Volume 5, Issue 1, March 2019, Page: 14-23
Stress Response in Swedish Ambulance Personnel Evaluated by Trier Social Stress Test
Kåre Karlsson, Ambulance Services, Skaraborg Hospital, Skovde, Sweden; The Research Fund at Skaraborg Hospital, Skovde, Sweden; School of Health and Welfare, University of Jonkoping, Jonkoping, Sweden
Patrik Persson Niemelä, Ambulance Services, Skaraborg Hospital, Skovde, Sweden; The Research Fund at Skaraborg Hospital, Skovde, Sweden
Anders Jonsson, School of Health Sciences, University of Borås, Borås, Sweden; Centre for Defence Medicine, The Swedish Armed Forces, West Frolunda, Sweden
Carl-Johan Törnhage, Department of Paediatrics, Skaraborg Hospital, Skovde, Sweden; Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Received: Jan. 7, 2019;       Accepted: Mar. 2, 2019;       Published: Mar. 19, 2019
DOI: 10.11648/j.jher.20190501.13      View  43      Downloads  23
According to previous research, ambulance personnel often consider themselves as healthy, but at the same time several studies show that they suffer from several stress-related illnesses, take early retirement and even suffer early death. The aim of this study was to explore mental stress during the Trier Social Stress Test. Questions were whether heart rate measurement could replace cortisol concentration in saliva as an indicator of stress and if there were differences between genders. During 20 Trier Social Stress Tests heart rate and salivary cortisol concentrations were measured. Heart rate was measured every 15 seconds and salivary cortisol was collected at seven occasions. Fourteen men and six women (sixteen ambulance nurses and four paramedics) participated. A questionnaire with background data was collected. Statistical analysis used was non-parametric tests to adjust for misalignment. During the Trier Social Stress Test women had their highest salivary cortisol concentration before start of test while the maximum values for men were 10 to 20 minutes after start. In contrast, there was no difference in heart rhythm before, during and after test between genders. No correlation between heart rate and salivary cortisol was found. There was no significant difference in stress response according to personnel’s age or level of education. Women and men exhibit different hormonal stress responses when it comes to performing unfamiliar actions, something that has not been seen before. Since no correlation could be seen between heart rate and salivary cortisol concentration they cannot replace each other as indicators of stress.
Ambulance Personnel, Heart Rate, Salivary Cortisol, Stress, Trier Social Stress Test
To cite this article
Kåre Karlsson, Patrik Persson Niemelä, Anders Jonsson, Carl-Johan Törnhage, Stress Response in Swedish Ambulance Personnel Evaluated by Trier Social Stress Test, Journal of Health and Environmental Research. Vol. 5, No. 1, 2019, pp. 14-23. doi: 10.11648/j.jher.20190501.13
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Socialstyrelsen, Socialstyrelsens föreskrifter (SOSFS 2009:10) om ambulanssjukvård 2009.
Wiitavaara, B., et al., Striking a balance—health experiences of male ambulance personnel with musculoskeletal symptoms: A grounded theory. International journal of nursing studies, 2007. 44(5): p. 770-779.
Nirel, N., et al., Stress, work overload, burnout, and satisfaction among paramedics in Israel. Prehospital and disaster medicine, 2008. 23(6): p. 537-546.
Aasa, U., et al., Work‐related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel. Scandinavian journal of caring sciences, 2005. 19(3): p. 251-258.
Jonsson, A. and K. Segesten, Daily stress and concept of self in Swedish ambulance personnel. Prehospital and disaster medicine, 2004. 19(3): p. 226-234.
Sterud, T., Ø. Ekeberg, and E. Hem, Health status in the ambulance services: a systematic review. BMC Health Services Research, 2006. 6(1): p. 82.
Maguire, B. J., et al., Occupational fatalities in emergency medical services: a hidden crisis. Annals of emergency medicine, 2002. 40(6): p. 625-632.
Grønkjær, L. L., Nurses’ experience of stress and burnout: a literature review. Klinisk Sygepleje, 2013. 27(01): p. 15-26.
Yang, Y., et al., Salivary cortisol levels and work-related stress among emergency department nurses. Journal of Occupational and Environmental Medicine, 2001. 43(12): p. 1011-1018.
Bounds, R., Factors affecting perceived stress in pre-hospital emergency medical services. Californian J Health Promot, 2006. 4(2): p. 113-131.
Huang, Y., et al., Association between job strain and risk of incident stroke A meta-analysis. Neurology, 2015. 85(19): p. 1648-1654.
Steptoe, A. and M. Kivimäki, Stress and cardiovascular disease: an update on current knowledge. Annual review of public health, 2013. 34: p. 337-354.
Heikkilä, K., et al., Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women. Bmj, 2013. 346: p. f165.
Hegg-Deloye, S., et al., Current state of knowledge of post-traumatic stress, sleeping problems, obesity and cardiovascular disease in paramedics. Emerg Med J, 2014. 31(3): p. 242-247.
Boudreaux, E., et al., Patient care and daily stress among emergency medical technicians. Prehospital and disaster medicine, 1996. 11(3): p. 188-193.
Backé, E. M., et al., Assessment of salivary cortisol as stress marker in ambulance service personnel: comparison between shifts working on mobile intensive care unit and patient transport ambulance. International archives of occupational and environmental health, 2009. 82(9): p. 1057-1064.
Millán, E. M., Occupational stress among health care professionals specialising in acute medicine. Emergencias, 2007. 19: p. 151-153.
Berland, A., G. K. Natvig, and D. Gundersen, Patient safety and job-related stress: a focus group study. Intensive and critical care nursing, 2008. 24(2): p. 90-97.
