Burnout is associated with reduced parasympathetic activity and reduced hpa axis responsiveness, predominantly in males
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There is mounting evidence that burnout is a risk factor for cardiovascular disease (CVD). Stress-related dysregulation of the sympathetic and parasympathetic system and the hypothalamic pituitary adrenal (HPA) axis may explain the enhanced risk for CVD. To test this hypothesis, 55 patients (34 males and 21 females) with burnout on sickness absence and 40 healthy participants (16 males and 24 females) were exposed to a psychosocial stressor consisting of mental arithmetic and public speech. Physiological variables (i.e., blood pressure, heart rate, cardiac output, vascular resistance, cortisol, and alpha-amylase) were measured. Basal levels, reactivity, and recovery were compared between groups. In male patients, baseline systolic blood pressure was higher, whereas basal alpha-amylase and cortisol reactivity were lower than in healthy males. In female patients, a tendency for lower basal cortisol was found as compared to healthy females. Furthermore, reduced basal heart rate variability and a trend for elevated basal cardiac output were observed in both male and female patients. Burnout is characterised by dysregulation of the sympathetic and parasympathetic system and the HPA axis, which was more pronounced in males than in females. This study further supports burnout as being a risk factor for CVD through dysregulation of the sympathetic and parasympathetic system and the HPA axis.
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HRV measures record the parasympathetic response of the autonomic nervous system and are an important measure of the hypothalamic-pituitary-adrenal axis, which regulates stress response and relates to anxiety, depression and burn-out.
“Such measures can record the parasympathetic response of the autonomic nervous system (ANS). This is an important measure of the hypothalamic-pituitary-adrenal axis, which regulates the stress response control and relates to other mental health symptoms such as anxiety, depression and burn-out.43 44”
From Novel ACT-based eHealth psychoeducational intervention for students with mental distress: A study protocol for a mixed-methodology pilot trial (2019) · cites this paper as [43]
The Introduction identifies heart rate variability as a measure of cardiac parasympathetic activation, and the Discussion links reduced HRV and altered HPA-axis responsiveness to burnout. But the paper assesses HPA-axis responsiveness through cortisol reactivity, not HRV, and these passages do not establish the claimed links to anxiety or depression. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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Cites
Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use
Electrophysiology, T. F. O. T. E. S. O. C. T. N. A. (1996) · Circulation · doi:10.1161/01.cir.93.5.1043 · Cited by 17,159 · see citing works
Heart rate variability: Standards of measurement, physiological interpretation, and clinical use
Malik, M., Bigger, J. T., Camm, A. J., Kleiger, R. E., Malliani, A., Moss, A. J., & Schwartz, P. J. (1996) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a014868 · Cited by 15,289 · see citing works
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001) · Annual Review of Psychology · doi:10.1146/annurev.psych.52.1.397 · Cited by 12,852 · cited 1× · see citing works
“Burnout complaints include emotional exhaustion, negative attitudes towards work, and a sense of diminished competence to fulfil the demands posed by the job [2, 3].”
BackgroundDiagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Hu, R. J. (2003) · Elsevier eBooks · doi:10.1016/b0-12-226870-9/01070-4 · Cited by 9,167 · see citing works
Sapolsky, R. M., Romero, L. M., & Munck, A. U. (2000) · Endocrine Reviews · doi:10.1210/edrv.21.1.0389 · Cited by 7,541 · see citing works
Sapolsky, R. M. (2000) · Endocrine Reviews · doi:10.1210/er.21.1.55 · Cited by 7,533 · see citing works
The Concepts of Stress and Stress System Disorders: Overview of Physical and Behavioral Homeostasis
Chrousos, G. P. (1992) · JAMA · doi:10.1001/jama.1992.03480090092034 · Cited by 2,689 · see citing works
Universal Definition of Myocardial Infarction: Clinical Insights
Paiva, L., Providencia, R. A., Barra, S., Dinis, P., Faustino, C., & Gonçalves, L. M. M. (2015) · Cardiology · doi:10.1159/000371739 · Cited by 2,513 · see citing works
Sex differences in HPA axis responses to stress: a review
Kudielka, B. M., & Kirschbaum, C. (2005) · Biological Psychology · doi:10.1016/j.biopsycho.2004.11.009 · Cited by 1,624 · see citing works
Salivary Cortisol in Psychobiological Research: An Overview
Kirschbaum, C., & Hellhammer, D. H. (2008) · Neuropsychobiology · doi:10.1159/000118611 · Cited by 1,532 · see citing works
Navazesh, M. (1993) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1993.tb18343.x · Cited by 1,449 · see citing works
Stress and cardiovascular disease
Steptoe, A., & Kivimäki, M. (2012) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2012.45 · Cited by 1,321 · see citing works
Yusuf, S., Reddy, S., Ôunpuu, S., & Anand, S. (2001) · Circulation · doi:10.1161/hc4701.099488 · Cited by 1,141 · see citing works
The effects of sex and hormonal status on the physiological response to acute psychosocial stress
Kajantie, E., & Phillips, D. I. W. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.07.002 · Cited by 1,035 · see citing works
Melamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006) · Psychological Bulletin · doi:10.1037/0033-2909.132.3.327 · Cited by 943 · see citing works
Stressor specificity of central neuroendocrine responses: implications for stress-related disorders
Pacák, K., & Palkovits, M. (2001) · Endocrine Reviews · doi:10.1210/edrv.22.4.0436 · Cited by 926 · see citing works
Dekker, J. M., Crow, R. S., Folsom, A. R., Hannan, P. J., Liao, D., Swenne, C. A., & Schouten, E. G. (2000) · Circulation · doi:10.1161/01.cir.102.11.1239 · Cited by 876 · see citing works
Is job strain a major source of cardiovascular disease risk?
