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Cited by 135Stress Responses and CortisolHealthcare professionals’ stress and burnoutAdrenal Hormones and Disorders

Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship

Open access
Mayer, Stefanie E., Lopez-Duran, Nestor L., Sen, Srijan, Abelson, James L.·2018·Psychoneuroendocrinology
DOI 10.1016/j.psyneuen.2018.03.020PMC PMC5924646
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Abstract

Background Stress plays a causal role in depression onset, perhaps via alteration of hypothalamic-pituitary-adrenal (HPA) axis functioning. HPA axis hyperactivity has been reported in depression, though inconsistently, and the nature of this relationship remains unclear, partly because cortisol measurement over time has been challenging. Development of hair cortisol assessment, a method that captures cortisol over prolonged periods of time, creates new possibilities. In this study, hair cortisol was incorporated into a prospective and longitudinal study of medical internship, stress and symptoms of depression. This provided a rare opportunity to 1) prospectively assess hair cortisol responses to stress, and 2) examine whether stress-induced changes in hair cortisol predict depressive symptom development. Methods Hair cortisol, depressive symptoms, and stress-relevant variables (work hours, sleep, perceived stress, mastery/control) were assessed in interns (n = 74; age 25-33) before and repeatedly throughout medical internship. Results Hair cortisol sharply increased with stressor onset, decreased as internship continued, and rose again at year’s end. Depressive symptoms rose significantly during internship, but were not predicted by cortisol levels. Hair cortisol also did not correlate with increased stressor demands (work hours, sleep) or stress perceptions (perceived stress, mastery/control); but these variables did predict depressive symptoms. Discussion Hair cortisol and depressive responses increased with stress, but they were decoupled, following distinct trajectories that likely reflected different aspects of stress reactivity. While depressive symptoms correlated with stressor demands and stress perceptions, the longitudinal pattern of hair cortisol suggested that it responded to contextual features related to anticipation, novelty/familiarity, and social evaluative threat.

AI snapshot

Written from the paper’s full text.

TL;DR

In a prospective longitudinal study of 74 medical interns, hair cortisol rose sharply with internship onset, fell during the year, and rose again near year’s end, while depressive symptoms increased and remained elevated. Despite both increasing with stress, hair cortisol and depressive symptoms were decoupled and did not predict one another.

Key findings

  • Hair cortisol changed significantly over time, F(6, 253) = 10.47, p < .001: it was elevated at 2 months (b = 0.1799, p < .001) and 4 months (b = 0.0938, p = .016) relative to pre-internship, then fell below pre-internship levels at 10 months (b = −0.0911, p = .011) before returning to comparable levels at 12 months (b = 0.0192, p = .524).
  • Depressive symptoms increased from pre-internship (M ± SD = 2.78 ± 2.94) to 3 months (M ± SD = 5.03 ± 4.14, p < .001) and remained elevated throughout internship; 33.3% reported at least moderate depressive symptoms (PHQ ≥ 10) at least once.
  • Hair cortisol change was not associated with depressive symptom trajectory (hair cortisol change-by-time b = 0.0323, p = .286; change-by-time² b = −0.0021, p = .378), and the two were not correlated (r(65) = −0.08, p = .51).
  • Depressive symptoms, but not hair cortisol, correlated with stressor demands and perceptions: increased work hours r(65) = 0.349, p = .004; decreased sleep r(51) = 0.386, p = .004; increased perceived stress r(50) = 0.394, p = .004; decreased mastery/control r(51) = 0.293, p = .033.

Methods

  • Prospective longitudinal naturalistic study of medical internship; participants were recruited from University of Michigan Medical School graduates matching within 50 miles of Ann Arbor, across 2012–2015 cohorts, yielding n = 74 (age 25–33; 56% female).
  • Hair cortisol was collected pre-internship and at 4, 8, and 12 months, cut into two 2-cm segments and assayed by immunoassay; depressive symptoms (PHQ-9), perceived stress (PSS), mastery/control, work hours, and sleep were assessed before and repeatedly during internship.
  • Analyses used repeated-measures ANOVA within a mixed-model framework, multilevel growth curve modeling, and Pearson correlations; missing hair cortisol data were imputed, and Segment 2 values were conservatively increased by 10% to adjust for wash-out.

