Mats Samuelsson

Burnout and physical and mental health among Swedish healthcare workers

AIM This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors. BACKGROUND Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes. METHOD A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout). RESULTS Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group. CONCLUSION Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout.

Reflecting peer-support groups in the prevention of stress and burnout : randomized controlled trial

AIM This paper is a report of a study to test the effect of participating in a reflecting peer-support group on self-reported health, burnout and on perceived changes in work conditions. BACKGROUND Stress-related conditions are one of the most common causes for long-term sick-leave. There is limited evidence for the effectiveness of person-directed interventions aimed at reducing stress levels in healthcare workers. Prior research in the relationship between support and burnout show somewhat inconsistent results. METHOD A randomized controlled trial with peer-support groups as the intervention was conducted with 660 healthcare workers scoring above the 75th percentile on the exhaustion dimension of the Oldenburg Burnout Inventory. One hundred and fifty-one (22.9%) agreed to participate. The intervention started in 2002 with 51 participants (96.1% were women), 80 of whom constituted the control group. Potential differences in outcome measures 12 months after the intervention were compared using ancova, and data collected was completed in 2004. Qualitative content analyses were used to analyse reported experiences from group participation. RESULTS Statistically significant intervention effects were found for general health, perceived quantitative demands at work, participation and development opportunities at work and in support at work. Seven categories of experiences from participating were identified: talking to others in a similar situation, knowledge, sense of belonging, self-confidence, structure, relief of symptoms and behavioural change. CONCLUSION Peer-support groups using a problem-based method could be a useful and comparatively inexpensive tool in alleviating work-related stress and burnout.

Attitudes of psychiatric nursing personnel towards patients who have attempted suicide

The aim of this study was to examine the attitudes towards suicidal patients of a group of psychiatric nursing personnel (n=197) and to establish a baseline of attitudinal measures against which the effects of a subsequent educational programme can be assessed. A scale, known as the Understanding of Suicide Attempt Patient Scale (USP Scale) was developed for this purpose. The reliability of the scale was satisfactory, and its correlation with visual analogue scale (VAS) scores based on clinical vignettes suggests that it has validity. Women tended to be more sympathetic than men, and older personnel were more favourably disposed than the younger nurses. Differences between personnel working in different settings were found, which might be explained by differences in the frequency of contact with suicide‐prone patients, more frequent exposure being associated with more positive attitudes.

Treatment of suicidal and deliberate self-harming patients with borderline personality disorder using dialectical behavioral therapy : the patients' and the therapists' perceptions.

The aim was to investigate patients and therapists perception of receiving and giving dialectical behavioral therapy (DBT). Ten deliberate self-harm patients with borderline personality disorder and four DBT-therapists were interviewed. The interviews were analyzed with qualitative content analysis. The patients unanimously regard the DBT-therapy as life saving and something that has given them a bearable life situation. The patients and the therapists are concordant on the effective components of the therapy: the understanding, respect, and confirmation in combination with the cognitive and behavioral skills. The experienced effectiveness of DBT is contrasted by the patients pronouncedly negative experiences from psychiatric care before entering DBT.

Training program in suicide prevention for psychiatric nursing personnel enhance attitudes to attempted suicide patients

Attitudes of psychiatric nursing personnel towards patients who had attempted suicide were examined before and after a training program in psychiatric suicide prevention. The attitudinal changes were measured by a newly constructed scale, the understanding of suicide attempt patients scale (USP-scale), and responses to three brief clinical vignettes. General understanding and willingness to nurse, as measured by the USP-scale, increased significantly, and the suicide risk of patients described in case vignettes was estimated more accurately after the program. The results suggest that it may be possible to enhance attitudes to attempted suicide patients among psychiatric nursing personnel.

Sense of coherence and psychiatric morbidity in terms of anxiety and depression in patients with major depression before and after electric convulsive treatment

The specific aim of this study was to explore if the Sense of Coherence (SOC) Scale reflects and overlaps with standardized psychiatric assessments of depression and anxiety leading to the main hypothesis that the degree of depression decreases while the SOC scores remain stable. Fifteen patients with a diagnosis of major depression according to Axis I in DSM-IV and planned electric convulsive treatment (ECT) participated in the study. The clinician-rated instruments, Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Function (GAF), and the self-assessment instruments such as SOC and the Comprehensive Psychopathological Rating Scale-Self Rating Scale for Affective Syndromes (CPRS-S-A) were used before and after the treatment. The patients showed statistically significant improvements in clinician-rated depression (p < 0.001) and functional status (p < 0.001), and in self-rated anxiety (p = 0.001) and depression (p = 0.003). There was no significant improvement in SOC (p = 0.213). No significant correlations were found between the SOC scores and any of the measures except for GAF after treatment (r = 0.57, p = 0.039); the lower the SOC scores the greater was the functional dysfunction. In conclusion, the SOC Scale seems not to be a measure of psychopathology in terms of depression or anxiety merely.

