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Cortisol as a Biomarker of Work-Related Stress in Firefighters: A Systematic Review

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Occupational and Environmental Safety and Health III

Abstract

Introduction: Work-related stress results from exposure to factors such as high workloads and lack of control over one’s work. This exposure stimulates the hypothalamic-pituitary-adrenal axis to increase the secretion of stress-related glucocorticoid hormones, including cortisol. The main objective of this study was to investigate the production of cortisol (or cortisol levels) of firefighters in response to work-related stress. Methodology: For the systematic literature review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement was used. The research was developed in the databases SCOPUS, Web Of Science, and Pubmed. Results: Eleven articles were included in the present study, with hormonal and physiological assessments verifying the psychophysiological response to stress. Discussion: The nervous system and the endocrine system trigger the production of hormones called corticosteroids in response to stress. The primary corticosteroid is cortisol, produced in the adrenal gland. Exposure to extreme environments and involvement in intense physical activities impact hormone production and all stress biomarkers. Conclusion: Further studies are needed to confirm cortisol as a biomarker of occupational stress, particularly in occupations with high physical and mental demands such as firefighters.

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Change history

  • 03 March 2022

    In the original version of the book, the following corrections have been incorporated:

    In Chapter 5 “Analysis of Safety Culture Maturity in Two Finnish Companies”, the first author name was corrected from Julius Pirhonena to Julius Pirhonen. The corresponding chapter author has been changed to ‘Sari Tappura’ and the email address was corrected from saritappura@tuni.fi to sari.tappura@tuni.fi

    In Chapter 16 “Long-Term Driving Causes Gait Plantar Pressure Alterations in Subjects Groups”, section “3.2 Plantar Pressure Distribution” was included.

    In Chapter 22 “Cortisol as a Biomarker of Work-Related Stress in Firefighters: A Systematic Review”, the author list was updated with the correct information (name, affiliations and email address) of the second author, Joana Santos.

    The chapters and the book have been updated with the above-mentioned changes.

References

  • Ahrens, T., Deuschle, M., Krumm, B., van der Pompe, G., den Boer, J.A., Lederbogen, F.: Pituitary-adrenal and sympathetic nervous system responses to stress in women remitted from recurrent major depression. Psychosom. Med. 70(4), 461–467 (2008). https://doi.org/10.1097/PSY.0b013e31816b1aaa

    Article  Google Scholar 

  • CDC: Heat Stress - Heat Related Illness (2018). https://www.cdc.gov/niosh/topics/heatstress/heatrelillness.html

  • Christison, K.S., Gurney, S.C., Sol, J.A., Williamson-Reisdorph, C.M., Quindry, T.S., Quindry, J.C., Dumke, C.L.: Muscle damage and overreaching during wildland firefighter critical training. J. Occup. Environ. Med. 63(4), 350–356 (2021). https://doi.org/10.1097/JOM.0000000000002149

    Article  Google Scholar 

  • Drake, R.L., A.W.V., A.W.M.M.: Gray’s - Anatonomia para Estudantes, 2nd edn. Elsevier, Amsterdam (2005)

    Google Scholar 

  • Fox, S.I.: Human Physiology, 12th edn. (2011)

    Google Scholar 

  • Greff, M.J.E., Levine, J.M., Abuzgaia, A.M., Elzagallaai, A.A., Rieder, M.J., van Uum, S.H.M.: Hair cortisol analysis: an update on methodological considerations and clinical applications. Clin. Biochem. 63, 1–9 (2019). https://doi.org/10.1016/j.clinbiochem.2018.09.010

    Article  Google Scholar 

  • Harrewijn, A., Vidal-Ribas, P., Clore-Gronenborn, K., Jackson, S.M., Pisano, S., Pine, D.S., Stringaris, A.: Associations between brain activity and endogenous and exogenous cortisol – A systematic review. Psychoneuroendocrinology 120, 104775 (2020). https://doi.org/10.1016/j.psyneuen.2020.104775

  • Heinrichs, M., Wagner, D., Schoch, W., Soravia, L.M., Hellhammer, D.H., Ehlert, U.: Predicting post-traumatic stress symptoms from pretraumatic risk factors: a 2-year prospective follow-up study in firefighters. Am. J. Psychiatry 162(12), 2276–2286 (2005). https://doi.org/10.1176/appi.ajp.162.12.2276

    Article  Google Scholar 

  • Huang, C.-J., Webb, H.E., Evans, R.K., McCleod, K.A., Tangsilsat, S.E., Kamimori, G.H., Acevedo, E.O.: Psychological stress during exercise: immunoendocrine and oxidative responses. Exp. Biol. Med. (Maywood, N.J.) 235(12), 1498–1504 (2010). https://doi.org/10.1258/ebm.2010.010176