Limitations

  • The paper states the sample was small and replication with a larger sample is needed; it also lacked power to test whether specialties differed in psychobiological trajectories, assumed a 1 cm/month hair growth rate despite individual variability, could not fully rule out seasonal effects without a control group, and found cohort effects in hair cortisol and depressive symptoms.
  • The paper states depressive symptoms were assessed only by self-report (PHQ-9), not clinical interviews or DSM criteria, and the design was correlational, so causal insights require controlled laboratory work.
  • Evident from the text: the sample was predominantly Caucasian (80%), single (61%), without children (89%), non-smoking, and recruited from one medical school/geographic area, limiting generalizability; missing Segment 2 hair data was substantial (31%), and the study did not use established measures of anticipation, novelty/familiarity, or social-evaluative threat.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.psyneuen.2018.03.020

Cites

72 of 72 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

15 of 54 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Existing literature does not clearly demonstrate season effects that could explain the early rise in hair cortisol seen here.

    “However, existing literature does not clearly demonstrate season effects that could explain the early rise in hair cortisol seen here.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Abell et al., 2016 source
    • cites Braig et al., 2015 source
    • cites Fischer et al., 2017 source
  • Premisecitation

    Medical internship is an established model of stress and depression.

    “an established model of stress and depression (Sen et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Sen et al., 2010 source
  • Premisecitation

    A recent meta-analysis found that the prevalence of depressive symptoms was similar across specialties.

    “a recent meta-analysis of studies recruiting residents from both single (n = 26) and multiple (n = 28) specialties found that the prevalence of depressive symptoms was similar across specialties, suggesting common underlying factors (Mata et al., 2015).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Mata et al., 2015 source

      The Results (Study Characteristics) report 26 studies recruiting from single specialties and 28 from multiple specialties. The Results (Prevalence by Study-Level Characteristics) found no significant difference between studies of nonsurgical residents and studies including both surgical and nonsurgical residents, but this is narrower than finding similar prevalence across specialties generally. The Discussion also identifies specialty as a contributor to between-study heterogeneity; the suggestion of common underlying factors is the citing authors’ interpretation. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    The chronic stressor of medical internship triggers new onset depression in a substantial number of those exposed.

    “These longitudinal data, collected in the context of a chronic stressor that triggers new onset depression in a substantial number of those exposed (Mata et al., 2015; Sen et al., 2010), add weight to the idea that hypercortisolemia is neither a cause nor direct correlate of depressive symptom states, at least in the context of a non-clinical sample.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Mata et al., 2015 source

      The Results (Secondary Analysis of Longitudinal Studies; page not specified) report a median 15.8-percentage-point increase in depressive symptoms after residency training began. The Discussion suggests causes common to the residency experience, but the paper assesses changes in depressive symptoms rather than establishing that internship causes new-onset depression. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Sen et al., 2010 source
  • Findingown data

    The overall hair cortisol trajectory during internship was cubic: an initial increase, a subsequent decline, and a deceleration of the decline toward the end.

    “A cubic trajectory represented the best fit for the data (lowest AIC; linear model AIC = 89.13; quadratic model AIC = 101.52; cubic model AIC = 61.79).”
    • Also stated in: § 3.2 Hair Cortisol Responses to Internship Stress · plain
      “hair cortisol initially increased in response to internship stress (time b = 0.1171, p < .001), followed by a decline in hair cortisol as internship continued (time2 b = −0.0288, p < .001), and a deceleration of this decline towards the end of internship (time3 b = 0.0016, p < .001; see Table 2 Unconditional Model).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 18

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9).

    “Self-reported depressive symptoms in the past 2 weeks were assessed prior to internship start and at three-month intervals during internship using the 9-item Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kroenke et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Meta-analytic evidence estimates an overall prevalence of depression during residency of 28.8%, ranging from 20.9% to 43.2%.

    “meta-analytic evidence (54 studies; n = 17 560 resident physicians) estimates an overall prevalence of depression during residency of 28.8%, ranging from 20.9% to 43.2% (Mata et al., 2015).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Mata et al., 2015 source

      The Results report a pooled prevalence of 28.8% across 54 studies and 17,560 residents. The Discussion gives the 20.9%–43.2% range, but specifies that trainees screened positive for depression or depressive symptoms; it also says the prevalence of major depressive disorder could not be precisely determined. Calling these figures the prevalence of depression alone omits that qualification. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    There is some evidence that HPA axis dysregulation may precede depression.

    “There is some evidence that HPA axis dysregulation may precede depression (Adam et al., 2010; Harris et al., 2000)”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Adam et al., 2010 source
    • cites Harris et al., 2000 source

  • May combine two claims.

    Premisecitation

    Some cross-sectional studies have shown positive associations between hair cortisol and clinically diagnosed depressed patients (mostly inpatients) and between hair cortisol and self-reported depressive symptoms in non-clinical community samples.

