Giorgio Grossi

Physiological correlates of burnout among women

OBJECTIVES The purpose of this study was to investigate the immune, endocrine, and metabolic correlates of burnout among women. METHODS Forty-three participants with high and 20 participants with low scores for the Shirom-Melamed Burnout Questionnaire were compared in terms of subjective symptoms, job strain, social support, plasma levels of prolactin, tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta), C-reactive protein (CRP), neopterin, serum levels of dehydroepiandrosterone sulphate (DHEAs), progesterone, estradiol, cortisol, and glycated hemoglobin (HbA1C) in whole blood. RESULTS Besides reporting more job strain, less social support at work, and higher levels of anxiety, depression, vital exhaustion (VE), and sleep impairments, participants with high burnout manifested higher levels of TNF-alpha and HbA1C, independent of confounders including depression. CONCLUSIONS Among women, burnout seems to involve enhanced inflammatory responses and oxidative stress.

Psychosocial correlates of long-term sick-leave among patients with musculoskeletal pain

We studied the associations between psychosocial variables and sick-leave among patients with musculoskeletal pain. Patients (n = 586) seeking care to relieve their pain at health care and physiotherapy centres, completed a questionnaire about such variables as clinical characteristics (e.g. pain intensity), psychological well-being (e.g. burnout, depression) and coping strategies. The results show that the patients who had been on sick-leave for >30 days (n = 217), were significantly more often divorced, immigrants, blue-collar workers and less educated than the rest of the sample. Compared with the rest of the patients, they rated their pain as significantly more severe, frequent, complex and functionally impairing. They reported using more pain medication and tranquillizers, and having undergone more somatic treatments. These patients also showed higher scores on job strain, more symptoms of burnout, anxiety/depression and posttraumatic stress reactions, and poorer coping capacity. Logistic regression analyses revealed that an index related to perceived disability was a major predictor of sick-leave within the group. After controlling for possible confounders, multivariate regression analyses showed that the strongest predictors of the disability index were symptoms of burnout and posttraumatic stress reactions. The results confirm that emotional distress, coping style and perceived disability are associated with sick-leave, after controlling for pain parameters and sociodemographic variables. The high levels of emotional distress and the poor coping capacity reported by the patients with a long history of absence due to illness suggest that cognitive behavioural interventions ought to be integrated in the treatment of musculoskeletal pain.

Burnout among women: associations with demographic/socio-economic, work, life-style and health factors

SummaryThis study examined the occurrence of low/high burnout among women and the demographic/socio-economic, work, life-style, and health “correlates” of high burnout. The sample consisted of 6.000 randomly selected women from the general population, of which 3.591 participated. The design was cross-sectional. The univariate analyses showed that about 21% of the women had high burnout, and compared to those with low burnout, they were more often younger, divorced, blue-collar workers, lower educated, foreigners, on unemployment/retirement/sick-leave, financially strained, used more medication and cigarettes, reported higher work demands and lower control/social support at work, more somatic problems (e.g. pain) and depression. The regression analysis showed that only age, sick-leave, financial strain, medication, work demands, depression and somatic ailments were independently associated with high burnout. Thus, women with high burnout were apparently faring poorly financially, emotionally and physically. Considering our findings, interventions to alleviate their problems may be necessary. We may have provided new insights into women’s burnout experiences, but longitudinal studies are warranted to firmly identify “determinants” of burnout.

Stress symptoms among adolescents: the role of subjective psychosocial conditions, lifestyle, and self-esteem.

Stress-related problems are increasing among Swedish adolescents, especially among females. The aims of this study were to survey the incidence of stress symptoms among 16-year-olds, to investigate the related gender differences, and to understand the factors that may contribute to stress symptoms. The study is questionnaire based, and the sample included 304 first-year high school students from two comparable schools. More than 30% of the high school students reported serious stress symptoms. Almost every second girl and every fifth boy reported that they felt stressed to a high degree. 8.2% were found to have severe stress symptoms, which would be considered a sign of chronic stress in adults. Besides the perception of high demands, low levels of global self-esteem, sleep disturbances, and poor social support played a crucial role in the prediction of stress symptoms. The findings highlight the need to develop and implement adequate stress prevention measures for adolescents.

Associations between financial strain and the diurnal salivary cortisol secretion of long-term unemployed individuals

Objective: The study investigated the associations between self-rated financial strain and overall diurnal salivary cortisol levels, as well as secretory patterns among long-term unemployed individuals.Methods: Psychosocial and life-style variables were assessed by means of questionnaires among 85 participants (mean age 42±9 years; 56% females). Salivary cortisol was sampled on four occasions during a 24-hour period and data was analysed separately for men and women.Results: Among females, high financial strain was related to higher overall cortisol levels, and to elevated levels in the evening. These associations did not reach significance among men. Multivariate analyses showed that evening levels of cortisol were positively associated with financial strain, but largely unrelated to life-style variables and psychological distress.Conclusions: The results suggest that high financial strain influences the diurnal cortisol secretion of unemployed individuals in terms of elevated cortisol levels in the evening. The mediating mechanisms are in need of further investigation.

