Abstract
BackgroundSeveral rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis.MethodsPatients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program.ResultsThe mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients.ConclusionThe symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.
Highlights
Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years
How are symptoms of exhaustion distributed in different patient groups, including patients with different diagnoses, men and women, and young and old patients? Second, are the symptom levels for exhaustion different in patients diagnosed with stress-related disorders compared to patients with other mental disorders and patients diagnosed with somatic disorders? Third, is Karolinska Exhaustion Disorder Scale (KEDS) useful for distinguishing between patients diagnosed with stress-related disorders and patients with other disorders, and may it as such be used for diagnostic purposes? is KEDS free of item bias, i.e. does the response to individual questions in the rating scale differs systematically between different patient groups?
The sensitivity and specificity of the KEDS sum score with regard to stress-related disorders were used to express the ability of KEDS to distinguish between patients diagnosed with stress-related disorders and patients diagnosed with somatic disorders
Summary
Several rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. The number of mental disorders reported to the Danish Working Environment Authority almost doubled from 2011 to 2014, making mental disorders the second most frequently reported occupational disorder after musculoskeletal diseases [4] These data, as well as other data [3, 5, 6], suggest that stress-related health problems are prevalent and have increased in recent years in Denmark. The mental health problems that result from chronic stress are not recognized as a unitary psychiatric disease in Denmark, and no common diagnostic criteria for stress-related disorders exist This means that there is no agreement on the core symptoms that such an instrument should address. The symptoms of exhaustion are typically accompanied by other symptoms such as sleeping problems, cognitive difficulties, emotional lability, increased sensitivity to stimuli (sounds, light, etc.), and increased sensitivity to further stress [7]
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