Journal of Clinical Monitoring and Computing

, Volume 26, Issue 6, pp 407–413 | Cite as

Do waking salivary cortisol levels correlate with anesthesiologist’s job involvement?

  • Moti Klein
  • Natan Weksler
  • Yori Gidron
  • Eliyahu Heldman
  • Eugen Gurski
  • Otto Robert F. Smith
  • Gabriel M. Gurman


Anesthetists’ work carries great responsibility and can be very stressful. Cognitive appraisal plays a central role in stress responses; however, little is known about the relationship between stress appraisal and biological markers of stress, particularly among anesthesiologists. Stress response may be associated with increased levels of systemic cortisol, which can be conveniently measured in saliva and used as a marker for the extent of stress. The objective of this study was to examine the correlation between work-related cognitive variables and waking salivary cortisol, a possible stress marker, in anesthesiologists. Thirty-eight anesthesiologists were assessed for work-related thought intrusions and perceived “mental distance” between themselves and their work, using the pictorial representation of illness self-measure (PRISM), and underwent an implicit association test reflecting implicit job-stress associations. Salivary cortisol was measured twice upon awakening and an hour later, in saliva samples, using a kit based on chemoluminescence competition assay. Only implicit job-stress associations were correlated with waking cortisol (r = 0.35, p < 0.05). Furthermore, high implicit job-stress was related to elevated cortisol only among anesthesiologists reporting large “mental distance” from work, which may represent limited job involvement related to burnout. Anesthesiologists with a low degree of job involvement who have high implicit job-stress associations have higher levels of waking salivary cortisol. Further studies are necessary to assess the impact of stress management techniques on anesthesiologists’ personal and professional behavior as well as on the quality of medical care.


