Ulla Peterson

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.

Psychometric properties of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPSNordic) : confirmatory factor analysis and prediction of certified long-term sickness absence

Psychometric properties, particularly predictive validity, of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPS(Nordic)) were assessed. The analysis is confined to the scales in the QPS(Nordic,) and 24 of the 26 scales are included. A large group of Swedish county council employees (n= 3,976; response rate = 65%) participated in a study and were given the QPS(Nordic). Register data for long-term sick leave (>90 days), with diagnosis, were used for predictive analysis. The following main results were obtained: Reliability was generally satisfactory, confirmatory factor analysis indicated good fit, concurrent validity was good, some less often investigated organizational variables predicted sickness absence, and scales were differentially associated with absence due to psychiatric and musculoskeletal disorders. In conclusion, the psychometric testing of the QPS(Nordic) so far suggests that it is a good instrument for assessing health-related factors at work.

Work characteristics and sickness absence in burnout and nonburnout groups: a study of Swedish health care workers

Ulla PetersonKarolinska InstituteEvangelia DemeroutiUtrecht University and Institute Psychology & HealthGunnar Bergstro ¨mKarolinska InstituteMarie Asberg and Ake NygrenDanderyd HospitalTheaimofthisstudywastosearchforconstellationsofworkcharacteristicsthatdiscriminate people who experience burnout from those who do not, and alsofrom those who score high in exhaustion but not in disengagement, and viceversa. The study is based on data from 3,719 employees in a County Council inSweden. Discriminant analysis revealed that four burnout categories (nonburn-out, disengaged, exhausted, and burnout), related in different ways to self-reported work characteristics. The proportions of respondents with overtime,sickness absence, and sickness presence were higher in the burnout and theexhausted groups compared with the nonburnout group. The most commonprofessions in the burnout group were, unexpectedly, dental nurses, secretaries,and service staff.

Novel biochemical markers of psychosocial stress in women

Background Prolonged psychosocial stress is a condition assessed through self-reports. Here we aimed to identify biochemical markers for screening and early intervention in women. Methods Plasma concentrations of interleukin (IL) 1-α, IL1-β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-γ (INF-γ), tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), thyroid stimulating hormone (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin, and testosterone were measured in: 195 women on long-term sick-leave for a stress-related affective disorder, 45 women at risk for professional burnout, and 84 healthy women. Results We found significantly increased levels of MCP-1, VEGF and EGF in women exposed to prolonged psychosocial stress. Statistical analysis indicates that they independently associate with a significant risk for being classified as ill. Conclusions MCP-1, EGF, and VEGF are potential markers for screening and early intervention in women under prolonged psychosocial stress.

Burnout levels and self-rated health prospectively predict future long-term sickness absence: a study among female health professionals

Objective: This study investigates the predictive validity of the Oldenburg Burnout Inventory (OLBI), and of three health indicators (depression, anxiety, and self-rated health), for long-term sickness absence (LTSA). Methods: Questionnaires were sent to all employees in a Swedish County Council (N = 6118), and the overall response rate was 65% (N = 3976). As 82% were women, only women were included in the study. Certified LTSA data were collected. Results: Logistic regression analyses showed that high scores on exhaustion, depression, and poor self-rated health increased the risk of future LTSA (≥90 days). Support for the proposed two-factorial structure of the OLBI was found, including the dimensions of exhaustion and disengagement from work. Conclusion: Using burnout measures might be useful to identify those at risk for LTSA, and to enable preventive solutions in organizations.

Construction and evaluation of a self rating scale for stress‐induced Exhaustion Disorder, the Karolinska Exhaustion Disorder Scale

Prolonged stress (≥ six months) may cause a condition which has been named exhaustion disorder (ED) with ICD-10 code F43.8. ED is characterised by exhaustion, cognitive problems, poor sleep and reduced tolerance to further stress. ED can cause long term disability and depressive symptoms may develop. The aim was to construct and evaluate a self-rating scale, the Karolinska Exhaustion Disorder Scale (KEDS), for the assessment of ED symptoms. A second aim was to examine the relationship between self-rated symptoms of ED, depression, and anxiety using KEDS and the Hospital Anxiety and Depression Scale (HAD). Items were selected based on their correspondence to criteria for ED as formulated by the Swedish National Board of Health and Welfare (NBHW), with seven response alternatives in a Likert-format. Self-ratings performed by 317 clinically assessed participants were used to analyse the scale’s psychometric properties. KEDS consists of nine items with a scale range of 0–54. Receiver operating characteristics analysis demonstrated that a cut-off score of 19 was accompanied by high sensitivity and specificity (each above 95%) in the discrimination between healthy subjects and patients with ED. Reliability was satisfactory and confirmatory factor analysis revealed that ED, depression and anxiety are best regarded as different phenomena. KEDS may be a useful tool in the assessment of symptoms of Exhaustion Disorder in clinical as well as research settings. There is evidence that the symptom clusters of ED, anxiety and depression, respectively, reflect three different underlying dimensions.

Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden.

Objectives: The objective of this study was to examine the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex among older people (65–80 years) and to investigate to what extent those who report depressive symptoms had visited a health care professional and/or used antidepressant medication. Method: A cross-sectional study was conducted in a Swedish sample randomized from the total population in the age group 65–80 years (n = 6659). Chi square tests and logistic regression analyses were conducted. Results: The data showed that 9.8% (n = 653) reported depressive symptoms and 27.5% reported feelings of loneliness. More men than women reported depressive symptoms, and the largest proportion was found among men in the age group 75–80 years. An association between the odds to have a depressive disorder and loneliness was found which, however, decreased with increasing age. Of those with depressive symptoms a low proportion had visited a psychologist (2.9%) or a welfare officer (4.2%), and one in four reported that they use antidepressant medication. Of those who reported depressive symptoms, 29% considered that they had needed medical care during the last three months but had refrained from seeking, and the most common reason for that was negative experience from previous visits. Conclusion: Contrary to findings in most of the studies, depressive symptoms were not more prevalent among women. The result highlights the importance of detecting depressive symptoms and loneliness in older people and to offer adequate treatment in order to increase their well-being.

Can scales assessing psychological and social factors at work be used across different occupations

AIM To assess the psychometric properties of a comprehensive tool for assessing psychosocial work characteristics(the QPSNordic), focusing on measurement invariance (MI) across occupations. METHODS QPSNordic consists of 26 scales covering task, individual, and organizational aspects of work. Multiple group confirmatory factor analyses were performed in order to elucidate MI across a variety of occupational groups. SUBJECTS Private sector employees and health care workers from the public sector participated. Equal size (n = 500) groups from six different occupations were drawn and entered in multiple group confirmatory factor analyses for assessment of MI. RESULTS Nine of the 24 analysed scales functioned well across all occupational groups and could thus be used for valid comparisons across professions. The majority of the remaining scales showed MI at least across some groups. CONCLUSION With some exceptions, the QPSNordic has good psychometric properties. Scales measuring organizational aspects of work could also be used across professional groups, enabling valid comparisons between differing workplaces and occupations.

Group discussions with structured reminiscence and a problem‐based method as an intervention to prevent depressive symptoms in older people

AIMS AND OBJECTIVES To evaluate the effect of group discussions, in which structured reminiscence and a problem-based method were used, on depressive symptoms, quality of life and self-rated health among older people. BACKGROUND Depressive symptoms in older people have a considerable impact on self-rated health and quality of life, with a high rate of co-morbidity and mortality. As the ageing population is growing, late-life depression is becoming an important public health problem and there is a need to find preventive interventions to avert unnecessary suffering. DESIGN The study was quasi-experimental, with a one-group pretest-post-test design and follow-up after one year. METHODS Initially, a questionnaire was sent to the total population of 55-80-year-old retirees in a community in the northeast of Sweden, (n = 679). The questionnaire concerned demographics and covered areas such as health, depression and quality of life. The intervention consisted of group discussions where structured reminiscence and a problem-based method were used. The participants (n = 18) met 10 times under the guidance of a group-leader, a registered nurse educated in the method. Each session had different themes with a focus on positive memories but also on the present situation and the future. Parametric, nonparametric tests and content analysis were used. RESULTS Participants evaluated the intervention positively, showed a decrease in depressive symptoms, an increase in self-rated health and experienced an increased autonomy. No long- lasting effect was seen. CONCLUSION Group discussions where structured reminiscence and a problem-based method are used might be an option to prevent depressive symptoms in older people. RELEVANCE TO CLINICAL PRACTICE This method might provide an opportunity for older people with depressive symptoms to improve their quality of life, however, to maintain the positive outcome the intervention should probably be continuous.