    “Some cross-sectional studies have also shown positive associations between hair cortisol and clinically diagnosed depressed patients (mostly inpatients; Dettenborn et al., 2012) as well as between hair cortisol and self-reported depressive symptoms in non-clinical community samples (Abell et al., 2016; Faresjo et al., 2013; Stalder et al., 2014; Wikenius et al., 2016).”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites Dettenborn et al., 2012 source
    • cites Abell et al., 2016 source
    • cites Faresjo et al., 2013 source

  • May combine two claims.

    Premisecitation

    The diagnostic validity of the PHQ-9 is good and comparable to clinician-administered assessments.

    “Diagnostic validity of the PHQ-9 is good and comparable to clinician-administered assessments (Kroenke and Spitzer, 2002; Kroenke et al., 2001; Spitzer et al., 1999)”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Kroenke and Spitzer, 2002 source
    • cites Kroenke et al., 2001 source

      The Discussion reports strong evidence for PHQ-9 validity, including criterion validity assessed through independent mental-health-professional interviews. The Methods treat those interviews as the diagnostic standard, while the Results report sensitivity and specificity against that standard. The paper does not establish that the PHQ-9’s diagnostic validity is comparable to clinician-administered assessments. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Spitzer et al., 1999 source

  • May combine two claims.

    Interpretationown data

    The longitudinal data add weight to the idea that hypercortisolemia is neither a cause nor direct correlate of depressive symptom states, at least in a non-clinical sample.

    “These longitudinal data, collected in the context of a chronic stressor that triggers new onset depression in a substantial number of those exposed (Mata et al., 2015; Sen et al., 2010), add weight to the idea that hypercortisolemia is neither a cause nor direct correlate of depressive symptom states, at least in the context of a non-clinical sample.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Mata et al., 2015 source
    • cites Sen et al., 2010 source

  • May combine two claims.

    Findingown data

    Perceived stress increased from pre-internship to 4 months and remained elevated over baseline throughout internship.

    “The experience was subjectively stressful, with an increase from pre-internship to 4 months in perceived stress (M±SD = 10.96 ±5.36, increasing to 13.83 ±5.21, t(50) = −4.12, p < .001) and a sustained elevation over baseline throughout internship (M±SD = 12.63±4.89, t(54) = −2.47, p = .017).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only 3.6% of interns endorsed being highly stressed prior to internship, but 26% did so (PSS ≥ 20) at least once during internship.

    “Only 3.6% of interns endorsed being highly stressed prior to internship, but 26% did so (PSS ≥ 20) at least once during internship.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Depressive symptoms increased significantly from pre-internship to 3 months and remained elevated over baseline throughout internship.

    “Depressive symptoms rose significantly during internship”
    • Also stated in: § 3.3 Depressive Symptom Responses to Internship Stress · plain
      “depressive symptoms increased significantly from before internship (M±SD = 2.78± 2.94) to 3 months (M±SD = 5.03 ± 4.14, p < .001), and remained elevated over baseline throughout internship (6 months: M±SD = 4.77 ± 3.42, p < .001; 9 months: 5.22 ± 4.36, p < .001; 12 months: 4.67 ± 4.51, p = .001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    During internship, participants worked an average of 62 hours per week and had on average 6 days off in the past month.

    “During their internship year, participants worked an average of 62 hours per week (SD = 12.47) and had on average 6 days off in the past month as indicated in quarterly surveys.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Hair cortisol concentrations were highest during the first 4 months of internship, which coincided with summer-fall months (July through October).

    “Hair cortisol concentrations were highest during the first 4 months of internship, which also coincided with summer- fall months (July through October).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Depressive symptoms were elevated throughout internship and correlated with stressor demands and subjective stress reactions.

    “depressive symptoms were elevated throughout internship and correlated with stressor demands and subjective stress reactions”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Hair cortisol and depressive symptoms were not directly correlated and showed no clear consistent linkages.

    “were not directly correlated with each other.”
    • Also stated in: § 4. Discussion · boosted
      “There were no clear and consistent linkages between cortisol levels and depressive symptoms in our study.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    These decline rates are remarkably consistent, suggesting that hair cortisol decline can be accounted for.

    “These rates are remarkably consistent, suggesting that hair cortisol decline can be accounted for; adjusting for this decline is important for comparisons across segments.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Hair samples were assayed for cortisol using a validated, commercially available immunoassay with chemiluminescent detection.

    “Hair samples were assayed for cortisol using a validated, commercially available immunoassay with chemiluminescent detection (procedures are described in more detail in Stalder et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Stalder et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Analyses controlled for fixed effects of potential confounding variables.