Belkic, K. L., Landsbergis, P. A., Schnall, P. L., & Baker, D. B. (2004) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.769 · Cited by 746 · see citing works
Cardiovascular Reactivity and Development of Preclinical and Clinical Disease States
Treiber, F. A., Kamarck, T., Schneiderman, N., Sheffield, D., Kapuku, G., & Taylor, T. (2003) · Psychosomatic Medicine · doi:10.1097/00006842-200301000-00007 · Cited by 683 · see citing works
Work stress and coronary heart disease: what are the mechanisms?
Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., Badrick, E., Kivimaki, M., & Marmot, M. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehm584 · Cited by 673 · see citing works
Burnout: An Overview of 25 Years of Research and Theorizing
Schaufeli, W. B., & Buunk, B. P. (2002) · doi:10.1002/0470013400.ch19 · Cited by 666 · see citing works
Nater, U. M., La Marca, R., Florin, L., Moses, A., Langhans, W., Koller, M. M., & Ehlert, U. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.05.010 · Cited by 630 · cited 1× · see citing works
“Alpha-amylase was added as an additional measure of change in the sympathetic tone when studied during a psychosocial stressor [34].”
BackgroundHuman salivary alpha-amylase reactivity in a psychosocial stress paradigm
Nater, U. M., Rohleder, N., Gaab, J., Berger, S., Jud, A., Kirschbaum, C., & Ehlert, U. (2005) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2004.09.009 · Cited by 618 · see citing works
Penttilä, J., Helminen, A., Jartti, T., Kuusela, T., Huikuri, H. V., Tulppo, M. P., Coffeng, R., & Scheinin, H. (2001) · Clinical Physiology · doi:10.1046/j.1365-2281.2001.00337.x · Cited by 567 · see citing works
Fatigue among working people: validity of a questionnaire measure
Beurskens, A. J. H. M., Bültmann, U., Kant, I., Vercoulen, J. H. M. M., Bleijenberg, G., & Swaen, G. M. H. (2000) · Occupational and Environmental Medicine · doi:10.1136/oem.57.5.353 · Cited by 526 · see citing works
Salivary alpha amylase as marker for adrenergic activity during stress: Effect of betablockade
van Stegeren, A., Rohleder, N., Everaerd, W., & Wolf, O. T. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.05.012 · Cited by 419 · see citing works
Schwartz, A. R., Gerin, W., Davidson, K. W., Pickering, T. G., Brosschot, J. F., Thayer, J. F., Christenfeld, N., & Linden, W. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000046075.79922.61 · Cited by 383 · see citing works
Cardiovascular reactivity in cardiovascular disease: “Once more unto the breach”
Manuck, S. B. (1994) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm0101_2 · Cited by 339 · see citing works
Lü, G., Yang, F., Taylor, J. A., & Stein, J. F. (2009) · Journal of Medical Engineering & Technology · doi:10.3109/03091900903150998 · Cited by 324 · see citing works
Rohleder, N., Wolf, J. M., Maldonado, E. F., & Kirschbaum, C. (2006) · Psychophysiology · doi:10.1111/j.1469-8986.2006.00457.x · Cited by 321 · see citing works
Elevated Heart Rate: A Major Risk Factor for Cardiovascular Disease
Palatini, P., & Julius, S. (2004) · Clinical and Experimental Hypertension · doi:10.1081/ceh-200031959 · Cited by 302 · see citing works
Fatigue and psychological distress in the working population
Bültmann, U., Kant, I., Kasl, S. V., Beurskens, A. J. H. M., & van den Brandt, P. A. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00228-8 · Cited by 283 · see citing works
Stressor Specificity of Central Neuroendocrine Responses: Implications for Stress-Related Disorders
Pacák, K. (2001) · Endocrine Reviews · doi:10.1210/er.22.4.502 · Cited by 280 · see citing works
Manuck, S. B., Kasprowicz, A. L., & Muldoon, M. F. (1990) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm1201_2 · Cited by 276 · see citing works
Ramasubbu, N., Venugopalan, P., Luo, Y., Brayer, G. D., & LEVINE, M. J. (1996) · Acta Crystallographica Section D Biological Crystallography · doi:10.1107/s0907444995014119 · Cited by 275 · see citing works
Burnout in the working population: relations to psychosocial work factors
Lindblom, K. M., Linton, S. J., Fedeli, C., & Bryngelsson, I. (2006) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1301_7 · Cited by 252 · see citing works
de Vente, W., Olff, M., van Amsterdam, J., Kamphuis, J. H., & Emmelkamp, P. M. G. (2003) · Occupational and Environmental Medicine · doi:10.1136/oem.60.suppl_1.i54 · Cited by 245 · see citing works
Biomarkers in burnout: a systematic review.