Shame-proneness in attempted suicide patients

BackgroundIt has been suggested that shame may be an important feature in suicidal behaviors. The disposition to react with shame, “shame-proneness”, has previously not been investigated in groups of attempted suicide patients. We examined shame-proneness in two groups of attempted suicide patients, one group of non-suicidal patients and one group of healthy controls. We hypothesized that the attempted suicide patients would be more shame-prone than non-suicidal patients and healthy controls.MethodsThe Test of Self-Conscious Affect (TOSCA), which is the most used measure of shame-proneness, was completed by attempted suicide patients (n = 175: 105 women and 3 men with borderline personality disorder [BPD], 45 women and 22 men without BPD), non-suicidal psychiatric patients (n = 162), and healthy controls (n = 161). The participants were convenience samples, with patients from three clinical research projects and healthy controls from a fourth research project. The relationship between shame-proneness and attempted suicide was studied with group comparisons and multiple regressions. Men and women were analyzed separately.ResultsWomen were generally more shame-prone than men of the same participant group. Female suicide attempters with BPD were significantly more shame-prone than both female suicide attempters without BPD and female non-suicidal patients and controls. Male suicide attempters without BPD were significantly less shame-prone than non-suicidal male patients. In multiple regressions, shame-proneness was predicted by level of depression and BPD (but not by attempted suicide) in female patients, and level of depression and non-suicidality in male patients.ConclusionsContrary to our hypothesis and related previous research, there was no general relationship between shame-proneness and attempted suicide. Shame-proneness was differentially related to attempted suicide in different groups of suicide attempters, with significantly high shame-proneness among female suicide attempters with BPD and a negative relationship between shame-proneness and attempted suicide among male patients. More research on state and trait shame in different groups of suicidal individuals seems clinically relevant.

Does Dialectical Behavioural Therapy Reduce Treatment Costs for Patients with Borderline Personality Disorder. A Pilot Study

Objective: In order to assess costs — consequences of dialectal behavioural therapy (DBT) in suicidal women with borderline personality disorder (BPD), the present study takes advantage of pilot data collected during a training phase, in relation to a large scale randomised controlled trail (RCT). Method: Under a 18 month period, 22 suicidal women with BPD were treated with outpatient DBT, with focus on reducing parasuicidal behaviour. Outcome data collected retrospectively 12 months before therapy start, were compared to prospective data collected up to 18 months in thrapy. The cost — analysis included direct health care costs only. Results & Conclusions: The results suggest that DBT may have a positive impact on treatment costs, which decreased significantly during the last 12 months in a 18 month therapy period. The reduction of costs is due to decrease in the number of psychiatric inpatient days. The conclusions that can be drawn from the results are, however, limited as the study was not made in RCT conditions and indirect costs to society were not assessed.

High Early Suicide Risk in Elderly Patients After Self-Poisoning

This article reports the findings of a follow-up study of suicide mortality in elderly patients after an index episode of self-poisoning. A total of 222 consecutive patients (143 female) aged 65 years or older (mean age 76.5 years; range 65–100) presenting at the emergency department of the Karolinska University Hospital after self-poisoning during 1994–2000, were followed up for the cause of death by January 1, 2006. Survival analysis was applied to study suicide and death risk. Of the 15 suicides, 13 (87%) occurred during the first year after the index episode of self-poisoning (cumulative suicide risk 6.2%). The risk of dying of all causes during the first year was increased fourfold. Self-poisoning in both elderly men and women is associated with high early suicide risk.

Suicide Risk in Young Men and Women after Substance Intoxication

This study investigates suicide and overdoses in 1,119 consecutive patients (64% women), 15 to 34 years of age, presenting at the emergency department after self-poisoning from1994 to 2000 and followed regarding death to 2006. Regression and Kaplan-Meier survival analyses were performed for suicide and other causes of death. The patients had about a 60 times higher risk (SMR = 61.95) of death due to suicide and 26 times higher (SMR = 26.47) for all-cause mortality. Men had a nearly 2 times higher risk for suicide than women and half of the suicides occurred during the first 2 years after admission. Poisoning was the most common suicide method and early prevention of self-poisoning is crucial to reducing future deaths.