Gunnar Ahlborg

Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ)

BackgroundBurnout is a mental condition defined as a result of continuous and long-term stress exposure, particularly related to psychosocial factors at work. This paper seeks to examine the psychometric properties of the Shirom-Melamed Burnout Questionnaire (SMBQ) for validation of use in a clinical setting.MethodsData from both a clinical (319) and general population (319) samples of health care and social insurance workers were included in the study. Data were analysed using both classical and modern test theory approaches, including Confirmatory Factor Analysis (CFA) and Rasch analysis.ResultsOf the 638 people recruited into the study 416 (65%) persons were working full or part time. Data from the SMBQ failed a CFA, and initially failed to satisfy Rasch model expectations. After the removal of 4 of the original items measuring tension, and accommodating local dependency in the data, model expectations were met. As such, the total score from the revised scale is a sufficient statistic for ascertaining burnout and an interval scale transformation is available. The scale as a whole was perfectly targeted to the joint sample. A cut point of 4.4 for severe burnout was chosen at the intersection of the distributions of the clinical and general population.ConclusionA revised 18 item version of the SMBQ satisfies modern measurement standards. Using its cut point it offers the opportunity to identify potential clinical cases of burnout.

A prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers

OBJECTIVE This study analyzes longitudinal associations between self-reported leisure-time physical activity (PA) and perceived stress, burnout and symptoms of depression and anxiety. METHOD Cohort data collected in 2004 and 2006 from health care and social insurance workers in western Sweden (2694 women; 420 men) were analyzed. Cox regression was conducted to examine associations between baseline levels of PA and mental health (MH) problems 2 years later. RESULTS Cross-sectional analysis show that individuals reporting either light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) were less likely to report high levels of perceived stress, burnout and symptoms of depression and anxiety, as compared to individuals reporting a sedentary lifestyle. The risks of symptoms of depression, burnout, and high stress levels at follow-up were significantly lower for those reporting LPA or MVPA at baseline. For symptoms of anxiety, an activity level corresponding to MVPA was required. CONCLUSION Participation in PA appeared to lower the risk of developing MH problems two years later. This relationship involved LPA and MVPA regarding feelings of depression, burnout and perceived stress, and exclusively MVPA regarding feelings of anxiety. The implications of these findings are important, as preventive strategies for psychosocial stress and mental health problems are needed.

The relationships of change in physical activity with change in depression, anxiety, and burnout: a longitudinal study of Swedish healthcare workers.

OBJECTIVE The purpose of the present study was to examine whether intraindividual changes in physical activity were correlated with intraindividual changes in mental health (depression, anxiety, and burnout) across four measurement time-points over 6 years, both from between-person and within-person perspectives. METHODS Health care workers (N = 3717; mean age = 46.9; SD = 10.0) were the target population in this study, which is part of a larger longitudinal survey that included questionnaires on physical activity levels and mental health (depression, anxiety, and burnout) at four time points across 6 years (2004-2010). Physical activity was assessed with an adapted version of the widely used 1-item, 4-level Saltin Grimby Physical Activity Level Scale (SGPALS). Depression, anxiety, and burnout were assessed using the Hospital Anxiety and Depression (HAD) scale and the Shirom-Melamed Burnout Questionnaire (SMBQ). Bivariate latent growth curve models were used to analyze the associations of change between physical activity and mental health. RESULTS Baseline levels of physical activity were moderately associated with baseline levels of mental health (rs = -.27 to -.40, ps < .01). Changes in physical activity were moderately to strongly associated (rs = -.57 to -.79, ps <. 01) with change in mental health at the between-person (correlated change) level and significantly, but weakly (rs = -.08 to -.14, ps <.01), associated with change at the within-person (coupled change) level of analysis. CONCLUSIONS Changes in physical activity were associated with, and traveled together with, changes in depression, anxiety, and burnout across time. Changes in physical activity, and not only current or previous levels of activity, may be important to consider in preventive work linked to mental health within this population.

Course of mental symptoms in patients with stress-related exhaustion: does sex or age make a difference?

