Effort-reward imbalance at work is associated with hair cortisol concentrations: Prospective evidence from the Dresden Burnout Study.

•Work stress in terms of failed reciprocity is suggested as a health risk factor.•Change between effort reward imbalance corresponds with HPA axis alterations.•First indications suggest blunted cortisol levels after long-term ERI.•A long-term switch from hyper- to hypocortisolism is hypothesized.