Cognitive appraisal Implicit measures Waking cortisol Anesthetists 


  1. 1.
    Kain ZN, Chan KM, Katz JD, et al. Anesthesiology and acute perioperative stress: a cohort study. Anesth Analg. 2002;95:177–83.PubMedCrossRefGoogle Scholar
  2. 2.
    Jackson SH. The role of stress in anaesthesiologists’ health and well-being. Acta Anaesthesiol Scand. 1999;43:583–602.PubMedCrossRefGoogle Scholar
  3. 3.
    Morais A, Maia P, Azevedo A, Amaral C, Tavares J. Stress and burnout among Portuguese anaesthesiologists. Eur J Anaesthesiol. 2006;23:433–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Maslach C, Pines A. Nurses burnout: an existential psychodynamic perspective. J Psychosoc Nurs Ment Health Serv. 2000;38:23–32.Google Scholar
  5. 5.
    De Vente W, Olff M, Van Amsterdam JG, Kamphuis JH, Emmelkamp PM. Physiological differences between burnout patients and healthy controls: blood pressure, heart rate, and cortisol responses. Occup Environ Med. 2003;11:54–61.CrossRefGoogle Scholar
  6. 6.
    Moch SL, Panz VR, Joffe BI, Havlik I, Moch JD. Longitudinal changes in pituitary-adrenal hormones in South African women with burnout. Endocrine. 2003;21:267–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Kudeilka BM, Bellingrath S, Hellhammer DH. Cortisol in burnout and vital exhaustation: an overview. G Ital Med Lav Ergon. 2006;28:34–42.Google Scholar
  8. 8.
    Danhof-Pont BM, van Veen T, Zitman FG. Biomarkers in burnout: a systematic review. J Psychosom Res. 2011;70:505–24.PubMedCrossRefGoogle Scholar
  9. 9.
    Chidad Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol. 2009;80:265–78.CrossRefGoogle Scholar
  10. 10.
    Seeley HF. The practice of anaesthesia a stressor for the middle-aged? Anaesthesia. 1996;51:571–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Nyssen AS, Hansez I. Stress and burnout in anaesthesia. Curr Opin Anaesthesiol. 2008;21:406–11.PubMedCrossRefGoogle Scholar
  12. 12.
    Maurier WL, Northcott HC. Job uncertainty and health status for nurses during restructuring of health care in Alberta. West J Nurs Res. 2000;22:623–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Baum A, Cohen L, Hall M. Control and intrusive memories as possible determinants of chronic stress. Psychosom Med. 1993;55:274–86.PubMedGoogle Scholar
  14. 14.
    Foa EB, Cashman L, Jacox L, Kevin P. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess. 1997;9:445–51.CrossRefGoogle Scholar
  15. 15.
    Buchi S, Villiger P, Kauer Y, Klaghofer R, Sensky T, Stoll T. PRISM (pictorial representation of illness and self measure)—a novel visual method to assess the global burden of illness in patients with systemic lupus erythematosus. Lupus. 2000;9:368–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Coutu MF, Durand MJ, Baril R, et al. A review of assessment tools of illness representations: are these adapted for a work disability prevention context? J Occup Rehabil. 2008;18:347–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74:583–602.Google Scholar
  18. 18.
    Baars BJ. Is a real psychoscope possible? Inferring when brain images involve conscious experiences, paper presented at Towards a Science of Consciousness 1998: Tucson III, April 27–May 2, Tucson, AZ, USA.Google Scholar
  19. 19.
    van Aken MO, Romijin JA, Miltenburg JA, Lentjes EG. Automated measurement of salivary cortisol. Clin Chem. 2003;49:1408–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Roberts ADL, Wessely S, Chalder T, Papadopoulos A, Cleare AJ. Salivary cortisol response to awakening in chronic fatigue syndrome. Brit J Psychol. 2004;184:136–41.CrossRefGoogle Scholar
  21. 21.
    Egloff B, Wilhelm FH, Neubauer DH, Mauss IB, Gross JJ. Implicit anxiety measure predicts cardiovascular reactivity to an evaluated speaking task. Emotion. 2002;2:3–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Nausheen B, Gidron Y, Gregg A, Tissarchondou HS, Peveler R. Loneliness, social support and cardiovascular reactivity to laboratory stress. Stress. 2007;10:37–44.PubMedCrossRefGoogle Scholar
  23. 23.
    Steffens MC. Is the implicit association test immune to faking? Exp Psychol. 2004;51:165–79.PubMedCrossRefGoogle Scholar
  24. 24.
    Fazio RH, Olson MA. Implicit measures in social cognition research: their meaning and use. Annu Rev Psychol. 2003;54:297–327.PubMedCrossRefGoogle Scholar
  25. 25.
    Luo Q, Nakic M, Wheatly T, Richell R, Martin A, Blair RJ. The neural basis of implicit moral attitude—an IAT study using event-related fMRI. Neuroimage. 2006;30:1449–57.PubMedCrossRefGoogle Scholar
  26. 26.
    Gitanjali B, Ananth R. Effect of acute exposure to loud occupational noise during daytime on the nocturnal sleep architecture, heart rate and cortisol secretion in healthy volunteers. J Occup Health. 2003;45:146–52.PubMedCrossRefGoogle Scholar
  27. 27.
    Sonnentag S, Kruel U. Psychological detachment from work during off-job time: the role of stressors, job involvement, and recovery-related self-efficacy. Eur J Work Org Psychol. 2006;15:197–217.CrossRefGoogle Scholar
  28. 28.
    Reilly NP. Exploring a paradox: commitment as a moderator of the stressor-burnout relationship. J Appl Social Psychol. 1994;24:397–414.CrossRefGoogle Scholar
  29. 29.
    Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Occupational stress and burnout in anaesthesia. Br J Anaesth. 2003;90:333–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Melamed S, Ugarten U, Shirom A, Kahana L, Lerman Y, Froom P. Chronic burnout, somatic arousal and elevated salivary cortisol levels. J Psychosom Res. 1999;46:591–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Lederer W, Kinzl JF, Trefalt E, Traweger C, Benzer A. Significance of working conditions on burnout in anesthetists. Acta Anaesthesiol Scand. 2006;50:58–63.PubMedCrossRefGoogle Scholar
  32. 32.
    Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in internal medicine residency program. Ann Intern Med. 2002;136:358–67.PubMedGoogle Scholar
  33. 33.
    Wachter RM, Provonost P. The 100,000 lives campaign: a scientific and policy review. Jt Comm J Qual Patient Saf. 2006;32:621–7.PubMedGoogle Scholar
  34. 34.
    Scheer FAJL, Buijs RM. Light affects morning salivary cortisol in humans. J Clin Endocrinol Metab. 1999;84:3395–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Moti Klein
    • 1
  • Natan Weksler
    • 2
  • Yori Gidron
    • 3
  • Eliyahu Heldman
    • 4
  • Eugen Gurski
    • 1
  • Otto Robert F. Smith
    • 5
  • Gabriel M. Gurman
    • 2
  1. 1.Division of Anesthesiology and Critical Care, Soroka Medical Center, Faculty of Health SciencesBen-Gurion University of the NegevBeershebaIsrael
  2. 2.Division of Anesthesiology and Intensive Care, Mayanei Hayeshua Medical Center, Faculty of Health SciencesBen-Gurion University of the NegevBnei BrakIsrael
  3. 3.Faculty of Medicine and PharmacyFree University of Brussels (VUB)BrusselsBelgium
  4. 4.Department of Applied Sciences, Clinical BiochemistryBen-Gurion University of the NegevBeershebaIsrael
  5. 5.Department of Medical PsychologyUniversity of TilburgTilburgThe Netherlands

Personalised recommendations