BackgroundLong-term sick leave due to mental health problems, especially among women, is a substantial problem in many countries, and a major reason for this is thought to be psychosocial stress. The recovery period of different patient groups with stress-related mental health problems can differ considerably. We have studied the course of mental health symptoms during 18 months of multimodal treatment in relation to sex and age in a group of patients with stress-related exhaustion.MethodsThe study group includes 232 patients (68% women) referred to a stress clinic and who fulfilled the criteria for Exhaustion Disorder (ED). The majority also fulfilled diagnostic criteria for depression and/or anxiety; this was similar among women and men. Symptoms were assessed at baseline, three, six, 12 and 18 months by the Shirom-Melamed Burnout Questionnaire (SMBQ) and the Hospital Anxiety and Depression scale (HAD). A total SMBQ mean score of ≥ 4 was used to indicate clinical burnout, which correlates well with the clinical diagnosis of ED.ResultsThere were no statistically significant differences between women and men or between young and old patients in the self-reported symptoms at baseline. The proportion that had high burnout scores decreased over time, but one-third still had symptoms of clinical burnout after 18 months. Symptoms indicating probable depression or anxiety (present in 34% and 65% of the patients at baseline, respectively) declined more rapidly, in most cases within the first three months, and were present only in one out of 10 after 18 months. The course of illness was not related to sex or age. The duration of symptoms before seeking health care, but not the level of education or co-morbid depression, was a predictor of recovery from symptoms of burnout after 18 months.ConclusionsThe course of mental illness in patients seeking specialist care for stress-related exhaustion was not related to sex or age. The burden of mental symptoms is high and similar for men and women, and at the 18 month follow-up, one-third of the study group still showed symptoms of burnout. A long duration of symptoms before consultation was associated with a prolonged time of recovery, which underlines the importance of early detection of stress-related symptoms.

Construct validity of the Psychological General Well Being Index (PGWBI) in a sample of patients undergoing treatment for stress-related exhaustion: a Rasch analysis.

PurposeThe Psychological General Well Being Index (PGWBI) is a widely used scale across many conditions. Over time issues have been raised about the dimensional structure of the scale, and it has not yet been subjected to scrutiny by modern Psychometric approaches. The current study thus evaluates the PGWBI with Rasch- and factor analysis.MethodsConsecutive patients recruited to a tertiary stress clinic were administered the PGBWI as part of routine clinical assessment at baseline and three months. Data from the scale was subjected to Factor Analyses and to Rasch analysis. In both cases adjustments for local independence violations were allowed.Results179 patients were recruited, with a mean age of 43 years, and of whom 70% were female. An initial Confirmatory Factor Analysis (CFA) with baseline data failed, but the modification indices also indicated considerable levels of local dependency requiring errors to be correlated. An EFA highlighted positive and negative effect domains. Rasch analysis confirmed that fit of data to the model was influenced by local dependency, and that in practice if the items from the six underlying domains were treated as six ‘super’ items, the scale was shown to measure one dominant construct of well being. An interval scale transformation was therefore possible. A significant improvement in well-being was observed over a three month period.ConclusionThe PGWBI scale has satisfactory internal construct validity when tested with modern psychometric techniques, using data obtained from patients treated for stress-related exhaustion. The instrument has qualities that make it suitable also for monitoring well-being during interventions for stress-related exhaustion/clinical burnout.

Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care - an observational study

BackgroundProlonged stress may lead to mental illness, but the prevalence of stress in a working age population seeking primary health care for whatever reason, is unknown. This paper seeks to examine to what extent this group perceives stress, as well as symptoms of burnout/exhaustion, depression and anxiety.MethodsIn 2009, 587 primary health care patients aged 18–65 years (377 women, 210 men), with an appointment with a primary health care physician, participated in the study.A screening questionnaire with questions about age, gender, marital status, employment, reason for medical consultation, and the QPS Nordic screening question about stress was distributed:” Stress is defined as a condition where you feel tense, restless, anxious or worried or cannot sleep at night because you think of problems all the time. Do you feel that kind of stress these days? There were five possible answers; “not at all” and ”only a little” (level 1),“to some extent” (level 2),“rather much” and “very much” (level 3). In a second step, symptoms of burnout/exhaustion (Shirom-Melamed Burnout Questionnaire and the Self-rated Exhaustion Disorder instrument) and anxiety/depression (Hospital Depression and Anxiety scale) were assessed among those with higher levels of perceived stress.Results345 (59%) of the study patients indicated stress levels 2 or 3 (237 women and 108 men). Women more often indicated increased levels of stress than men. Two thirds of the participants expressing stress levels 2–3 indicated a high degree of burnout, and approximately half of them indicated Exhaustion Disorder (ED). Among highly stressed patients (level 3), 33% reported symptoms indicating possible depression and 64% possible anxiety.ConclusionMore than half of this working age population perceived more than a little stress, as defined, women to a greater extent than men. Symptoms of burnout and exhaustion were common. A high level of perceived stress was often accompanied by symptoms of depression and/or anxiety.