Danhof-Pont, M. B., van Veen, T., & Zitman, F. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.10.012 · Cited by 234 · see citing works
Bosch, J. A., Brand, H. S., Ligtenberg, T., Bermond, B., Hoogstraten, J., & Amerongen, A. V. N. (1996) · Psychosomatic Medicine · doi:10.1097/00006842-199607000-00010 · Cited by 219 · see citing works
Bellingrath, S., Weigl, T., & Kudielka, B. M. (2008) · Stress · doi:10.1080/10253890802042041 · Cited by 205 · see citing works
The role of cardiac autonomic function in hypertension and cardiovascular disease
Palatini, P., & Julius, S. (2009) · Current Hypertension Reports · doi:10.1007/s11906-009-0035-4 · Cited by 195 · see citing works
Chronic stress, salivary cortisol, and α-amylase in children with asthma and healthy children
Wolf, J. M., Nicholls, E. F., & Chen, E. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2007.12.004 · Cited by 186 · see citing works
Steptoe, A., Siegrist, J., Kirschbaum, C., & Marmot, M. G. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000126198.67070.72 · Cited by 183 · see citing works
Differential Hypothalamic-Pituitary-Adrenal Axis Reactivity to Psychological and Physical Stress1
Singh, A. P., Petrides, J. S., Gold, P. W., Chrousos, G. P., & Deuster, P. A. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.6.5746 · Cited by 176 · see citing works
Ostrander, M. M., Ulrich‐Lai, Y. M., Choi, D. C., Richtand, N. M., & Herman, J. P. (2006) · Endocrinology · doi:10.1210/en.2005-1041 · Cited by 168 · see citing works
Changes in cortisol and DHEA plasma levels after psychotherapy for PTSD
Olff, M., de Vries, G.-J., Güzelcan, Y., Assies, J., & Gersons, B. P. R. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.04.001 · Cited by 159 · see citing works
Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies
Gasperin, D., Netuveli, G., da Costa, J. S. D., & Pattussi, M. P. (2009) · Cadernos de Saúde Pública · doi:10.1590/s0102-311x2009000400002 · Cited by 154 · see citing works
Matthews, K. A., Gump, B. B., & Owens, J. F. (2001) · Health Psychology · doi:10.1037/0278-6133.20.6.403 · Cited by 148 · see citing works
Do Background Stressors Influence Reactivity to and Recovery From Acute Stressors? 1
Gump, B. B., & Matthews, K. A. (1999) · Journal of Applied Social Psychology · doi:10.1111/j.1559-1816.1999.tb01397.x · Cited by 146 · see citing works
Roy, M. P., Steptoe, A., & Kirschbaum, C. (1998) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.75.5.1273 · Cited by 145 · see citing works
Roy, M. P. (2001) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(00)00061-5 · Cited by 143 · see citing works
de Vente, W., Kamphuis, J. H., Emmelkamp, P. M. G., & Blonk, R. W. B. (2008) · Journal of Occupational Health Psychology · doi:10.1037/1076-8998.13.3.214 · Cited by 142 · see citing works
Salivary cortisol patterns in vital exhaustion
Nicolson, N. A., & van Diest, R. (2000) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(00)00166-5 · Cited by 135 · see citing works
Glucocorticoid sensitivity in humans-interindividual differences and acute stress effects
Rohleder, N., Wolf, J. M., & Kirschbaum, C. (2003) · Stress · doi:10.1080/1025389031000153658 · Cited by 118 · see citing works
Cortisol in burnout and vital exhaustion: an overview.
