The Role of Stress in Absenteeism: Cortisol Responsiveness Among Patients on Long-Term Sick Leave

PLoS One. 2014 May 2;9(5):e96048. doi: 10.1371/journal.pone.0096048. eCollection 2014.

Abstract

Objective: This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal.

Methods: Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G.

Results: Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups.

Conclusions: The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absenteeism*
  • Adult
  • Female
  • Heart Rate
  • Humans
  • Hydrocortisone / metabolism*
  • Male
  • Self Report
  • Sick Leave*
  • Stress, Psychological / metabolism*
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology

Substances

  • Hydrocortisone

Grant support

This study was done using government funding through the regional health. The full name of funder is the Central Norway Regional Health Authority. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.