Abstract
Background
Psychological disorders arising from bullying at work (BW) are common. The relationship between these disorders and putative markers is not well established.
Aims
To measure saliva dehydroepiandrosterone sulphate (DHEAS) and saliva cortisol as putative markers in individuals suffering from BW.
Methods
Forty one subjects suffering from BW were screened for mental distress at the institute of occupational health in Clermont-Ferrand, France. They were compared with 28 psychologically healthy controls (group C). The conditions causing BW were recorded. The hospital anxiety and depression (HAD) scale, the Beech questionnaire and the visual analogic scale (VAS) of stress were used to determine the psychological consequences of BW. Saliva samples were collected at awakening (7 am), 30 and 60 min after awakening, and then every 2 h until bed time (11 pm).
1. Introduction
Bullying at work (BW) is an emerging problem which has led to the provision of consultations for mental disorders in centres of occupational health (Brousse et al., 2008). BW can be defined as repeated behaviour aimed at or resulting in a deterioration in working conditions likely to undermine the rights and dignity of the employee targeted, affect their physical or mental health, or compromise their career paths (Brousse et al., 2008).
The prevalence of BW varied from 3% to 8%:5% and 6% in employees working in Finnish hospitals (Kivimäki et al., 2003), 4% in a random sample of Finnish social welfare and health care workers aged 25–64 (Kauppinen, Aaltonen, & Lehtinen, 1997), 3% in assistant nurses from hospitals and nursing homes, and 8% in employees in a sample of 2105 health care workers in Norwegian studies (Einarsen & Skogstad, 1996). Almost 40% of employees experienced BW when a broader definition was used in a study of a British National Health Services Community Trust, and 42% had witnessed the BW of others (Quine, 1999).
BW produces anxiety, burn-out, depression and suicidal ideas, a cluster of pathologies considered as resulting from stress (Brousse et al., 2008). As a result, the hypothalamic–pituitary–adrenal (HPA) axis, which plays a major role in conveying the central stress response to the peripheral body systems, is activated. Cortisol and dehydroepiandrosterone sulphate (DHEAS) are secreted by the adrenal gland in response to this activation. Cortisol is the standard biological marker to assess the degree of stress (Lac and Chamoux, 2003, Mason, 1968 and Taverniers et al., 2010). However, previous studies have reported that it is poorly correlated with burn-out and anxiety (for review, see Danhof-Pont, Veen, & Zitman, 2010). The neurosteroid DHEAS is a highly specific individual marker of the hormonal milieu (Thomas et al., 1994). Some studies have connected a rise in DHEAS levels with pathologies frequently induced by BW situations (Brousse et al., 2008), such as anxiety and depression (Assies et al., 2004, Boudarene et al., 2002 and Hsiao, 2006), and burn-out (Mommersteeg, Heijnen et al., 2006, Mommersteeg, Keijsers et al., 2006 and Sonnenschein et al., 2007).
Cortisol and DHEAS can now be assayed in saliva, and hence their salivary levels have been suggested for use as stress markers (MacLaughlin et al., 2011).
In the current pilot study, the modification of HPA axis was assessed by measuring saliva cortisol and saliva DHEAS in patients with psychopathological disorders induced by BW. BW seems to be an appropriate model to study these stress markers because it produces stress, anxiety, depression, and burn-out.
2. Methods
2.1. Participants
Sixty-seven individuals (characteristics in Table 1) were divided into two groups: a BW group of 41 patients (13 males and 28 females), complaining of and being identified as exposed to psychological harassment at work, and a control group (C) of 28 psychologically healthy individuals (nine males, 19 females). Only patients having given written informed consent were included in the study. The protocol was approved by the Regional Ethics Committee. Exclusion criteria were: age <18 years, endocrine disease, pregnancy, recent extraprofessional deleterious life events (such as death of a near relation and divorce) and personality disorders as diagnosed by a senior psychiatrist and a senior physician.
5. Conclusions
In conclusion, we found significant modifications of saliva DHEAS levels in psychological distress arising from BW, and a correlation with anxiety, depression and burnout. Thus, saliva DHEAS level, because of its particular stability conferred by its long half life of 10–15 h, seems to be a good means of evidencing a mean state of chronic stress. Further investigations are needed to confirm the role of DHEAS in the global response of the HPA axis in situations generating chronic stress.