Perceptions of employment, domestic work, and leisure as predictors of health among women and men

Background: The aims of this longitudinal study were to analyse whether perceptions of employment, domestic work and leisure were predictors of health among women and men, and whether the predictors revealed were the same for both genders. Method: A random sample comprising of 2,683 employees in public health care and social insurance offices (2286 women and 397 men) in western Sweden, answered a survey twice, within a two‐year interval. Results: The results showed that perceptions of low stress, good balance and high meaning in the occupations of everyday life predicted both good self‐rated health and balanced work attendance among women but not among men. For men, the most important predictor of both good self‐rated health and balanced work attendance was low work place stress. Conclusion: The men seemed to have a better balance between employment, domestic work, and leisure than the women. Furthermore, the results indicated that leisure might be a more pronounced health protector for women than for men.

Trichloroethylene exposure in vapour degreasing and the urinary excretion of N-acetyl-β-D-glucosaminidase

In order to elucidate the potential nephrotoxicity of low level occupational exposure to trichloroethylene (TRI), urine analysis of the tubular enzyme N-acetyl-β-dglucosaminidase (U-NAG) was included in a cross-sectional study of metal degreasers in central Sweden. Eightysix percent of 8-h TRI in air measurements were well below 50 mg/m3. Normal levels of NAG were found in morning urine samples from 29 workers compared to a historical reference group. A weak positive correlation (r = 0.48;P <0.01) was observed between U-NAG activity and the concentration of the TRI metabolite trichloroacetic acid in urine but not with other estimates of recent or long-term exposure. In conclusion, TRI does not seem to be nephrotoxic at low exposure levels.

The level of leisure time physical activity is associated with work ability-a cross sectional and prospective study of health care workers.

BackgroundWith increasing age, physical capacity decreases, while the need and time for recovery increases. At the same time, the demands of work usually do not change with age. In the near future, an aging and physically changing workforce risks reduced work ability. Therefore, the impact of different factors, such as physical activity, on work ability is of interest. Thus, the aim of this study was to evaluate the association between physical activity and work ability using both cross sectional and prospective analyses.MethodsThis study was based on an extensive questionnaire survey. The number of participants included in the analysis at baseline in 2004 was 2.783, of whom 2.597 were also included in the follow-up in 2006. The primary outcome measure was the Work Ability Index (WAI), and the level of physical activity was measured using a single-item question. In the cross-sectional analysis we calculated the level of physical activity and the prevalence of poor or moderate work ability as reported by the participants. In the prospective analysis we calculated different levels of physical activity and the prevalence of positive changes in WAI-category from baseline to follow-up. In both the cross sectional and the prospective analyses the prevalence ratio was calculated using Generalized Linear Models.ResultsThe cross-sectional analysis showed that with an increased level of physical activity, the reporting of poor or moderate work ability decreased. In the prospective analysis, participants reporting a higher level of physical activity were more likely to have made an improvement in WAI from 2004 to 2006.ConclusionsThe level of physical activity seems to be related to work ability. Assessment of physical activity may also be useful as a predictive tool, potentially making it possible to prevent poor work ability and improve future work ability. For employers, the main implications of this study are the importance of promoting and facilitating the employees’ engagement in physical activity, and the importance of the employees’ maintaining a physically active lifestyle.

Healthcare workers' participation in a healthy-lifestyle-promotion project in western Sweden.

BackgroundHealthcare professionals play a central role in health promotion and lifestyle information towards patients as well as towards the general population, and it has been shown that own lifestyle habits can influence attitudes and counselling practice towards patients. The purpose of this study was to explore the participation of healthcare workers (HCWs) in a worksite health promotion (WHP) programme. We also aimed to find out whether HCWs with poorer lifestyle-related health engage in health-promotion activities to a larger extent than employees reporting healthier lifestyles.MethodA biennial questionnaire survey was used in this study, and it was originally posted to employees in the public healthcare sector in western Sweden, one year before the onset of the WHP programme. The response rate was 61% (n = 3207). In the four-year follow-up, a question regarding participation in a three-year-long WHP programme was included, and those responding to this question were included in the final analysis (n = 1859). The WHP programme used a broad all-inclusive approach, relying on the individuals decision to participate in activities related to four different themes: physical activity, nutrition, sleep, and happiness/enjoyment.ResultsThe participation rate was around 21%, the most popular theme being physical activity. Indicators of lifestyle-related health/behaviour for each theme were used, and regression analysis showed that individuals who were sedentary prior to the programme were less likely to participate in the programmes physical activities than the more active individuals. Participation in the other three themes was not significantly predicted by the indicators of the lifestyle-related health, (body mass index, sleep disturbances, or depressive mood).ConclusionOur results indicate that HCWs are not more prone to participate in WHP programmes compared to what has been reported for other working populations, and despite a supposedly good knowledge of health-related issues, HCWs reporting relatively unfavourable lifestyles are not more motivated to participate. As HCWs are key actors in promoting healthy lifestyles to other groups (such as patients), it is of utmost importance to find strategies to engage this professional group in activities that promote their own health.