Burnout, perceived stress, and cortisol responses to awakening

Psychosom Med. Mar-Apr 1999;61(2):197-204. doi: 10.1097/00006842-199903000-00012.


Objective: The effects of burnout and perceived stress on early morning free cortisol levels after awakening were investigated in a group of teachers. Previous studies revealed that cortisol levels show a significant increase after awakening, with high intraindividual stability.

Methods: Sixty-six teachers from local public schools (42 women and 24 men, mean age 42+/-5 years) were asked to sample saliva for cortisol analysis on 3 consecutive days. On each day, cortisol levels were measured at the time of awakening and 15, 30, and 60 minutes thereafter. On the night before the third day, subjects took 0.5 mg dexamethasone orally for testing glucocorticoid feedback inhibition. Burnout and perceived stress were measured by three different questionnaires.

Results: Perceived stress correlated with increases of cortisol levels during the first hour after awakening after dexamethasone pretreatment. In addition, teachers scoring high on burnout showed lower overall cortisol secretion on all sampling days, and a higher suppression of cortisol secretion after dexamethasone administration. In the subgroup of teachers with both high levels of perceived stress and high levels of burnout, a lower overall cortisol secretion was observed on the first 2 days, with stronger increases during the first hour after awakening after dexamethasone suppression. This subgroup also showed the lowest self-esteem, the highest external locus of control, and the highest number of somatic complaints.

Conclusions: These results demonstrate differential effects of burnout and perceived stress on hypothalamic-pituitary-adrenal axis regulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenocorticotropic Hormone / analysis
  • Adult
  • Analysis of Variance
  • Burnout, Professional / metabolism*
  • Burnout, Professional / psychology*
  • Contraceptives, Oral / analysis
  • Dexamethasone
  • Fatigue Syndrome, Chronic / diagnosis
  • Fatigue Syndrome, Chronic / psychology
  • Female
  • Humans
  • Hydrocortisone / analysis*
  • Hypothalamo-Hypophyseal System / metabolism
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Male
  • Middle Aged
  • Pituitary-Adrenal System / metabolism
  • Pituitary-Adrenal System / physiopathology*
  • Saliva / chemistry
  • Severity of Illness Index
  • Thyrotropin-Releasing Hormone / analysis
  • Time Factors
  • Wakefulness*


  • Contraceptives, Oral
  • Thyrotropin-Releasing Hormone
  • Dexamethasone
  • Adrenocorticotropic Hormone
  • Hydrocortisone