Psychophysiological correlates of organizational change and threat of unemployment among police inspectors

The study examined psychosocial work-conditions and physiological reactions among thirty-six police inspectors (median age 45 years, 81% males) who participated in a reorganization. At this time, subjects were threatened by unemployment and had to reapply for their positions in a new police district. Data were collected during the reorganization and at three years follow-up, by means of questionnaires (Stress Profile) and blood samples. The blood samples were used to determine serum levels of gammaglutamyltransferase (GGT), glucose, lipids, prolactin, testosterone and cortisol. The results show a positive association betweenworry about employment and symptoms ofburnout during the reorganization. Mean scores for the Stress Profile sub-scalesworry about employment (p<.01) andwork-load (p<.05) decreased between measurements but an impairment inrelationships with management was noticed (p<.05). No significant changes were observed in terms of self-rated health complaints. Significant decreases in total cholesterol (p<.0001), LDL-cholesterol (p<.0001), LDL/HDL-ratio (p<.01), prolactin (p<.0001), as well as increases in testosterone (p<.01) and cortisol (p<.001) were observed for the whole sample. Glucose decreased with marginal significance (<.07). Controlling for age and gender, multivariate regression analyses showed that subjects who reported deteriorations insatisfaction with work manifested the most modest decreases in prolactin (p<.05). Also, the decrease in glucose was larger for subjects who experienced impairments in,satisfaction with work (p<.05), information (p<.05), task-oriented leadership, (p<.05), andrespect and dignity (p<.05). Subjects who perceived deteriorations in theethical and moral standards of the organization increased their cortisol level to a lower degree than their counterparts (p<.05). Favorable changes in employment status and psychosocial work environment seem to be related to improved physiological functioning.

Stress-related exhaustion disorder – clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout

The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.

Experience of Musculoskeletal Pain Comparison of Immigrant and Swedish Patients

We explored differences regarding several psychosocial constructs (e.g. coping with pain) between immigrant (n = 140) and Swedish (n = 446) patients seeking treatment for pain at health and physiotherapy centres. A cross-sectional study design was used. The findings showed that, compared with Swedes, immigrants more often relied on benefits for their support and were more concerned with their financial situation. They also had longer periods of sick-leave. In addition, immigrants felt more disabled, reported more job strain and relied more on passive coping strategies for pain. Finally, they were more emotionally distressed, as they showed more symptoms of burnout, anxiety, depression and post-traumatic stress reactions, and lower self-confidence. Multivariate analyses performed separately for immigrant and Swedish patients showed differential patterns of associations between sociodemographic variables, financial strain, emotional distress, perceived disability, passive coping and job strain. We conclude that immigrant patients live under more strained psychosocial conditions and experience a deeper impact of pain than do their Swedish counterparts.

Psychological Correlates of Salivary Cortisol Secretion among Unemployed Men and Women

The aim of the present study was to examine the association between psychological factors and salivary cortisol secretion (baseline level, reactivity to laboratory stressors) in a sample of 59 long-term unemployed men and women (mean age 42±10 years). Subjects were divided into four groups according to their basal levels of salivary cortisol as well as their reactivity to experimental stress (stress level minus baseline): (1) low base/low reactivity; (2) high base/low reactivity; (3) low base/high reactivity; and (4) high base/high reactivity. The low base/low reactivity group was characterized by significantly higher somatic anxiety, muscular tension, irritability, and depression (Beck’s Depression Inventory) and lower perceived control (mastery) than the other groups. The low base/high reactivity group was also characterized by depression and low perceived control. The high base/low reactivity group was higher in terms of monotony avoidance, Type-A behavior (JAS) and mastery, but lower in depression. The results indicate that (1) individuals with personality traits reflecting emotional distress are more vulnerable to exhaustion of the HPA-axis following long-term unemployment and (2) monotony avoidance and Type-A behavior, at least temporarily, seem to exert a beneficial influence on mental well-being among long-term unemployed individuals.

Gender differences in coping with musculoskeletal pain

Gender differences in coping with musculoskeletal pain were cross-sectionally investigated, using questionnaires (Coping Strategies Questionnaire), in 446 Swedish patients (mean age 46 years, 72% women) seeking care for their ailments. Compared to male patients, women reported more disability, a larger consumption of analgesics, more work strain, higher levels of posttraumatic stress reactions, a lower self-esteem, and higher scores for the Coping Strategies Questionnaire indexes: diverting attention, praying/hoping, catastrophizing, increased behavioural activity, and pain behaviours. All gender differencesin coping were ruled out in multivariate analyses, except for the association between the interaction term Gender x Posttraumatic Stress Reactions and Catastrophizing. Among women, catastrophizing was positively associated with posttraumatic stress reactions, perceived disability, and the number of previous treatments for pain.Nosuch associations were found among men. Women’s poorer capacity to cope with musculoskeletal pain is related to higher level of emotional distress, greater disability, and a history of treatments for pain.