    “Analyses also controlled for fixed effects of potential confounding variables.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    The first 2-cm hair segment reflects total cortisol production over the 2 months prior to collection; the next 2-cm segment reflects secretion during months 2-4 before collection.

    “The first 2–cm segment (Segment 1) thus reflects total cortisol production over the 2 months prior to the collection time point; the next 2–cm segment (Segment 2) reflects secretion during months 2-4 before the collection time point.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Imputed hair cortisol values did not differ from non-imputed data (all p values > .80, except hair cortisol at 10 months, p = .16).

    “Imputed hair cortisol values did not differ from non-imputed data (all p values > .80, except hair cortisol at 10 months, p = .16).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The final covariate-adjusted model controlled for age, marital status, and cohort effects.

    “We subsequently only controlled for age, marital status, and cohort effects.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Perceived stress was measured using the 10-item Perceived Stress Scale (PSS).

    “Perceived stress and sense of mastery/control were measured prior to internship start and at four-month intervals during internship using the 10-item Perceived Stress Scale (PSS; Roberti et al., 2006) and Pearlin’s 7-item Mastery Scale (Pearlin and Schooler, 1978), respectively”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Roberti et al., 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Life stress is the most common causal trigger of depression onset.

    “Life stress is the most common causal trigger of depression onset (Kendler et al., 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kendler et al., 1999 source

  • May combine two claims.

    Study design and conductown data

    Male participants often had insufficient hair length to obtain a second 2-cm segment, resulting in significant missing Segment 2 data (31%), yielding overall missing data of 18%.

    “Male participants often had insufficient hair length to obtain a second 2–cm segment, which resulted in significant missing Segment 2 data (31%), yielding overall missing data of 18% (50% of participants had complete hair cortisol data for every time point and both hair segments).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Hair cortisol and depressive responses increased with stress but were decoupled, following distinct trajectories that likely reflected different aspects of stress reactivity.

    “Hair cortisol and depressive responses increased with stress, but they were decoupled, following distinct trajectories that likely reflected different aspects of stress reactivity.”
    • Also stated in: § 4. Discussion · hedged
      “we found no relationship between neuroendocrine and depressive responses to stress exposure, suggesting that changes in these two dimensions reflect different aspects of stress reactivity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Sense of mastery/control was measured using Pearlin's 7-item Mastery Scale.

    “Perceived stress and sense of mastery/control were measured prior to internship start and at four-month intervals during internship using the 10-item Perceived Stress Scale (PSS; Roberti et al., 2006) and Pearlin’s 7-item Mastery Scale (Pearlin and Schooler, 1978), respectively”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pearlin and Schooler, 1978 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Analyses without imputing missing data and adjusting Segment 2 values yielded identical results.

    “However, analyses without the additional manipulations (imputing missing data and adjusting Segment 2 values) yielded identical results.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Hair samples were collected following guidelines from the Society of Hair Testing.

    “Hair samples were collected 1-2 months prior to internship start (pre-internship) and at the four-, eight- and twelve-month time points during internship year, following guidelines from the Society of Hair Testing (Cooper et al., 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cooper et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Elevated hair cortisol levels have previously been found in stressed populations.

    “Elevated hair cortisol levels in stressed populations have previously been found (reviewed in Stalder et al., 2017; Staufenbiel et al., 2013).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Stalder et al., 2017 source
    • cites Staufenbiel et al., 2013 source

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisereasoning

    Prospective stress designs are needed to determine the temporal relationships between chronic stress, long-term HPA axis activity, and depressive symptoms.

    “Prospective stress designs are needed to determine the temporal relationships between chronic stress, long-term HPA axis activity, and depressive symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Internship and assay procedures did not change over time.

    “Internship and assay procedures did not change over time”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A seasonal impact on hair cortisol results cannot be fully ruled out in this study.

    “However, a seasonal impact on hair cortisol results cannot be fully ruled out in this study and requires further research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    It is unknown whether the depression onset examined here is comparable to the development of depression types examined in earlier studies.

    “we do not know if depression onset examined here is comparable to the development of depression types examined in earlier studies”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The linkages reported are correlational and causal insights require controlled laboratory work.

    “the linkages reported are correlational and causal insights require controlled laboratory work.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Hair cortisol fluctuated through the year, perhaps tracking specific contextual aspects related to anticipation, novelty/familiarity, and social evaluative threat.

