Qualitative and Quantitative

LATIFA FADILLAH

K032211015

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Evaluation of stress, burnout and hair cortisol levels in health
workers at a University Hospital during COVID-19 pandemic

1 INTRODUCTION

2 MATERIAL AND METHOD

3 RESULT

4 DISCUSSION

5 CONCLUSION
In the critical context of COVID
-19 pandemic, healthcare workers
are on the front line, participating
directly in the care, diagnosis, and
treatment of patients with COVID-
19.

This exposes them to a higher risk

of developing chronic stress,
psychological distress, and any
other mental health symptoms.

Objective: to evaluate stress and

burnout in a health workers
population and, in addition, to
measure hair cortisol concentration
as a current biomarker of stress.
Materials and methods: 234 health workers from Hospital de Clínicas “Jos´e de San Martín”,
Buenos Aires University, were included in this study. In this population hair samples were
obtained from the posterior vertex as close to the scalp as possible and the individuals
completed the following surveys: perceived stress, social support, burnout scale, life event
scale, and sociodemographic data. Hair cortisol was measured by an automated
chemiluminescent method. The
Welcome!!
studied population was divided into three groups considering those individuals below the
healthy reference sample range (< 40 pg/mg
Insert the title hair),
of yourwithin
subtitlethe healthy reference range (40–128
Here
pg/mg hair) and above the reference range (> 128 pg/mg hair). This study used a transversal
and observational design.
 Hair sample collection and hair cortisol measurement

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Each sample Herein a
was stored Your Picture Here
Hair cortisol concentration
paper envelope at room
Hair samples were reference interval in healthy
temperature until it was
individuals with low levels of
obtained with scissors processed. Once
stress is 40–128 pg/mg hair
from the posterior vertex the samples were obtained, three
(P2.5- P97.5) (Gonzalez et
as close centimeters were measured from
al., 2019). The studied
the root segment adjacent to the
to the scalp as possible. populatio
cutting. Then, each sample was
Considering that hair n was divided into three
weighed, and cortisol was
grows approximately 1 groups considering this
extracted and processed by an
healthy reference sample
cm per month, 3 cm were automated chemiluminescent
range: below
obtained in order to method (Immulite 2000
the lower value (< 40 pg/mg
evaluate hair cortisol autoanalyzer, Siemens, LA,
hair), within the healthy
USA) according to the patented
levels of reference sample range (40–
procedure
the last 3 months. 128 pg/mg hair) and above
developed in our laboratory. The
the reference range (> 128
results were expressed in pg/mg.
pg/mg hair).
Epidemiological data and psychological tests
All participants were asked
to complete an
epidemiological sheet
including data about: age,
sex, weight, height, family
nucleus, medication, dye
hair, used shampoo, any
cosmetic hair treatment,
smoking, profession,
workplace, and pre-existing
pathologies. In addition, they
completed the following
surveys: perceived stress
(Cohen et al., 1988), social
support (Timmerman et al.,
2000), burnout scale
(Maslach et al., 1997), and
life event scale Homes-Rahe
(Holmes and Rahe, 1967)
Perceived stress survey consists The reliability analysis of
in 4 items, answered on a 5- the psychological tools
point Likert scale ranging from used yielded a
“never” to “very often”. Social Cronbach’s alpha of
support survey consists in 5 0.708 for perceived
items, answered using a Likert stress survey, 0.805 for
scale ranging from 1 to 4 each burnout survey and
item. Holmes-Rahe life events 0.815 for social support
scale consist in an inventory of scale
45 life events with different
scores from 11 to 100 each
event. For the analysis, median
values were used as follows, for
social support (median score
14.5), perceived stress (median
score 6) and life events (median
score 180)
 Burnout

The multidimensional concept of burnout was measured by

Maslach Burnout Inventory - Human Services Survey (MBI -
HSS) This scale consists of 22 items distributed into three
subscales: emotional exhaustion (EE) scoring from 0 to 54,
depersonalization (DP) scoring from 0 to 30 and personal
accomplishment (PA) scoring
from 0 to 48. Item responses are from 0 (never) to (6) every day
(Maslach and Leiter, 2016), the definition of burnout requires the
presence of the three subscales: high EE (score > 26), high DP
(score > 9) and low PA (score < 34).
Our Services
Results: Our results show that 40% of the studied population
Insert the title of your subtitle Here
presented hair cortisol values outside of the healthy reference
range. In the whole studied population, a direct correlation was
found between hair cortisol concentration and perceived stress
as well as between hair cortisol concentration and the
emotional exhaustion component of burnout (r = 0.142, p =
0.030;
r = 0.143, Content
p = 0.029,
Here respectively).
Content Here 12% ofHere
Content the studied
Content Here
population showed Burnout (52% doctors and residents, 19%
nurses,
19% administrative personnel). Higher values in hair cortisol
levels were found in the group with burnout versus individuals
without burnout (p = 0.034). Finally, a mediation analysis was
performed,Content Herethat Content
finding Here Content is
depersonalization Here Content Here
a mediating
variable in the relationship between self-perceived stress and
hair
 RESULT

Sociodemographic and psychological

characteristics of the study population

Stress and hair cortisol concentration

Burnout and hair cortisol concentration

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Conclusion: This is the first study in which a stress biomarker such as hair cortisol is
evaluated in this population and in this context. Healthcare workers are subjected to
increased levels of stress and burnout. High depersonalization, emotional exhaustion,
and decreased personal sense of accomplishment characterize this population. It is the
responsibility of the health authorities to implement strategies to manage this
psychological emergency
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