Kudielka, B. M., Bellingrath, S., & Hellhammer, D. H. (2006) · PubMed · Cited by 113 · see citing works
Mommersteeg, P. M. C., Heijnen, C. J., Verbraak, M. J. P. M., & van Doornen, L. J. P. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.07.003 · Cited by 111 · see citing works
Salivary alpha‐amylase and cortisol in toddlers: Differential relations to affective behavior
Fortunato, C., Dribin, A. E., Granger, D. A., & Buss, K. A. (2008) · Developmental Psychobiology · doi:10.1002/dev.20326 · Cited by 107 · see citing works
Sonnenschein, M., Mommersteeg, P. M. C., Houtveen, J. H., Sorbi, M. J., Schaufeli, W. B., & van Doornen, L. J. P. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2007.02.001 · Cited by 103 · see citing works
Hormonal, cardiovascular, and subjective responses to acute stress in smokers
Childs, E., & de Wit, H. (2009) · Psychopharmacology · doi:10.1007/s00213-008-1359-5 · Cited by 97 · see citing works
Cortisol deviations in people with burnout before and after psychotherapy: A pilot study.
Mommersteeg, P. M. C., Keijsers, G. P. J., Heijnen, C. J., Verbraak, M. J. P. M., & van Doornen, L. J. P. (2006) · Health Psychology · doi:10.1037/0278-6133.25.2.243 · Cited by 83 · see citing works
Heart Rate, Sympathetic Cardiovascular Influences, and The Metabolic Syndrome
Grassi, G. M., Arenare, F., Quarti‐Trevano, F., Seravalle, G., & Mancia, G. (2009) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2009.05.007 · Cited by 79 · see citing works
Oosterholt, B. G., Maes, J. H. R., van der Linden, D., Verbraak, M. J. P. M., & Kompier, M. A. J. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.11.003 · Cited by 78 · see citing works
Burnout symptom sub-types and cortisol profiles: What's burning most?
Marchand, A., Juster, R., Durand, P., & LUPIEN, S. J. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.10.011 · Cited by 52 · see citing works
The Neuroendocrinology of Stress
Kaltsas, G., Chrousos, G. P., & Sternberg, E. M. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511546396.013 · Cited by 50 · see citing works
School burnout and cardiovascular functioning in young adult males: a hemodynamic perspective
May, R. W., Sanchez‐Gonzalez, M. A., Brown, P. C., Koutnik, A. P., & Fincham, F. D. (2013) · Stress · doi:10.3109/10253890.2013.872618 · Cited by 47 · see citing works
de Beurs, E., van Dyck, R., Marquenie, L. A., Lange, A., Blonk, R. W. B., van Dyck, R., Lange, A., Blonk, R., & Lange, P. (2001) · Cited by 41 · see citing works
May, R. W., Sanchez‐Gonzalez, M. A., & Fincham, F. D. (2014) · Stress · doi:10.3109/10253890.2014.969703 · Cited by 34 · see citing works
van Doornen, L. J. P., Houtveen, J. H., Langelaan, S., Bakker, A. B., van Rhenen, W., & Schaufeli, W. B. (2009) · Stress and Health · doi:10.1002/smi.1279 · Cited by 33 · see citing works
Osterziel, K. J., & Dietz, R. (1996) · Journal of Cardiovascular Pharmacology · doi:10.1097/00005344-199600002-00006 · Cited by 29 · see citing works
de Vente, W., Kamphuis, J. H., Blonk, R. W. B., & Emmelkamp, P. M. G. (2015) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-015-9573-6 · Cited by 24 · see citing works
Flagged first, then by citations
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- [43]Olff M. Mulder L. J. M. The T. H. de Leij L. Emmelkamp P. M. G. The psychobiological stress response in depressed patients compared to healthy controls Proceedings of the 29th Annual Congress of the EABCT September 1999 Dresden, Germany p. 345
Cited by
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Fioranelli, M., Bottaccioli, A. G., Bottaccioli, F., Bianchi, M., Rovesti, M., & Roccia, M. G. (2018) · Frontiers in Immunology · doi:10.3389/fimmu.2018.02031 · Cited by 358 · see citing works
Salivary Alpha-Amylase as a Biomarker of Stress in Behavioral Medicine
Ali, N., & Nater, U. M. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-019-09843-x · Cited by 304 · see citing works
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Bayes, A. J., Tavella, G., & Parker, G. B. (2021) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2021.1907713 · Cited by 191 · see citing works
