# Perceived stress precedes declines in Well-being: A prospective study of stress, well-being, hair cortisol, and low-grade inflammation in hospital employees

## TL;DR

This study finds that higher perceived stress in hospital employees predicts lower well-being six months later, but not changes in stress or inflammation markers.

## Contribution

This is the first prospective study to examine the temporal links between stress, well-being, hair cortisol, and inflammation in hospital employees.

## Key findings

- Increases in perceived stress predicted later decreases in well-being.
- No causal links were found between stress or well-being and hair cortisol or C-reactive protein.
- Well-being declined for nearly half of participants over six months.

## Abstract

Chronic low-grade inflammation may help explain the relationship between stress, well-being, and disease, but the pathway and temporal order have not yet been tested prospectively. To understand the pathways between perceived stress, well-being, C-reactive protein, and hair cortisol, we investigated the temporal ordering of these variables in a sample of hospital employees.

Random-intercepts cross-lagged panel models were conducted using three 6-monthly waves of data collected from new employees at a German hospital (N = 296, 77.7 % female, M age = 28.59) in a prospective cohort study. Self-reported data on perceived stress and well-being, hair strands for hair cortisol concentration, and capillary blood samples for C-reactive protein were collected for analysis.

While our study did not support a causal relationship between changes in stress levels and later changes in either hair cortisol or low-grade inflammation, we provide evidence to suggest that increases in perceived stress led to later decreases in well-being. In contrast, changes in well-being did not predict changes in perceived stress levels.

This is the first prospective repeated-measure study to examine the temporal associations between stress, well-being, hair cortisol concentrations, and chronic low-grade inflammation. Our analyses suggest that perceived stress in this sample precedes changes in well-being, highlighting the importance of prevention and early intervention.

•Stress increases predicted lower well-being 6 months later, not vice versa.•No links found between stress or well-being with HCC or CRP over time.•Stress, HCC, CRP stable; well-being declined for nearly half of participants.•Early stress reduction may prevent reduced well-being.

Stress increases predicted lower well-being 6 months later, not vice versa.

No links found between stress or well-being with HCC or CRP over time.

Stress, HCC, CRP stable; well-being declined for nearly half of participants.

Early stress reduction may prevent reduced well-being.