Endocannabinoids, endocannabinoid-like compounds and cortisone in head hair of health care workers as markers of stress and resilience during the early COVID-19 pandemic

The pandemic caused by SARS-CoV-2 impacted health systems globally, creating increased workload and mental stress upon health care workers (HCW). During the first pandemic wave (March to May 2020) in southern Germany, we investigated the impact of stress and the resilience to stress in HCW by measuring changes in hair concentrations of endocannabinoids, endocannabinoid-like compounds and cortisone. HCW (n = 178) recruited from multiple occupation and worksites in the LMU-University-Hospital in Munich were interviewed at four interval visits to evaluate mental stress associated with the COVID-19 pandemic. A strand of hair of up to 6 cm in length was sampled once in May 2020, which enabled retrospective individual stress hormone quantifications during that aforementioned time period. Perceived anxiety and impact on mental health were demonstrated to be higher at the beginning of the COVID-19 pandemic and decreased significantly thereafter. Resilience was stable over time, but noted to be lower in women than in men. The concentrations of the endocannabinoid anandamide (AEA) and the structural congeners N-palmitoylethanolamide (PEA), N-oleoylethanolamide (OEA) and N-stearoylethanolamide (SEA) were noted to have decreased significantly over the course of the pandemic. In contrast, the endocannabinoid 2-arachidonoylglycerol (2-AG) levels increased significantly and were found to be higher in nurses, laboratory staff and hospital administration than in physicians. PEA was significantly higher in subjects with a higher resilience but lower in subjects with anxiety. SEA was also noted to be reduced in subjects with anxiety. Nurses had significantly higher cortisone levels than physicians, while female subjects had significant lower cortisone levels than males. Hair samples provided temporal and measurable objective psychophysiological-hormonal information. The hair endocannabinoids/endocannabinoid-like compounds and cortisone correlated to each other and to professions, age and sex quite differentially, relative to specific periods of the COVID-19 pandemic.

1. Please indicate how likely you think it is that you will be infected with COVID-19 0 1 2 3 2. How afraid have you been for the last 14 days for your health because of the COVID-19 pandemic?0 1 2 3 3. How hopeful have you been the last 14 days that the COVID-19 pandemic is soon over?0 1 2 3 4.Because of the COVID-19 pandemic I was very stressed over the past 14 days?0 1 2 3

II. Adhering the rules:
1.Over the last 14 days, I obeyed the reduction of social contacts as recommended?0 1 2 3 2.Over the last 14 days, I obeyed the hygiene measures as recommended?0 1 2 3 3.Over the last 14 days, I obeyed the curfew?0 1 2 3

III. Impact of the psychological health:
Over the last 14 days, I suffered from problems, such as difficulty falling asleep, difficulty sleeping through the night or early morning awakening 0 1 2 3 Over the last 14 days, I suffered from unforeseeable severe anxiety attacks (panic) with physical symptoms (e.g.palpitations, chest pain, dizziness).0 1 2 3 Over the last 14 days, I suffered from upsetting dreams that replay part of the experience of the COVID-19 pandemic or are clearly related to it 0 1 2 3 Over the last 14 days, I suffered from the excessive urge to wash and/or disinfect my hands again and again so that I do not pass on germs or contamination to other people.Questionnaire with question-set I-IV for Visit 2, 3 and 4; for Visit 1 only the question-sets I-III were applied.Question-set I evaluates anxiety.The question 1 in question-set was not eligible as it asked for the momentary state, while all other questions refer to the situation 2 weeks ago and the hair data, accordingly.Question-set II is about adhering to the new COVID-19 rules.Question-set III is about the impact on the psychological health and question-set IV is the brief resilience scale.Model of question-set III (impact of the psychological health): the impact was significantly higher for females than males and in the age group 50-59, but significantly lower in the emergency ward and endoscopy personnel.There are also higher 2-AG-levels with subjects with COVID-19 contact.Regarding PEA, significantly higher PEA-levels in subjects with higher resilience was seen, while lower PEA-concentrations were quantified in stressed subjects.
tend to take a long time to get over set-backs in my Models of question-set II in dependency of the occupation (column 1), ward (column 2) or COVID-19 ward (column 3).Model of question-set II (adhering the new COVID-19 rules): adherence to the new COVID-19 rules was significantly lower in nurses than in physicians and significant higher in the age group 60-69 Models of question-set III in dependency of the occupation (column 1), ward (column 2) or COVID-19 ward (column 3).

Linear Model of Cortisone at Visit 1 with Factorized Stress Score Cortisone
Mixed Model without hair related factors over the whole time period A significant higher concentration of 2-AG in nurses and administration/laboratory workers was quantified.The decrease of PEA, OEA, SEA and AEA and an increase of 2-AG over the time-period was significant.

Linear Model of Cortisone at Visit 3 with Factorized Stress Score Cortisone
Linear Model of cortisone at Visit 1 (6a) and Visit 3 (6b) with Factorized Stress Score Supplement 6: Linear Model of cortisone at Visit 1 (6a) and Visit 3 (6b) with Factorized Stress Score At both visits, nurses had higher cortisone levels than physicians.At Visit 3 significant higher cortisone level in the age group 40-49 than in the age group 20-29 and significant lower cortisone level in female were observed.