Zänkert, S., Bellingrath, S., Wüst, S., & Kudielka, B. M. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.10.027 · Cited by 139 · see citing works
Heyat, M. B. B., Akhtar, F., Abbas, S. J., Al-Sarem, M., Alqarafi, A., Stalin, A., Abbasi, R., Muaad, A. Y. M., Lai, D., & Wu, K. (2022) · Biosensors · doi:10.3390/bios12060427 · Cited by 117 · see citing works
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Jónsdóttir, I. H., & Sjörs, A. (2018) · European Journal of Endocrinology · doi:10.1530/eje-18-0741 · Cited by 123 · see citing works
Chemical probes to potently and selectively inhibit endocannabinoid cellular reuptake
Chicca, A., Nicolussi, S., Bartholomäus, R., Blunder, M., Rey, A. A., Petrucci, V., Reynoso-Moreno, I., Paredes, J. M. V., Gens, M. D., Lutz, B., et al. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1704065114 · Cited by 96 · see citing works
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Lennartsson, A.-K., Jónsdóttir, I. H., & Sjörs, A. (2016) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2016.08.005 · Cited by 85 · see citing works
de Looff, P. C., Cornet, L. J. M., Embregts, P. J. C. M., Nijman, H. L. I., & Didden, H. C. M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0205741 · Cited by 74 · see citing works
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Deneva, T., Ianakiev, Y., & Keskinova, D. (2019) · Medicina · doi:10.3390/medicina55050209 · Cited by 72 · see citing works
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Kanthak, M. K., Stalder, T., Hill, L. K., Thayer, J. F., Penz, M. S., & Kirschbaum, C. (2017) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.3647 · Cited by 64 · see citing works
Basu, B., Chowdhury, O., & Saha, S. (2018) · Journal of Human Reproductive Sciences · doi:10.4103/jhrs.jhrs_78_17 · Cited by 61 · see citing works
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Hosseini‐Kamkar, N., Lowe, C. J., & Morton, J. B. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.04.006 · Cited by 55 · see citing works
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Meyer, T., & Wirtz, P. H. (2017) · Antioxidants and Redox Signaling · doi:10.1089/ars.2017.7186 · Cited by 40 · see citing works
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Wang, C., Dai, J., & Li, J. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.07.001 · Cited by 30 · see citing works
Cynicism as subscale of burnout
Viljoen, M., & Claassen, N. (2017) · Work · doi:10.3233/wor-172518 · Cited by 30 · see citing works
Kuć, J., Szarejko, K. D., & Gołębiewska, M. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.646293 · Cited by 26 · see citing works
The hypothalamo–pituitary–adrenal axis and the autonomic nervous system in burnout
Sjörs, A., Jónsdóttir, I. H., & Hansson, C. (2021) · Handbook of clinical neurology · doi:10.1016/b978-0-12-819973-2.00006-x · Cited by 26 · see citing works
Gavelin, H. M., Neely, A. S., Aronsson, I., Josefsson, M., & Andersson, L. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108661 · Cited by 21 · see citing works
Association between burnout and immunological and endocrine alterations
Ciobanu, A. M., Damian, A. C., & Neagu, C. (2021) · Romanian Journal of Morphology and Embryology · doi:10.47162/rjme.62.1.02 · Cited by 20 · see citing works
Gurgoglione, F. L., Solinas, E., Pfleiderer, B., Vezzani, A., & Niccoli, G. (2023) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2023.117273 · Cited by 19 · see citing works
Wekenborg, M., Schwerdtfeger, A. R., Rothe, N., Penz, M. S., Walther, A., Kirschbaum, C., Thayer, J. F., Wittling, R. A., & Hill, L. K. (2022) · Scientific Reports · doi:10.1038/s41598-022-14743-4 · Cited by 18 · see citing works
von Känel, R., van Nuffel, M., & Fuchs, W. J. (2016) · BioPsychoSocial Medicine · doi:10.1186/s13030-016-0082-4 · Cited by 18 · see citing works
JOSHIPURA, K. J., Muñoz‐Torres, F. J., Campos, M., Rivera-Díaz, A. D., & Zevallos, J. C. (2017) · Journal of Human Hypertension · doi:10.1038/s41371-017-0009-y · Cited by 18 · see citing works
von Känel, R., Princip, M., Holzgang, S. A., Garefa, C., Rossi, A., Benz, D. C., Giannopoulos, A. A., Kaufmann, P. A., Buechel, R. R., Zuccarella‐Hackl, C., et al. (2023) · BMC Medicine · doi:10.1186/s12916-023-03192-z · Cited by 16 · see citing works
