{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:01:15Z","timestamp":1786122075021,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nurs. Rep.","Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Healthcare staff, especially nurses, face high occupational stress, yet objective biological indicators that complement self-report are not well established. We examined whether metabolic, hormonal and physiological markers act as indicators of stress and relate to anxiety, depression and burnout in nurses and other healthcare workers. Methods: We conducted a cross-sectional study of 300 hospital employees (239 in healthcare, of whom 123 were nurses; 61 non-healthcare) at a Croatian university hospital; of 329 completed questionnaires, 300 (91.2%) met the inclusion criteria and were analysed. Fasting glucose, lipids, thyroid hormones, cortisol, heart rate and blood pressure were measured; psychological status was measured using the 42-item Depression Anxiety Stress Scales (DASS-42), Maslach Burnout Inventory and Zung scale. Analyses used Mann\u2013Whitney and Kruskal\u2013Wallis tests, Spearman correlation, hierarchical logistic regression adjusted for age, sex, smoking and thyroid medication use, and receiver operating characteristic (ROC) analysis. Results: Healthcare workers had more favourable glucose, total and low-density lipoprotein (LDL) cholesterol than the older non-healthcare group (all p \u2264 0.003); because the groups differed substantially in age, these unadjusted differences are descriptive only. Metabolic markers correlated only weakly with distress and burnout. Within healthcare workers, elevated stress was discriminated in univariable analysis by low high-density lipoprotein (HDL) cholesterol (area under the curve (AUC) 0.72), raised triglycerides (AUC 0.67) and glucose (AUC 0.66); however, after adjustment for age, sex, smoking and thyroid medication use, none of the markers remained independently associated with elevated stress. Conclusions: In this relatively healthy hospital workforce, routinely available biological markers showed limited value as standalone indicators of occupational stress; they are exploratory rather than validated biomarkers, and require confirmation in larger, prospective, multicentre studies before they can complement\u2014rather than replace\u2014psychological screening in occupational-health practice.<\/jats:p>","DOI":"10.3390\/nursrep16080277","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:01:36Z","timestamp":1786089696000},"page":"277","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Candidate Biological Indicators of Occupational Stress in Healthcare Workers: Heart Rate, Free Triiodothyronine and HDL Cholesterol\u2014A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2200-7653","authenticated-orcid":false,"given":"Tanja","family":"Lupieri","sequence":"first","affiliation":[{"name":"Clinical Hospital \u201cSveti Duh\u201d, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0056-3711","authenticated-orcid":false,"given":"Martina","family":"Hrva\u010di\u0107","sequence":"additional","affiliation":[{"name":"Clinical Hospital \u201cSveti Duh\u201d, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6200-2405","authenticated-orcid":false,"given":"Dubravka","family":"\u0160vob \u0160trac","sequence":"additional","affiliation":[{"name":"Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Ru\u0111er Bo\u0161kovi\u0107 Institute, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-3814","authenticated-orcid":false,"given":"Suzana","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrap\u010de, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2199-4043","authenticated-orcid":false,"given":"Dunja","family":"Degme\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University Hospital Centre Osijek, 31000 Osijek, Croatia"},{"name":"Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/wps.20311","article-title":"Understanding the burnout experience: Recent research and its implications for psychiatry","volume":"15","author":"Maslach","year":"2016","journal-title":"World Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ed\u00fa-Valsania, S., Lagu\u00eda, A., and Moriano, J.A. (2022). Burnout: A review of theory and measurement. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031780"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ghahramani, S., Lankarani, K.B., Yousefi, M., Heydari, K., Shahabi, S., and Azmand, S. (2021). A systematic review and meta-analysis of burnout among healthcare workers during COVID-19. Front. 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