Relationship between depression anxiety stress scale (DASS) and urinary hydroxyproline and proline concentrations in hospital workers.

Most people experience depression, anxiety, and stress(DAS) in their lifetime. There have been numerousstudies on pathophysiological effects like hormonalchange that were caused by DAS. Activation of nervoussystem caused by psychological stimuli like DASpromotes the excretion of catecholamine such asepinephrine and norepinephrine [1]; and steroidhormones such as cortisol [2-3] in the adrenal gland.However, if mental stimuli disappear, hormones returnto normal range values quickly. Therefore, stresshormones are not suitable biomarkers for chronic stress.There have been many studies on association betweenstress and reactive oxygen species (ROS) as apathophysiological change. Anxiety increased secretionof plasma norepinephrine as a stress hormone, which inturn increased ROS formation by mononuclear cells [4].In addition, high anxiety level significantly increased thegeneration of ROS in the peripheral blood lymhpocytes,granulocytes and monocytes [5]. In recent study, elevatedROS caused by DAS augmented concentration of 8-hydroxy-2’-deoxyguanosine, a biomarker of aging [6]. Depression has been likened to a state of “acceleratedaging” and depressed individuals have a higherincidence of aging diseases [7]. Besides, ROS can causeboth a decrease in fibrillar collagen synthesis and anincrease in matrix metalloproteinase (MMP) activities[8]. Moreover, in recent years, it has become clear thatROS serves an important role as signaling moleculesthat regulate many genes, including MMPs [9-12].hydroxyproline (Hyp) and proline (Pro) are especiallyabundant in collagen and give rigidity to collagenmolecules [13]. It is well known that Hyp and Pro,highly correlated with collagen degradation, is excretedinto urine [14].Several published research papers found that DAS isconcerned with collagen metabolism causing hormonal