Bärtl, C., Henze, G., Peter, H. L., Giglberger, M., Bohmann, P., Speicher, N., Konzok, J., Kreuzpointner, L., Waller, L., Walter, H., et al. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106926 · Cited by 17 · see citing works
Wang, M., Lin, P., Huang, C., & Huang, H. (2017) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000002439 · Cited by 15 · see citing works
Fleuren, B. P. I., Nübold, A., Uitdewilligen, S., Verduyn, P., & Hulsheger, U. R. (2023) · European Journal of Work and Organizational Psychology · doi:10.1080/1359432x.2022.2161369 · Cited by 15 · see citing works
von Känel, R., Princip, M., Holzgang, S., Sivakumar, S., Pazhenkottil, A., Vieito, D. G., & Zuccarella-Hackl, C. (2023) · Biological Psychology · doi:10.1016/j.biopsycho.2023.108687 · Cited by 12 · see citing works
Zhang, M., Liu, L., Shi, Y., Yang, Y., Yu, X., Angerer, P., Kristensen, T. S., & Li, J. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.05.008 · Cited by 13 · see citing works
Orosz, A., Federspiel, A., Eckert, A., Seeher, C., Dierks, T., Tschitsaz, A., & Cattapan, K. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2539 · Cited by 12 · see citing works
Xie, C., Li, L. L., & Li, Y. (2024) · Nurse Education Today · doi:10.1016/j.nedt.2024.106287 · Cited by 12 · see citing works
Neuroendocrine Insights into Burnout Syndrome
Trifu, S. C. (2019) · Acta Endocrinologica (Bucharest) · doi:10.4183/aeb.2019.404 · Cited by 12 · see citing works
Kerr, P., LUPIEN, S. J., & Juster, R. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104634 · Cited by 11 · see citing works
Edwards, D. J., Rainey, E., Boukouvala, V., Wells, Y., Bennett, P., Tree, J., & Kemp, A. H. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029411 · Cited by 9 · see citing works
“This is an important measure of the hypothalamic-pituitary-adrenal axis, which regulates the stress response control and relates to other mental health symptoms such as anxiety, depression and burn-out.(43) 44 The vagus nerve also facilitates capacity for social engagement(45) and has been shown to sustain positive em…”
BackgroundCortisol Reactivity to Acute Psychosocial Stress in Physician Burnout
Zuccarella‐Hackl, C., Princip, M., Holzgang, S. A., Sivakumar, S., Kuenburg, A., Pazhenkottil, A. P., Vieito, D. G., & von Känel, R. (2024) · Biomedicines · doi:10.3390/biomedicines12020335 · Cited by 21 · see citing works
Pertab, J. L., Merkley, T. L., Winiarski, H. R., Cramond, K. M. J., & Cramond, A. J. (2025) · Journal of Personalized Medicine · doi:10.3390/jpm15010033 · Cited by 11 · see citing works
Heart Rate Complexity in US Army Forward Surgical Teams During Pre Deployment Training
Mulder, M. B., Sussman, M. S., Eidelson, S. A., Gross, K. R., Buzzelli, M. D., Batchinsky, A. I., Schulman, C. I., Namias, N., & Proctor, K. G. (2019) · Military Medicine · doi:10.1093/milmed/usz434 · Cited by 12 · see citing works
Wekenborg, M., Hill, L. K., Miller, R. E., Tobias Stalder, A., Thayer, J. F., Penz, M. S., & Kirschbaum, C. (2018) · Stress · doi:10.1080/10253890.2018.1479393 · Cited by 10 · see citing works
Malan, L., Hamer, M., von Känel, R., Kotliar, K. E., van Wyk, R. D., Lambert, G. W., Vilser, W., Ziemssen, T., Schlaich, M. P., Smith, W. T., et al. (2021) · Cardiovascular journal of South Africa/Cardiovascular journal of Southern Africa · doi:10.5830/cvja-2020-031 · Cited by 9 · see citing works
Evans, L. V., Ray, J. M., Bonz, J. W., Joseph, M., Gerwin, J. N., Dziura, J. D., Venkatesh, A. K., & Wong, A. H.-W. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058980 · Cited by 8 · see citing works
Examining surgeon stress in robotic and laparoscopic surgery
Sujka, J., Ahmed, A., Kang, R. W., Grimsley, E. A., Weche, M., Janjua, H., Mi, Z., English, D., Martinez, C., Velanovich, V., et al. (2024) · Journal of Robotic Surgery · doi:10.1007/s11701-024-01834-9 · Cited by 8 · see citing works
Wekenborg, M., Hill, L. K., Grabbe, P., Thayer, J. F., Kirschbaum, C., Lindenlaub, S., Wittling, R. A., & von Dawans, B. (2022) · BMC Public Health · doi:10.1186/s12889-022-13333-3 · Cited by 8 · see citing works
Impact of autonomic regulation on burnout and performance in thoracic surgery residents
