Stress-related Diagnoses Research Articles

Why do I have to suffer? Symptom management, views and experiences of persons with a CPTSD: a grounded theory approach

BackgroundFor the 11th version of the International Classification of Diseases, a new stress related diagnosis has been proposed: complex post-traumatic stress disorder (CPTSD). It is described as a chronic condition with several severe and concurrent symptoms. In the literature, these symptoms are discussed as a common reason for seeking psychiatric treatment as they can influence and impair the quality of life not only for affected persons but also for their social and familial system.AimThis research studies symptom management in everyday life by exploring and reconstructing the views, perceptions, experiences, facilitators and barriers of adults with CPTSD.MethodsA theoretical sampling was used to recruit 18 to 65 years old patients diagnosed with CPTSD from an inpatient setting. The 17 semi-structured interviews were audio recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on Corbin and Strauss was used to analyse the data.ResultsWe provide a process model with 5 interacting phases: trauma experience, emotional ignorance, overcompensation, paroxysm, and perspectives. Each phase is specified with subcategories.ConclusionsThe participants did not recognise their symptoms as such and were unaware of their diagnosis for many years. Nevertheless, they used various resources and were able to develop skills and techniques to deal with their symptoms and to function on a day-to-day basis. Overall, the process of symptom management was extremely exhausting for the participants and they felt left alone with it. The participants were eager to gain support from healthcare professionals and, when necessary, financial support from the government. Thus, these results indicate an essential need to develop support and tailored interventions for the symptom management of persons with a CPTSD.Trial registrationEthical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268.

Prevalence of persons contacting general practice for psychological stress in Denmark

Objective: The prevalence of psychological stress has previously been estimated based on self-reported questionnaires. This study aimed to investigate the prevalence of persons who contact the general practitioner (GP) for psychological stress and to explore associations between psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors.Design: Cross-sectional computer assisted journal audit.Setting: General practice in the Region of Southern Denmark.Subjects: Patients aged 18–65 years with a consultation during a six-month period that was classified with a stress-related diagnosis code.Main outcome measures: Six months prevalence of GP-assessed psychological stress and characteristics relating to the patient, the GP, and area-specific socioeconomic factors.Results: Fifty-six GPs (7% of the invited) identified 1066 patients considered to have psychological stress among 51,422 listed patients. Accordingly, a 2.1% six months prevalence of psychological stress was estimated; 69% of cases were women. High prevalence of psychological stress was associated with female sex, age 35–54 years, high education level and low population density in the municipality, but not with unemployment in the municipality or household income in the postal district. GP female sex and age <50 years, few GPs in the practice and few patients per GP were also associated with a higher prevalence of psychological stress.Conclusions: A total of 2% of the working-age population contacted the GP during a six-month period for psychological stress. The prevalence of psychological stress varies with age, sex and characteristics of both the regional area and the GP.Key points Psychological stress is a leading cause of days on sick leave, but its prevalence has been based on population surveys rather than on assessment by health care professionals. • This study found that during six months 2.1% of all working-age persons have at least one contact with the GP regarding psychological stress. • The six months prevalence of psychological stress was associated with patient age and sex, GP age and sex, practices’ number of GPs and patients per GP, and area education and urbanization level.

Work-Home Interference, Perceived Total Workload, and the Risk of Future Sickness Absence Due to Stress-Related Mental Diagnoses Among Women and Men: a Prospective Twin Study

PurposeWork-home interference has been proposed as an important explanation for sickness absence (SA). Previous studies show mixed results, have not accounted for familial factors (genetics and shared everyday environment), or investigated diagnosis specific SA. The aim was to study whether work-home interference and perceived total workload predict SA due to stress-related mental diagnoses, or SA due to other mental diagnoses, among women and men, when adjusting for various confounders and familial factors.MethodsThis study included 11,916 twins, 19–47 years (49% women). Data on work-to-home and home-to-work conflicts, perceived total workload, and relevant confounders were derived from a 2005 survey, and national register data on SA spells until 2013 were obtained. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Discordant twin pair design was applied to adjust for familial factors.ResultsEach one unit increase in work-to-home and home-to-work conflicts, and perceived total workload was associated with higher odds for SA due to stress-related mental diagnoses and to SA due to other mental diagnoses among women, when adjusting for sociodemographic factors (ORs 1.15–1.31). Including health or familial factors, no associations remained. For men, each one unit increase in work-to-home conflicts was associated with higher odds for SA due to stress-related diagnoses (ORs 1.23–1.35), independently of confounders.ConclusionWork-to-home conflict was independently associated with future SA due to stress-related diagnoses among men only. Health- and work-related factors seem to be important confounders when researching work-home interference, perceived total workload, and SA. Not including such confounders involves risking drawing incorrect conclusions. Further studies are needed to confirm sex differences and whether genetic factors are important for the associations studied.