    “hair cortisol fluctuated through the year, perhaps tracking specific contextual aspects related to anticipation, novelty/familiarity, and social evaluative threat.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    HPA axis hyperactivity has been shown in depression in studies using cortisol measures in blood, saliva, and urine, but with great variability depending on patient characteristics and clinical status or subtype.

    “Links between HPA axis hyperactivity and depression have been shown in studies using cortisol measures in blood, saliva, and urine (reviewed in Nemeroff and Vale, 2005), but great variability exists, depending on patient characteristics and clinical status or subtype (Lamers et al., 2013; Stetler and Miller, 2011).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Nemeroff and Vale, 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Lamers et al., 2013 source
    • cites Stetler and Miller, 2011 source
34 of 34

  • The paper relies on this without support.

    Medical internship is a relatively standardized and homogenous chronic stressor that reduces noise in stress-depression relationships.

    “The somewhat homogenous sample facing a relatively “standardized” stressor may provide a paradigm with reduced “noise” that might otherwise obscure linkages.”

  • The paper relies on this without support.

    Missing hair cortisol data are missing at random, so multiple imputation yields unbiased estimates.

    “We imputed missing hair cortisol data using a Fully Conditional Specification Method Iterations – an iterative Markov Chain Monte Carlo (MCMC) method.”

  • The paper relies on this without support.

    The study has adequate statistical power to detect an association between hair cortisol and depressive symptoms.

    “the change in hair cortisol from pre-internship to 2 months was not associated with depressive symptom trajectory during internship (hair cortisol change-by-time b = 0.0323, p = .286, hair cortisol change-by-time2 b = −0.0021, p = .378).”

  • The authors state this as an assumption.

    Hair growth rate is 1 cm per month.

    “our hair cortisol analyses assumed a hair growth rate of 1cm/month”
4 of 4

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(52) = 5.58reported p < .001 · recomputed p < .001

    “t(52) = 5.58, p < .001”

  • Consistentt(50) = -4.12reported p < .001 · recomputed p < .001

    “t(50) = −4.12, p < .001”

  • Consistentt(54) = -2.47reported p = .017 · recomputed p = .017

    “t(54) = −2.47, p = .017”

  • ConsistentF(6, 253) = 10.47reported p < .001 · recomputed p < .001

    “F(6, 253) = 10.47, p < .001”

  • Consistentr(51) = 0.677reported p < .001 · recomputed p < .001

    “r(51) = .677, p < .001”

  • Consistentr(65) = -0.08reported p = .51 · recomputed p = .520

    “r(65) = −0.08, p = .51”

  • Consistentr(65) = 0.349reported p = .004 · recomputed p = .004

    “r(65) = 0.349, p = .004”

  • Consistentr(51) = 0.386reported p = .004 · recomputed p = .004

    “r(51) = 0.386, p = .004”

  • Consistentr(50) = 0.394reported p = .004 · recomputed p = .004

    “r(50) = 0.394, p = .004”

  • Consistentr(51) = 0.293reported p = .033 · recomputed p = .033

    “r(51) = 0.293, p = .033”

10 of 10

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

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Related

Authors
Mayer, S. E., Lopez-Duran, N. L., Sen, S., & Abelson, J. L.
Affiliations
University of Michigan (US)
Corresponding author
Mayer, Stefanie E.
ORCID
Venue
Psychoneuroendocrinology
Publisher
Elsevier BV
Published
2018-06
Volume
92
Pages
57-65
ISSN
0306-4530 (ISSN-L)
DOI
10.1016/j.psyneuen.2018.03.020
PMC
PMC5924646
OpenAlex
W2794460941
Semantic Scholar
e7fbbd07158c68ab3322902a356ebc10050eeff9
Cited by
135
References
72
Citations by year
2026: 6 · 2025: 13 · 2024: 18 · 2023: 28 · 2022: 27 · 2021: 16 · 2020: 13 · 2019: 8 · 2018: 6
FWCI
4.90
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychoneuroendocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
  • National Institute of Mental Health (R01-MH-101459)
  • Blue Cross Blue Shield of Michigan Foundation
  • Horace H. Rackham School of Graduate Studies, University of Michigan
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
chronic stress, hair cortisol, depression, depressive symptoms, medical internship, hypothalamic-pituitary-adrenal axis, stress reactivity, perceived stress, mastery, working hours, sleep, social-evaluative threat
MeSH terms
Adult, Chronic Disease, Depression, Depressive Disorder, Female, Hair, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Internship and Residency, Longitudinal Studies, Male, Pituitary-Adrenal System, Prospective Studies, Stress, Psychological, Students, Medical, Self Report

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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