Barron, L. M., & Moon, M. R. (2022) · JTCVS Open · doi:10.1016/j.xjon.2022.04.044 · Cited by 7 · see citing works
Ciências da Saúde: Investigação e Prática
Pérez, G. J. G., & López, M. G. V. (2023) · Editora Artemis eBooks · doi:10.37572/edart_291123093 · Cited by 6 · see citing works
Cascino, G., Ruzzi, V., D’Agostino, G., Barone, E., Giorno, C. D., Monteleone, P., & Monteleone, A. M. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110713 · Cited by 6 · see citing works
Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability
Wekenborg, M., Künzel, R. G., Rothe, N., Penz, M. S., Walther, A., Kirschbaum, C., Thayer, J. F., & Hill, L. K. (2023) · Annals of Epidemiology · doi:10.1016/j.annepidem.2023.09.008 · Cited by 6 · see citing works
Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals
Fumagalli, M., Provenzi, L., Sorrentino, G., Ciceri, F., Fontana, C., Passera, S., Moncecchi, M., Plevani, L., Laquintana, D., Borgatti, R., et al. (2021) · Advances in Neonatal Care · doi:10.1097/anc.0000000000000848 · Cited by 6 · see citing works
Psychophysiological markers of athlete burnout: a call to arms
Moore, L. J., Isoard‐Gautheur, S., & Gustafsson, H. (2024) · International Journal of Sports Medicine · doi:10.1055/a-2433-3930 · Cited by 5 · see citing works
Huang, J., Zhang, R., Liu, X., & Meng, Y. (2017) · Current Medical Research and Opinion · doi:10.1080/03007995.2017.1333954 · Cited by 4 · see citing works
Almén, N. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114005 · Cited by 4 · see citing works
Sex differences in impact of daily and chronic psychological stressors on diurnal cortisol level
Malykhin, N. V., Serrano, J., Hegadoren, K., & Pietrasik, W. (2026) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2026.174165 · Cited by 4 · see citing works
Krank durch chronischen Stress
Krähenmann, R., & Seifritz, E. (2019) · DNP - Der Neurologe und Psychiater · doi:10.1007/s15202-019-2113-z · Cited by 3 · see citing works
Ardani, Y., Shatri, H., Koesnoe, S., Yunir, E., Wiguna, T., Wibowo, H., Sawitri, D. R., Sarwono, J., Mansyur, M., Ricardo, W., et al. (2025) · Narra J · doi:10.52225/narra.v5i1.1686 · Cited by 2 · see citing works
Evans, L. V., Bonz, J. W., Buck, S., Gerwin, J. N., Bonner, S., Ikejiani, S., Moylan, T., Joseph, M., Almeida, G. D. O., Ray, J. M., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0331488 · Cited by 2 · see citing works
(2019) · ARC Journal of Anesthesiology · doi:10.20431/2455-9792.0401001 · Cited by 2 · see citing works
Hirokawa, K., Ohira, T., Kajiura, M., Imano, H., Kitamura, A., Kiyama, M., Okada, T., & Iso, H. (2020) · Brain and Behavior · doi:10.1002/brb3.1541 · Cited by 2 · see citing works
Emotional intelligence and its effects on biomarkers of workplace stress
King, J. B. (2020) · The University of Queensland · doi:10.14264/uql.2020.241 · Cited by 2 · see citing works
Laldinpuii, Sailo, L., Weller, S., Varte, C. L., Tochhawng, L., Bandara, P., McCredden, J., & Zothansiama (2026) · Electromagnetic Biology and Medicine · doi:10.1080/15368378.2026.2623473 · Cited by 2 · see citing works
Biological Markers of Burnout Severity: A Systematic Review
Balia, M., Zenasni, F., Lepoittevin, M., Benani, A., Bianchi, R., Julian, A., Bodard, S., & Bringer, M. (2026) · Stress and Health · doi:10.1002/smi.70205 · Cited by 5 · see citing works
Antão, H. S., Sacadura‐Leite, E., Aguiar, P. M. V., Góis, C., Marques, J., Pombo›, S., & Figueira, M. L. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1425792 · Cited by 1 · see citing works
TINJAUAN PUSTAKA: HUBUNGAN BURNOUT SYNDROME DAN KUALITAS TIDUR PADA TENAGA MEDIS
Kurniasari, K., & Rahmiputri, K. D. (2025) · Jurnal Akta Trimedika · doi:10.25105/aktatrimedika.v2i1.21708
Long working hours and cardiovascular risk: A call for focus on healthcare professionals
Hirani, R., Allen, A. E., & Etienne, M. (2025) · Preventive Medicine · doi:10.1016/j.ypmed.2025.108258 · Cited by 1 · see citing works
Hosseini‐Kamkar, N., Lowe, C. J., & Morton, J. B. (2021) · doi:10.31234/osf.io/qnyr8 · Cited by 1 · see citing works
Associations of Continuous Electrodermal Activity with Job Burnout and Work EngagementPreprint
