Cortisol, cortisone and inflammation in relation to burnout symptoms.

Burnout is highly prevalent in high-demand healthcare professions, with medical students and trainees already at increased risk. The pathophysiological processes associated with burnout remain insufficiently understood as previous research is mostly limited to cross-sectional studies focusing on specific biological correlates. This study aims to investigate a wide range of biological correlates associated with burnout symptoms by exploring cortisol, cortisone, and multiple inflammatory markers in medical students and physicians-in-training. A three-year open cohort study was carried out in medical students and physicians-in-training. Burnout symptoms were assessed using the Maslach Burnout Inventory. The cortisol and cortisone awakening response were measured simultaneously in saliva samples via liquid chromatography-tandem mass spectrometry, while inflammatory markers were measured in blood samples. Linear mixed-effects models were used to investigate changes of biological correlates in burnout symptoms. In total, 154 participants were included, contributing 241 measurements. The analysis indicated no significant associations between burnout symptoms and cortisol or cortisone awakening responses. Higher burnout symptoms were associated with a lower inflammatory index, and associations between inflammatory markers and HPA-axis measures were observed. Our results suggest associations between burnout symptoms and inflammatory markers, as well as between inflammatory markers and HPA-axis measures. Long-term follow-up studies with repeated assessments are needed to further investigate the biological correlates of burnout and its relationship with neuroendocrine-immune processes.