  • Iob, E., Steptoe, A.: Cardiovascular disease and hair cortisol: a novel biomarker of chronic stress. Curr. Cardiol. Rep. 21(10), 116 (2019). https://doi.org/10.1007/s11886-019-1208-7

    Article  Google Scholar 

  • Jonathan, D., Kibble, P., Halsey, C.R.: Medical Physiology, 1st edn. McGraw-Hill Education/Medical, New York (2009)

    Google Scholar 

  • Kemeny, M.E.: The psychobiology of stress. Curr. Dir. Psychol. Sci. 12(4), 124–129 (2003). https://doi.org/10.1111/1467-8721.01246

    Article  Google Scholar 

  • Khan, A.A., Lip, G.Y.H., Shantsila, A.: Heart rate variability in atrial fibrillation: the balance between sympathetic and parasympathetic nervous system. Eur. J. Clin. Inve. 49(11), e13174 (2019). https://doi.org/10.1111/eci.13174

  • Kim, S.-C., Lee, H.-J., Shin, D.-M., Ku, B.-S., Oh, J.-H., Cho, B.-J., In, H., Ma, J.-Y.: Cardiovascular risk in fire academy instructors during live-fire simulation activity. Ann. Burns Fire Disasters 31(4), 313–321 (2018)

    Google Scholar 

  • Lim, G.-Y., Jang, T.-W., Sim, C.-S., Ahn, Y.S., Jeong, K.S.: Comparison of cortisol level by shift cycle in Korean firefighters. Int. J. Env. Res. Public Health 17(13) (2020). https://doi.org/10.3390/ijerph17134760

  • Maercker, A., Brewin, C.R., Bryant, R.A., Cloitre, M., van Ommeren, M., Jones, L.M., Humayan, A., Kagee, A., Llosa, A.E., Rousseau, C., Somasundaram, D.J., Souza, R., Suzuki, Y., Weissbecker, I., Wessely, S.C., First, M.B., Reed, G.M.: Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry: Official J. World Psychiatric Ass. (WPA) 12(3), 198–206 (2013). https://doi.org/10.1002/wps.20057

    Article  Google Scholar 

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., Group, T.P: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 6(7), e1000097 (2009)

    Google Scholar 

  • Nunneley, S., Dowd, P., Myhre, L., Stribley, R.: Physiological and psychological effects of heat stress simulating cockpit conditions. Aviat. Space Environ. Med. 49, 763–767 (1978)

    Google Scholar 

  • Perroni, F., Tessitore, A., Cibelli, G., Lupo, C., D’Artibale, E., Cortis, C., Cignitti, L., De Rosas, M., Capranica, L.: Effects of simulated firefighting on the responses of salivary cortisol, alpha-amylase and psychological variables. Ergonomics 52(4), 484–491 (2009). https://doi.org/10.1080/00140130802707873

    Article  Google Scholar 

  • Perroni, Fabrizio, Guidetti, L., Cignitti, L., Baldari, C.: Psychophysiological responses of firefighters to emergencies: a review. Open Sports Sci. J. 7(1), 8–15 (2014). https://doi.org/10.2174/1875399X01407010008

    Article  Google Scholar 

  • Pineles, S.L., Rasmusson, A.M., Yehuda, R., Lasko, N.B., Macklin, M.L., Pitman, R.K., Orr, S.P.: Predicting emotional responses to potentially traumatic events from pre-exposure waking cortisol levels: a longitudinal study of police and firefighters. Anxiety Stress Coping 26(3), 241–253 (2013). https://doi.org/10.1080/10615806.2012.672976

    Article  Google Scholar 

  • Powers, S.K., Howley, E.T.: Fisiologia do Exercício (E. Manole (ed.); 5a) (2004)

    Google Scholar 

  • Raff, H., Levitzky, M.: Medical Physiological - A systems Approach. McGraw-Hill, New York (2011)

    Google Scholar 

  • Rodrigues, S., Paiva, J.S., Dias, D., Pimentel, G., Kaiseler, M., Cunha, J.P.S.: Wearable biomonitoring platform for the assessment of stress and its impact on cognitive performance of firefighters: an experimental study. Clin. Prac. Epidemiol. Mental Health: CP & EMH 14, 250–262 (2018). https://doi.org/10.2174/1745017901814010250

    Article  Google Scholar 

  • Rosalky, D.S., Hostler, D., Webb, H.E.: Work duration does not affect cortisol output in experienced firefighters performing live burn drills. Appl. Ergon. 58, 583–591 (2017). https://doi.org/10.1016/j.apergo.2016.04.008

    Article  Google Scholar 

  • Rose, D.M., Seidler, A., Nübling, M., Latza, U., Brähler, E., Klein, E.M., Wiltink, J., Michal, M., Nickels, S., Wild, P.S., König, J., Claus, M., Letzel, S., Beutel, M.E.: Associations of fatigue to work-related stress, mental and physical health in an employed community sample. BMC Psychiatry 17(1), 167 (2017). https://doi.org/10.1186/s12888-017-1237-y