Salonius, H., Kytölä, P., Pakarinen, S., Mäkikangas, A., Liukkonen, V., & Mauno, S. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4726455 · Cited by 1 · see citing works
Toward early detection of burnout: A systematic review of potential biomarkersPreprint
Balia, M., Zenasni, F., Lepoittevin, M., Bianchi, R., Julian, A., Bodard, S., & Bringer, M. (2025) · medRxiv · doi:10.1101/2025.08.05.25332953 · Cited by 1 · see citing works
Gedminas, M., Neimanas, L., Vaitkaitis, D., Jasinskas, N., Šaferis, V., Stašaitis, K., Dobožinskas, P., & Mačiukas, A. (2018) · Sveikatos mokslai · doi:10.5200/sm-hs.2018.005
Biomarkers in Breast Cancer Survivors: The Search for Predictors
Lambert, M. (2021) · uO Research (University of Ottawa) · doi:10.20381/ruor-26793
Martins, J. M. R., Pereira, J. A., Pereira, T. S., Santos, S., & Conde, J. (2023) · Editora Artemis eBooks · doi:10.37572/edart_2911230936
Asamoah, K. T., Dei‐Asamoa, R., Ampofo, E. B., Awindaogo, F. R., Agyekum, F., Doku, A., Ohene, S., & Amable, E. (2025) · medRxiv · doi:10.1101/2025.10.12.25337844
Schilbach, M., Baethge, A., Shoshan, H. N., & Rigotti, T. (2026) · Journal of Business and Psychology · doi:10.1007/s10869-026-10099-y
De l’importance des médiateurs du stress dans le contrôle de l’immunité
Bacou, E. (2017) · theses.fr (ABES) · doi:10.70675/c3e20630z2e84z4f0ez9c4ez2ff5647f0f03
Baka, Ł., Kapica, Ł., Sienkiewicz-Jarosz, H., Bugajska, J., Bańkowska, M., Neugebauer, K., Pietras, K., & Świtaj, P. (2026) · Chronobiology International · doi:10.1080/07420528.2026.2663950
Yan, J., Bultinck, F., Meng, L., Scheepers, D. T., & van Steenbergen, H. (2026) · Biological Psychology · doi:10.1016/j.biopsycho.2026.109279
Manga, L. J. O., Ndongo, J. M., Bian, W. M., Lele, E. C. B., Ntida, E. M. F. N., Fouda, A. A. B., Dissongo, J. I., Guessogo, W. R., Foko, L. P. K., Njoya, E. G. N., et al. (2026) · BMC Public Health · doi:10.1186/s12889-026-29318-5
Böckelmann, I., Hartung, J., Darius, S., Sammito, S., & Thielmann, B. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1908141
Salonius, H., Kytölä, P., Pakarinen, S., Mäkikangas, A., Liukkonen, V., & Mauno, S. (2026) · JMIR Formative Research · doi:10.2196/104167
Burnout Syndrome Identification from Electrodermal Signals Using Machine Learning Algorithms
Vera-Díaz, J. E., Torres-García, A. A., Pérez-Espinosa, H., Ramírez-Quintana, J. A., & Camacho-Ávila, A. (2026) · Proceedings - IEEE Symposium on Computer-Based Medical Systems · doi:10.1109/cbms69103.2026.00054
- Authors
- de Vente, W., van Amsterdam, J. G. C., Olff, M., Kamphuis, J. H., & Emmelkamp, P. M. G.
- Affiliations
- Department of Clinical Psychology, University of Amsterdam, Weesperplein 4, 1018 XA Amsterdam, Netherlands
- Amsterdam Institute for Addiction Research, Academic Medical Center, P.O. Box 75867, 1070 AW Amsterdam, Netherlands
- Amsterdam UMC Location University of Amsterdam (NL)
- University of Amsterdam (NL)
- King Abdulaziz University (SA)
- Venue
- BioMed Research International
- Publisher
- Wiley
- Published
- 2015
- Volume
- 2015
- Pages
- 1-13
- ISSN
- 1110-7243 (ISSN-L)
- 2314-6133
- 2314-6141
- PMC
- PMC4628754
- OpenAlex
- W2112136843
- Cited by
- 90
- References
- 69
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 7 · 2021: 12 · 2020: 5 · 2019: 10 · 2018: 11 · 2017: 9 · 2016: 4
- FWCI
- 5.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BioMed Research International (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion, cc-by)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- UvA-DARE (University of Amsterdam) (acceptedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Netherlands Organization for Scientific Research (580-02.403, 2200.0005)
- ZonMw (580-02.403, 2200.0005)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- burnout, parasympathetic activity, hypothalamic-pituitary-adrenal axis, cardiovascular risk, sex differences, psychosocial stress, cortisol, alpha-amylase, heart rate variability, cardiac output, blood pressure, sick leave
- MeSH terms
- Adult, alpha-Amylases, Blood Pressure, Female, Heart Rate, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Parasympathetic Nervous System, Pituitary-Adrenal System, Stress, Psychological
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