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  • Title: Effort-reward imbalance in police work: associations with the cortisol awakening response.
    Author: Violanti JM, Fekedulegn D, Gu JK, Allison P, Mnatsakanova A, Tinney-Zara C, Andrew ME.
    Journal: Int Arch Occup Environ Health; 2018 Jul; 91(5):513-522. PubMed ID: 29516173.
    Abstract:
    PURPOSE: We hypothesized that effort-reward imbalance (ERI) is associated with an atypical cortisol response. ERI has been associated with higher job stress. Stress triggers cortisol secretion via the hypothalamic-pituitary-adrenal (HPA) axis, and significant deviation from a typical cortisol pattern can indicate HPA axis dysfunction. METHODS: 176 police officers participated from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. ERI was the exposure variable. Outcome variables were saliva-based peak and mean cortisol values, total area under the curve ground (AUCG) and baseline (AUCI); linear regression line fitted to log-transformed cortisol. Regression analyses were used to examine linear trend between ERI and cortisol parameters. Repeated measures analysis examined whether the pattern of cortisol over time differed between low ERI (< median) and high ERI (≥ median). RESULTS: Mean age was 46 years (SD = 6.6). After adjustment for potential confounders, there was a significant inverse association between ERI and peak cortisol (β = - 0.20, p = 0.009), average cortisol (β = - 0.23, p = 0.003), and total area under the curve (β = - 0.21, p = 0.009). ERI was not significantly associated with AUCI (β = - 0.11, p = 0.214); slope of the regression line fitted to the cortisol profile (β = - 0.009, p = 0.908). Repeated measures analyses showed that the cortisol pattern did not vary significantly between high and low ERI using the median as a cut point (interaction p value = 0.790). CONCLUSIONS: ERI was inversely associated with the magnitude of awakening cortisol over time, indicating HPA axis dysregulation and potential future health outcomes.
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