Acute Stress and Anxiety in Medical Residents on the Emergency Department Duty

José Peinado,Concepción Iribar,Joaquín González-Cabrera,María Fernández-Prada,María Salinero-Bachiller,Rogelio Molina-Ruano

doi:10.3390/ijerph15030506

Abstract

The objectives of this longitudinal study were to compare salivary cortisol release patterns in medical residents and their self-perceived anxiety levels between a regular working day and a day when on call in the emergency department (ED-duty day) and to determine any differences in cortisol release pattern as a function of years of residency or sex. The study included 35 residents (physicians-in-training) of the Granada University Hospital, Granada, Spain. Acute stress was measured on a regular working day and an ED-duty day, evaluating anxiety-state with the Spanish version of the State-Trait Anxiety Inventory. Physiological stress assessment was based on salivary cortisol levels. Cortisol release concentrations were higher on an ED-duty day than on a regular working day, with a significantly increased area under the curve (AUC) (p < 0.006). This difference slightly attenuated with longer residency experience. No gender difference in anxiety levels was observed (p < 0.001). According to these findings, the hypothalamic-pituitary-adrenal axis activity and anxiety levels of medical residents are higher on an ED-duty day than on a regular working day.

Highlights

It should be kept in mind that stress can be positive or negative
The objectives of the study were to compare the patterns of release of salivary cortisol and perceived anxiety-state levels in medical residents between a regular working day and an emergency department (ED)-duty day, and to compare cortisol release patterns as a function of years of residency
Controversial findings have been published on cortisol response to stress in healthcare professionals, with some authors reporting higher cortisol concentrations than described for the general population among emergency physicians [19] and surgeons [30], while others have found no differences among emergency physicians [31] or intensive care unit nurses [32]

Summary

Introduction

It should be kept in mind that stress can be positive (eustress) or negative (distress). Eustress is essential to grow, develop, and achieve high levels of performance in a wide range of tasks and activities. Distress is considered a potential source of physical and psychological problems, especially when chronic [1,2]. Anxiety and stress are widespread psychological disorders. Acute and chronic stress has been associated with physiological impairments [4,5], psycho-somatic diseases and, especially, cardiovascular disease [6]. It has been reported that anxiety levels are higher in healthcare professionals than in the general population, attributed to frequent night-time working, with few hours of sleep, and exhausting workloads, among other causes [7]

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Discussion

Conclusion