Majda Gotovac

Background/Objectives: Public healthcare workers face significant occupational stress during crisis situations, yet research on this particular population remains limited compared to other healthcare workers. The aim of this study was to investigate the impact of the COVID-19 pandemic on distress levels and the sense of coherence among public health workers by integrating psychological assessments with physiological markers of stress to identify protective factors against pandemic-related occupational stress. Methods: This longitudinal study was conducted at the Teaching Public Health Institute of Split and Dalmatia County from July 2021 to February 2022 at two time points: the latency phase (between COVID-19 waves) and hyperarousal phase (during an active wave). Fifty-four public health workers participated in the study. There were three questionnaires assessing psychological distress: Kessler Psychological Distress Scale, Impact of Events Scale—Revised and Sense of Coherence Scale-29. Salivary and blood samples were collected at both time points to measure cortisol levels, cortisol awakening response, and interleukin-6 concentrations. Results: The cortisol area under the curve with respect to ground (AUCg) was significantly elevated during the stress phase compared to the latency phase (234.8 vs. 201.8; p = 0.023), indicating heightened physiological stress responses. Epidemiologists demonstrated significantly lower sense of coherence scores compared to non-epidemiologists (117.9 ± 9.1 vs. 125.6 ± 10.5; p = 0.029). A lower sense of coherence was significantly associated with higher psychological distress and post-traumatic stress symptoms. Multiple linear regression analysis revealed that sense of coherence and interleukin-6 levels were significant independent predictors of cortisol changes. Conclusions: The findings demonstrate that public health workers experience measurable physiological stress responses during pandemic peaks, with sense of coherence emerging as a protective psychological factor. Interventions targeting sense of coherence and organizational support may possibly enhance resilience and reduce mental health morbidity in this vulnerable workforce during crisis situations.

Background and Objectives: Patients with primary Sjögren’s disease (pSjD) show contradictory results regarding the activity of the hypothalamic–pituitary–adrenal (HPA) axis. The aim of this study was to determine the salivary cortisol concentration to evaluate the function of the HPA axis (hypoactive/hyperactive) between patients with pSjD and control subjects. Materials and Methods: A total of 34 subjects participated in the cross-sectional study: 17 patients with pSjD and 17 control subjects. Stimulated whole saliva (SWS) was used to determine salivary cortisol concentration using an enzyme-linked immunosorbent assay (ELISA). Results: The salivary cortisol concentration showed a statistically significant difference between patients with pSjD and control subjects (4.69 ± 2.88 vs. 0.49 ± 0.37; p < 0.001; Student t-test). The area under the curve (AUC) was 100.0% in patients with pSjD (p < 0.001). The cut-off point was set to >1.454. The patients with pSjD had four times higher scores for depression and stress and six times higher scores for anxiety compared to the control subjects (p = 0.048, p < 0.001, p = 0.038; Mann–Whitney U test). The patients with pSjD had a statistically significantly higher total Oral Health Impact Profile (OHIP) score compared to the control subjects (p < 0.001, Mann–Whitney U test). Conclusions: The patients with pSjD showed short-term hyperactivity of the HPA axis compared to the control subjects.