    Article  Google Scholar 

  • Russell, G., Lightman, S.: The human stress response. Nat. Rev. Endocrinol. 15(9), 525–534 (2019). https://doi.org/10.1038/s41574-019-0228-0

    Article  Google Scholar 

  • Schneiderman, N., Ironson, G., Siegel, S.D.: Stress and health: psychological, behavioral, and biological determinants. Annu. Rev. Clin. Psychol. 1, 607–628 (2005). https://doi.org/10.1146/annurev.clinpsy.1.102803.144141

    Article  Google Scholar 

  • Shahsavarani, A. M., Azad Marz Abadi, E., Hakimi Kalkhoran, M.: Stress: facts and theories through literature review. Int. J. Med. Rev. 2(2), 230–241 (2015). http://www.ijmedrev.com/article_68654.html

  • Smith, S.M., Vale, W.W.: The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dial. Clin. Neurosci. 8(4), 383–395 (2006). https://doi.org/10.31887/DCNS.2006.8.4/ssmith

  • Smith, D.L., Petruzzello, S.J., Kramer, J.M., Misner, J.E.: The effects of different thermal environments on the physiological and psychological responses of firefighters to a training drill. Ergonomics 40(4), 500–510 (1997). https://doi.org/10.1080/001401397188125

    Article  Google Scholar 

  • Smith, D.L., Petruzzello, S.J., Chludzinski, M.A., Reed, J.J., Woods, J.A.: Selected hormonal and immunological responses to strenuous live-fire firefighting drills. Ergonomics 48(1), 55–65 (2005). https://doi.org/10.1080/00140130412331303911

    Article  Google Scholar 

  • Susoliakova, O., Smejkalova, J., Bicikova, M., Potuznikova, D., Hodacova, L., Grimby-Ekman, A., Fiala, Z.: Salivary cortisol in two professions: daily cortisol profiles in school teachers and firefighters. Neuro Endocrinol. Lett. 35(4), 314–321 (2014)

    Google Scholar 

  • Thau, L., Gandhi, J., Sharma, S.: Physiology, Cortisol (2021)

    Google Scholar 

  • The National Institute for Occupational Safety and Health (NIOSH): Stress at work (2013). https://www.cdc.gov/niosh/topics/stress/default.html

  • Wolkow, A., Aisbett, B., Reynolds, J., Ferguson, S.A., Main, L.C.: Relationships between inflammatory cytokine and cortisol responses in firefighters exposed to simulated wildfire suppression work and sleep restriction. Physiol. Rep. 3(11) (2015). https://doi.org/10.14814/phy2.12604

  • Wolkow, A., Aisbett, B., Ferguson, S.A., Reynolds, J., Main, L.C.: Psychophysiological relationships between a multi-component self-report measure of mood, stress and behavioural signs and symptoms, and physiological stress responses during a simulated firefighting deployment. Int. J. Psychophysiol.: Official J. Int. Org. Psychophysiol. 110, 109–118 (2016a). https://doi.org/10.1016/j.ijpsycho.2016.10.015

    Article  Google Scholar 

  • Wolkow, A., Aisbett, B., Reynolds, J., Ferguson, S.A., Main, L.C.: The impact of sleep restriction while performing simulated physical firefighting work on cortisol and heart rate responses. Int. Arch. Occup. Environ. Health 89(3), 461–475 (2016b). https://doi.org/10.1007/s00420-015-1085-3

    Article  Google Scholar 

  • Wolkow, A., Aisbett, B., Jefferies, S., Main, L.C.: Effect of heat exposure and simulated physical firefighting work on acute inflammatory and cortisol responses. Ann. Work Expos. Health 61(5), 600–603 (2017). https://doi.org/10.1093/annweh/wxx029

    Article  Google Scholar 

  • Wyon, D.P., Andersen, I., Lundqvist, G.R.: Chapter 16 the Effects of moderate heat stress on mental performance. In: Cena, K., Clark, J.A. (eds.) Bioengineering, Thermal Physiology and Comfort, vol. 10, pp. 251–267. Elsevier, Amsterdam (1981). https://doi.org/10.1016/S0166-1116(08)71093-8

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Teixeira, T., Santos, J., Bustos, D., Guedes, J.C. (2022). Cortisol as a Biomarker of Work-Related Stress in Firefighters: A Systematic Review. In: Arezes, P.M., et al. Occupational and Environmental Safety and Health III. Studies in Systems, Decision and Control, vol 406. Springer, Cham. https://doi.org/10.1007/978-3-030-89617-1_22

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  • DOI: https://doi.org/10.1007/978-3-030-89617-1_22

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