Keywords: Bulgaria, daily habits, general practitioners, salivary α-amylase, salivary cortisol, stress.

Background:

Stress triggers physiological responses involving the hypothalamic–pituitary–adrenal axis and autonomic nervous system. These can be assessed via salivary biomarkers (α-amylase, cortisol), heart rate, and blood pressure. This study aims to evaluate stress development in general practitioners (GPs) working in remote rural areas of Bulgaria due to their daily professional routines.

Research questions:

Method:

Out of 128 general practitioners who completed a questionnaire on health status, habits, priorities, and ethical patient relationships, 40 were selected for this study (n = 40; mean age 55.92 ± 8.8 years). Each provided four saliva samples over one week—two on Monday (morning and after work) and two on Friday. Blood pressure and pulse were measured after each sampling using a standard monitor. Salivary biomarkers were quantitatively analyzed using the ELISA method.

Results:

Salivary α-amylase levels were significantly higher at the end of the workday, particularly on Friday (142.28 ± 23.34 U/mL; p = 0.018), with no significant difference between the start and end of the week. A typical cortisol awakening response was observed only at the beginning of the week, with a marked disruption by week's end. Morning cortisol levels decreased significantly from Monday (30.1 ± 10.84 ng/mL) to Friday (25.73 ± 10.51 ng/mL; p = 0.033). Smoking (p = 0.002) and alcohol consumption (p = 0.036) were associated with elevated α-amylase levels, but not cortisol. Blood pressure increased significantly by the end of the week (p = 0.04), while pulse varied within the day, showing higher values at the end of the workday.

Conclusions:

The professional lives of the GPs who work in distant and rural places are associated with stress development. Different habits from the daily routine, such as alcohol consumption, smoking and physical activity, could be considered as modulators of stress development.

Points for discussion: