Ministero della Difesa

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Work-related Stress. New Indicators and New Biomarkers

Lavoro e Sicurezza - Domenico Della Porta

Roma,  29 gennaio 2013

In few years it will probably be possible to asses if a worker suffers from work-related stress through hair analysis or salivary analysis.
This will permit to dispel doubts about the diagnosis of a mainly self-perceived condition. Stress, indeed, is an extremely complex phenomenon, as what is stressing for one individual could be perceived as pleasing for somebody else and vice versa. It is, therefore, impossible to provide solutions or advices which are always applicable.

Self awareness of one’s condition comes first and above all: to learn how to listen to one’s body and one’s mind, to recognize the first signs of stress (sleep disturbances, headache, functional gastrointestinal disorders, allergies, low sexual desire, muscle pain, eating disorders, increase in smoking or alcohol consumption, anxiety, indecisiveness, expressive language disorders, awkwardness, etc.).

When stress is related to work environment it becomes an actual and increasingly hazardous risk for health and safety of workers. It arises when working requirements exceed worker capacity to fulfil them. Up to now work-related stress has been assessed by analysing employee indicators (on-the-job accidents, illness-related absences, absenteeism, turnover rates, extraordinary sick leaves, etc.), work context indicators (organizational position and role, career development, relationships, etc.), working condition indicators (work environment and equipment, task management, work burden, work pace, working time).

The cutting-edge research of Occupational Medicine, instead, is focused on the identification of biomarkers in order to assess employee stress levels. The correct, accurate and rigorous evaluation of stress levels has become a legal obligation in accordance with the occupational health and safety regulations in force (Legislative Decree nr. 106, 2009). This was one of the topic discussions of the 75th Convention of Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) held in Bergamo.

As Professor Giovanni Maina – tenured professor of Occupational Medicine at the University of Turin - pointed out, even if work-related stress has been related to an increase in cardiovascular disease risk, the physiopathological events whereby this relation occurs remain uncertain. That is the reason why researchers are conducting studies to identify biomarkers of the two neuroendocrine axes (sympathetic-adrenal axis and hypothalamic–pituitary–adrenal axis) which are involved into stress/health relation, and to fully exploit the potentiality of these biological markers. These biomarkers come from the psycho-neuroendocrinological research as they belong to the category of intermediate-effect biomarkers. They differentiate from exposure biomarkers as they are biomarkers of effective dose and/or early effect; therefore they have a closer impact on health and are potentially useful to provide information for prevention too.

As for autonomic nervous system, current research is focused on plasma and urinary catecholamines. As for hypothalamic–pituitary–adrenal axis, instead, researchers have analysed variation of cortisol levels before and after awakening, content of cortisol in hair and testosterone, and prolactin levels in men and women.

Even if uncertainty on clinical implications still remains, as this is just an early stage, analysis of the first results shows that work-related stress is associated to increased levels of catecholamines (especially in urinary samples’ values), reduced heart rate variability, increased cortisol response to awakening, increased prolactin levels and reduced testosterone levels. But their effects on workers’ health are still to be investigated.