Emotional exhaustion and overcommitment to work are differentially associated with hypothalamus–pituitary–adrenal (HPA) axis responses to a low-dose ACTH_1–24 (Synacthen) and dexamethasone–CRH test in healthy school teachers

Figures & data

Table I.  Sample description.

	N = 53	Mean ± SD	Range
Sex
Men	22
Women in the luteal phase	10
Women using oral contraception	11
Postmenopausal women	10
Age (years)		49.3 ± 9.4	30–64
BMI		24.0 ± 2.6	20–29
CBG
Concentrations (μg/ml)
Men		59.8 ± 12.19
Women in the luteal phase		70.8 ± 10.66
Women using oral contraception		101.6 ± 45.3*
Postmenopausal women		72.2 ± 9.91
Years of employment		19.3 ± 11.5	3–42
German school types
Elementary/primary school (Grundschule)	14
Basic level secondary school (Hauptschule)	5
Secondary school (Realschule)	2
Grammar school (Gymnasium)	12
Comprehensive school (Gesamtschule)	8
Vocational school (Berufsbildende Schule)	7
Not further specified	5
ERI scores
Effort		18.7 ± 4.14	11–27
Reward		44.3 ± 6.63	30–55
ERI ratio		0.81 ± 0.27	0.39–1.47
OC scores		16.6 ± 3.49	8–23
MBI scores
EE		18.5 ± 10.01	2–53
Depersonalization		5.4 ± 5.41	0–30
Lack of accomplishment		12.7 ± 8.21	0–36
HADS-D scores		6.4 ± 2.36	3–12

Note: One-way ANOVA shows that CBG levels are significantly higher in women using oral contraception (F _3,49 = 8.55; p < 0.001).

Figure 1.  Mean total plasma cortisol concentration response ( ± SEM) to injection of 1 μg ACTH_1–24 in subjects with high vs. low EE. For illustration reasons, the sample was artificially divided by median split into groups with high (N = 27) vs. low (N = 26) EE; statistics are based on continuous EE questionnaire scores; the figure presents untransformed raw values. ANCOVA analysis for repeated measures controlling for sex, BMI, and CBG concentrations revealed that higher EE (entered as continuous variable) was associated with higher concentrations of total plasma cortisol in response to the ACTH_1–24 injection (p = 0.045).

Figure 2.  Mean ACTH (A), total plasma cortisol (B), and free salivary cortisol (C) concentration responses ( ± SEM) to injection of 100 μg CRH in subjects with high vs. low OC to work. Note: For illustration reasons, the sample was artificially divided by median split into groups with high (N = 26) vs. low (N = 27) OC; statistics are based on continuous OC questionnaire scores; the figures present untransformed raw values. ANCOVA analyses for repeated measures controlling for sex, BMI, and CBG concentrations revealed that higher OC (entered as continuous variable) was associated with lower concentrations of ACTH (p = 0.045), total plasma cortisol (p = 0.005), and free salivary cortisol (p = 0.023) in response to the CRH injection.

Table II.  Pearson correlation matrix for MBI-EE, OC, and HADS-D.

	MBI-EE	OC
OC	0.585**
HADS-D	0.503**	0.407**

MBI: Maslach burnout inventory; EE: emotional exhaustion; OC: overcommitment to work; HADS-D: Hospital anxiety and depression scale, subscale depression. **p < 0.01.