Efeitos da auriculoterapia no estresse percebido e nos níveis de cortisol salivar em trabalhadores de saúde: ensaio clínico controlado randomizado

Abstract

Introduction: Healthcare workers are subject to work-related stressors that can lead to physical, psychological, social, and behavioral problems, making stress management at work extremely important. Integrative and Complementary Health Practices can contribute to this process, such as auriculotherapy, which demonstrates a good cost benefit ratio for controlling mental disorders such as stress and anxiety. Objectives: To evaluate the effects of auriculotherapy on perceived stress levels and salivary cortisol levels in primary healthcare workers in the municipality of Salvador, Bahia, Brazil; to identify non-pharmacological therapies used in stress management in healthcare workers and their effects on self-reported stress and physiological stress; to measure and correlate self-reported stress and cortisol levels in primary healthcare workers; to identify factors associated with perceived stress and salivary cortisol levels in primary healthcare workers; to estimate the prevalence of burnout and its associated factors in primary healthcare workers; to identify the prevalence and types of violence experienced by primary healthcare workers. Methods: Epidemiological survey followed by a randomized controlled clinical trial. A sociodemographic, occupational, and human biology questionnaire, the Perceived Stress Scale (ESP-10), and the Maslach Burnout Inventory (MBI) were applied to healthcare workers in the Family Health Strategy. Approximately 1 milliliter of saliva was also collected in Salivette® tubes to measure salivary cortisol levels. Measures of central tendency and frequencies were used for descriptive analysis, correlation measures between cortisol levels, burnout, and perceived stress; logistic regression with the dependent variable burnout (binary) and linear regression with the numerical dependent variables perceived stress and burnout dimensions were used. For the clinical trial, workers with perceived stress above the overall average and with cortisol levels above the median were randomized into two groups: auriculotherapy, with application of the therapy to the Shenmen, kidney, heart, sympathetic, and brainstem points, and a placebo group, with application to the external ear and wrist points. After 4 sessions, a paired t-test (before and after therapy) was performed in case of normal sample distribution, and the Wilcoxon test was used for non-parametric distribution. The Mann-Whitney test was also used for comparison between groups. Results: there are few studies in the literature on the use of auriculotherapy to reduce physiological and perceived stress in healthcare workers. Among the workers, 58.54% presented high perceived stress, 17.48% presented burnout, 76.4% had low professional self-esteem, 58.8% had suffered some type of violence at work, and 78.8% were dissatisfied with their economic situation. The correlation between salivary cortisol and perceived stress was positive, but weak and statistically insignificant (r = 0.036 and p-value = 0.534). Perceived stress was associated with age (β=-0.11 and p=0.001), economic dissatisfaction (β=2.98 and p<0.001), and not engaging in physical activity (β=2.29 and p=0.005). Cortisol levels were associated with not having experienced violence (p=0.038) and moderate alcohol consumption (p=0.005). Burnout was associated with age (β=-0.04 and p=0.04) and economic dissatisfaction (β=1.12 and p=0.026). The emotional exhaustion dimension of burnout was associated with age (β=-0.09 and p=0.007), economic dissatisfaction (β=3.15 and p<0.001), and having experienced workplace violence (β=2.85 and p<0.001). Low self-esteem was associated with age (β=0.06 and p=0.012) and salary dissatisfaction (β=-2.061 and p<0.001). In the clinical trial, the auriculotherapy group reduced perceived stress from 24.8±3.44 to 17.6±5.59, p<0.001. The comparison with the placebo group also showed statistical significance (p<0.001). The effect size of the therapy was considered large in relation to perceived stress (Cohen's d = 1.59). There were no significant effects in relation to salivary cortisol levels. Conclusion: Salivary cortisol levels did not have a significant correlation with perceived stress, which shows still conflicting results in the literature and the existing methodological diversity. Economic dissatisfaction was associated with perceived stress, burnout and its dimensions of emotional exhaustion and low professional self-esteem, which reflects the need for professional recognition through financial appreciation of these workers. Most workers have already suffered some type of violence in the workplace. In this context, institutional policies are urgently needed to protect these workers and the work environment. Auriculotherapy has proven effective in reducing perceived stress in primary healthcare workers and could be applied within the Brazilian Unified Health System (SUS) for stress management and quality of life at work.