Effort–reward imbalance in police work: associations with the cortisol awakening response
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We hypothesized that effort–reward imbalance (ERI) is associated with an atypical cortisol response. ERI has been associated with higher job stress. Stress triggers cortisol secretion via the hypothalamic–pituitary–adrenal (HPA) axis, and significant deviation from a typical cortisol pattern can indicate HPA axis dysfunction.
176 police officers participated from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. ERI was the exposure variable. Outcome variables were saliva-based peak and mean cortisol values, total area under the curve ground (AUCG) and baseline (AUCI); linear regression line fitted to log-transformed cortisol. Regression analyses were used to examine linear trend between ERI and cortisol parameters. Repeated measures analysis examined whether the pattern of cortisol over time differed between low ERI (< median) and high ERI (≥ median).
Mean age was 46 years (SD = 6.6). After adjustment for potential confounders, there was a significant inverse association between ERI and peak cortisol (β = − 0.20, p = 0.009), average cortisol (β = − 0.23, p = 0.003), and total area under the curve (β = − 0.21, p = 0.009). ERI was not significantly associated with AUCI (β = − 0.11, p = 0.214); slope of the regression line fitted to the cortisol profile (β = − 0.009, p = 0.908). Repeated measures analyses showed that the cortisol pattern did not vary significantly between high and low ERI using the median as a cut point (interaction p value = 0.790).
ERI was inversely associated with the magnitude of awakening cortisol over time, indicating HPA axis dysregulation and potential future health outcomes.
KeywordsPolice Stress Effort reward imbalance Awakening cortisol HPA axis dysregulation
This study was funded by the National Institute for Occupational Safety and Health, Contract #200-2003-01580. The funders had no involvement in the design, data collection, analysis, interpretation, or writing the manuscript or decision to publish.
Compliance with ethical standards
Conflict of interest
This research was conducted at The State University of New York at Buffalo, Buffalo, NY, USA, and was funded by the National Institute for Occupational Safety and Health (NIOSH), Contract no. 200-2003-01580. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the University at Buffalo, State University of New York Internal Review Board, and duly approved by the review board.
Informed consent was obtained from all participants included in the study.
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