. 1998;93(1):27-39.

Loussouarn G, El Rawadi C, Genain, G. Diversity of hair growth profiles. Int J Dermatol. 2005;44:6-9.

Gow R, Thomson S, Rieder M, Van Uum S, Koren G. An assessment of cortisol analysis in hair and its clinical applications. Forensic Sci Int. 2010;196(1-3):32-7.

Weckesser LJ, Dietz F, Schmidt K, Grass J, Kirschbaum C, Miller R. The psychometric properties and temporal dynamics of subjective stress, retrospectively assessed by different informants and questionnaires, and hair cortisol concentrations. Sci Rep. 2019;9(1):1098.

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Published

2019-09-26

How to Cite

Governo, R. J. M., Alyusuf, D. A., & Gard, P. R. (2019). Healthcare workers in Saudi Arabia perceive stress differently according to gender but not in cortisol levels: an immunoassay study. International Journal Of Community Medicine And Public Health, 6(10), 4154–4161. https://doi.org/10.18203/2394-6040.ijcmph20194468

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Original Research Articles