Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty

Int J Environ Res Public Health. 2018 Mar 13;15(3):506. doi: 10.3390/ijerph15030506.


The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day) and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training) of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC) (p < 0.006). This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001). According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.

Keywords: Emergency Department-duty day; acute stress; anxiety; cortisol; medical resident.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anxiety / epidemiology*
  • Anxiety / metabolism
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Hydrocortisone / metabolism*
  • Hypothalamo-Hypophyseal System
  • Internship and Residency*
  • Longitudinal Studies
  • Male
  • Personality Inventory
  • Physicians / psychology
  • Pituitary-Adrenal System
  • Saliva / chemistry
  • Spain / epidemiology
  • Stress, Physiological
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / metabolism


  • Hydrocortisone