Stress and hair cortisol concentrations in nurses during the first wave of the COVID-19 pandemic.

During the COVID-19 pandemic, frontline healthcare workers have been exposed to very stressful conditions. Measuring hair cortisol concentrations (HCCs), which reflect the integrated long-term cortisol levels, may elucidate the impact of COVID-19 related stress on healthcare professionals. In the current study, we investigated experienced stress in 693 healthcare workers, with hair samples for cortisol analysis collected from a subset of 67 female nurses. The HCCs in two 3 cm hair segments corresponding to periods before and during the peak of the first wave of COVID-19 were compared. To evaluate the effect of working in the first line, the sample was divided into two groups based on the COVID-19 risk estimated by the nurses. Covariates in the model included perceived stress (PSS), perceived social support (MSPSS), and quality of sleep (PSQI) measured via an online questionnaire. The data showed that more than 75% of healthcare workers agreed that COVID-19 led to increased stress at their workplace. The hair cortisol analysis showed higher HCCs in the hair segments corresponding to the time of the pandemic compared to hair corresponding to an earlier period (partial η290%CI = 0.123-0.397); in the same model, higher HCCs were also found in nurses from high-risk environments compared to low-risk ones (partial η290%CI = 0.002-0.176). None of the subjective questionnaire measures were significant predictors of HCCs. In conclusion, these data showed that HCCs reflect the increased stress among nurses during the COVID-19 pandemic as well as the difference in nurses between high- and low-risk environments.

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

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 "José 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 studied population was divided into three groups considering those individuals below the healthy reference sample range (< 40 pg/mg hair), within the healthy reference range (40-128 pg/mg hair) and above the reference range (> 128 pg/mg hair). This study used a transversal and observational design. RESULTS: Our results show that 40% of the studied population 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, p = 0.029, respectively). 12% of the studied 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, finding that depersonalization is a mediating variable in the relationship between self-perceived stress and hair cortisol level (F = 4.86, p = 0.0086; indirect effect IC: 0.0987-1.8840). 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.