Understanding long-term sick leave in female white-collar workers with burnout and stress-related diagnoses: a qualitative study

BackgroundSick leave rates in Sweden have been significant since the end of the 1990s. In this paper we focus on individual female white-collar workers and explore various factors and setting-based sources of ill health in working life and in private life, in order to understand impaired work ability, leading ultimately to long-term sick leave.MethodsA qualitative methodology was chosen, and thematic, open-ended interviews were carried out with 16 women. The interviewees were strategically selected from a cohort of 300 women in full-time white-collar jobs in high-level positions, living in three urban areas in Sweden, and on long-term sick leave ≥90 days. A qualitative content analysis was carried out.ResultsThe informants in the study were generally well educated, but a few had surprisingly little formal education considering their salary level and position on the labour market. The women were in professional positions more commonly held by men, either as specialists with some degree of managerial role or as executives with managerial responsibilities. Both external and internal stressors were identified. The analysis indicated that being in these gender-typed jobs could have induced sex discrimination and role conflicts. The women expressed strong agreement regarding success in working life, but emphasised the lack of competence matching in their present jobs. They also lacked the sense of having a rewarding job, saw leadership as weak, and disliked their present workplace and colleagues. Impaired health may have hindered them from changing jobs; conversely, their locked-in positions could have resulted in deterioration in their health status. The women displayed personal overcommitment, both at work and in private life, and had difficulties in setting limits.ConclusionsFactors in working life, as well as in private life, played an important role in the informants' deteriorated health and long-term sick leave. Job and workplace mismatching, problems in connection with company profitability, and poor leadership contributed to stress-related symptoms, resulting in reduced working capacity. On the basis of these findings, attention should be paid to identification of early indicators of exhaustion, and measures should be taken in work settings and in working life as a whole to promote retained work ability.

Individual differences in psychophysiological reactivity in adults with childhood abuse

AbstractLittle is known about the neurobiological correlates of stress‐related disorders. In particular almost nothing is known about biological correlates of specific personality disorders that have been linked to stress. We measured heart rate and blood pressure reactivity in response to personalized traumatic scripts together with subjective psychological ratings in four women with a history of childhood abuse with no disorder, Posttraumatic Stress Disorder, Borderline Personality Disorder, and Histrionic Personality Disorder. Psychophysiology as well as subjective ratings differed markedly between the four women, with elevated reactions found in PTSD and histrionic personality, and extreme decline in physiological reactivity associated with a dissociative response in the borderline patient. It is concluded that reactivity to traumatic reminders can be correlated with the existence of different stress‐related diagnoses. Personality characteristics seem to have an influence on psychophysiological reactivity in patients with stress‐related psychiatric disorders. Copyright © 2002 John Wiley &amp; Sons, Ltd.

Age, Affective Distress, and Illness Detection in Patients Evaluated for Gastrointestinal Complaints

A study of 260 patients was conducted in 1990 using a questionnaire that was designed to measure and assess their recall of symptom patterns, symptom distress levels, symptom interpretation, and physician-recommended treatment plans. The questionnaire was mailed 6-18 months after they had undergone a gastrointestinal workup for unexplained chest or abdominal pain. The authors found comparably high rates of both younger patients (age < 65) and older patients (age > or = 65) reporting symptom patterns sufficient to meet DSM-III criteria for panic, generalized anxiety, and depressive disorders. For younger but not older patients, the number of symptom complaints was related to their recall of a stress-related diagnosis made by the physician, which was less frequent for older patients. The older patients less often identified their symptoms as tension-related. Further research is needed concerning symptom reporting, illness attribution, and physician recognition of emotional etiology among elderly and younger patients with somatizing disorders.

Stress-related diagnosis and barriers to health care among foreign students: results of a survey.

Abstract This survey of 476 college health center directors was made to determine if certain stress-related diagnoses were more prevalent among foreign than domestic students and to identify barriers to health care among foreign students. Previously, a pilot longitudinal study at the University of Southern California (USC) Student Health Center (SHC) revealed that 50 disease entities were significantly increased and 30 were significantly decreased in international students. Further analysis of the diagnoses that may be stress related revealed a greater proportion of those conditions among international students. The findings in this survey of college health centers correlated with the results of the pilot study at USC in two major ways: (1) foreign students had higher frequencies than domestic students in 10 of the stress-related diagnoses; and (2) the barriers to health care found among the USC foreign students were also described by the health center directors. These included language difficulties, diff...