LeBlanc, V. R., et al., Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator. Prehospital Emergency Care, 2005. 9(4): p. 439-444.
LeBlanc, V. R., et al., The impact of stress on paramedic performance during simulated critical events. Prehospital and disaster medicine, 2012. 27(4): p. 369-374.
Almeida-Filho, N., Towards a Unified Theory of Health-Disease: I. Health as a complex model-object. Revista de Saúde Pública, 2013. 47: p. 433-450.
Boorse, C., Health as a theoretical concept. Philosophy of science, 1977. 44(4): p. 542-573.
Ereshefsky, M., Defining ‘health’and ‘disease’. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences, 2009. 40(3): p. 221-227.
Arman, M., et al., The Nordic tradition of caring science: the works of three theorists. Nursing science quarterly, 2015. 28(4): p. 288-296.
Eriksson, K., Hälsans idé.(2. uppl.) Stockholm: Liber. 1996, Almqvist & Wiksell medicin.
Eriksson, K., Den lidande människan. 1994: Liber utbildning.
Segesten, K. and K. Dahlberg, Hälsa och vårdande: I teori och praxis. Stockholm: Natur & kultur, 2010.
Hellhammer, D. H., S. Wüst, and B. M. Kudielka, Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology, 2009. 34(2): p. 163-171.
Törnhage, C.-J., Salivary cortisol for assessment of hypothalamic-pituitary-adrenal axis function. Neuroimmunomodulation, 2009. 16(5): p. 284-289.
Karlsson, K., P. Niemelä, and A. Jonsson, Heart rate as a marker of stress in ambulance personnel: a pilot study of the body's response to the ambulance alarm. Prehospital and disaster medicine, 2011. 26(1): p. 21-26.
Kirschbaum, C., K.-M. Pirke, and D. H. Hellhammer, The ‘Trier Social Stress Test’–a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 1993. 28(1-2): p. 76-81.
Het, S., et al., Neuroendocrine and psychometric evaluation of a placebo version of the ‘Trier Social Stress Test’. Psychoneuroendocrinology, 2009. 34(7): p. 1075-1086.
Von Dawans, B., C. Kirschbaum, and M. Heinrichs, The Trier Social Stress Test for Groups (TSST-G): A new research tool for controlled simultaneous social stress exposure in a group format. Psychoneuroendocrinology, 2011. 36(4): p. 514-522.
Jönsson, P., et al., Cardiovascular and cortisol reactivity and habituation to a virtual reality version of the Trier Social Stress Test: a pilot study. Psychoneuroendocrinology, 2010. 35(9): p. 1397-1403.
Törnhage, C.-J., Reference values for morning salivary cortisol concentrations in healthy school-aged children. Journal of Pediatric Endocrinology and Metabolism, 2002. 15(2): p. 197-204.
Pruessner, J. C., et al., Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology, 2003. 28(7): p. 916-931.
Fekedulegn, D. B., et al., Area under the curve and other summary indicators of repeated waking cortisol measurements. Psychosomatic medicine, 2007. 69(7): p. 651-659.
Kirschbaum, C., et al., Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis. Psychosomatic medicine, 1999. 61(2): p. 154-162.
Schommer, N. C., D. H. Hellhammer, and C. Kirschbaum, Dissociation between reactivity of the hypothalamus-pituitary-adrenal axis and the sympathetic-adrenal-medullary system to repeated psychosocial stress. Psychosomatic medicine, 2003. 65(3): p. 450-460.
Reschke‐Hernández, A. E., et al., Sex and stress: Men and women show different cortisol responses to psychological stress induced by the Trier social stress test and the Iowa singing social stress test. Journal of neuroscience research, 2017. 95(1-2): p. 106-114.
Kudielka, B. M. and C. Kirschbaum, Sex differences in HPA axis responses to stress: a review. Biological psychology, 2005. 69(1): p. 113-132.
Kumsta, R., et al., Sex specific associations between common glucocorticoid receptor gene variants and hypothalamus-pituitary-adrenal axis responses to psychosocial stress. Biological psychiatry, 2007. 62(8): p. 863-869.
Steptoe, A. and G. Willemsen, The influence of low job control on ambulatory blood pressure and perceived stress over the working day in men and women from the Whitehall II cohort. Journal of hypertension, 2004. 22(5): p. 915-920.
Karlsson, K. J., et al., Using shoulder straps decreases heart rate variability and salivary cortisol concentration in Swedish ambulance personnel. Safety and health at work, 2016. 7(1): p. 32-37.
Hellhammer, J. and M. Schubert, The physiological response to Trier Social Stress Test relates to subjective measures of stress during but not before or after the test. Psychoneuroendocrinology, 2012. 37(1): p. 119-124.
Eriksson, K., Caring science in a new key. Nursing science quarterly, 2002. 15(1): p. 61-65.
Almeida Filho, N. d., For a general theory of health: preliminary epistemological and anthropological notes. Cadernos de Saúde Pública, 2001. 17: p. 753-770.
Törnhage, C. J. and G. Alfvén, Children with recurrent psychosomatic abdominal pain display increased morning salivary cortisol and high serum cortisol concentrations. Acta Paediatrica, 2015. 104(12).
Dorn, L. D., et al., Salivary cortisol reflects serum cortisol: analysis of circadian profiles. Annals of clinical biochemistry, 2007. 44(3): p. 281-284.
Puri, K., et al., Declaration of Helsinki, 2008: implications for stakeholders in research. Journal of postgraduate medicine, 2009. 55(2): p. 131.
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