Stress-related Mental Health Problems Research Articles

Prevalence and course of somatic symptoms in patients with stress-related exhaustion: does sex or age matter.

BackgroundBoth mental and somatic symptoms are commonly reported in patients with stress-related problems. We have explored the prevalence of somatic symptoms in patients seeking medical care for stress-related mental health problems and followed the course of illnes alongside with that the patients receive multimodal treatment.MethodThis study comprises data from 228 patients (69% women, mean age 43 years) who fulfilled the criteria for Exhaustion Disorder (ED). Somatic symptoms were assessed at baseline and after 3, 6, 12 and 18 months using the one-page questionnaire Primary Care Evaluation of Mental Disorders. Prevalence of different symptoms was compared between men and women and patients, over and below 40 years of age, and possible predictors of recovery were explored.ResultsTiredness and low energy are the core symptom reported by the patients. Almost all (98%) reported at least one somatic symptom and 45% reported six symptoms or more, which was similar for men and women. Nausea, gas or indigestion are the most common symptoms (67%) followed by headaches (65%) and dizziness (57%). The number of symptoms reported was significantly related to the severity of mental health problems. The only difference between the sexes was that “chest pain” and “pain or problems during sexual intercourse” were more common among males. Patients over forty more often reported “pain in arms, legs or joints, knees, hips” and this was also the only symptom that did not significantly decline during treatment. Neither sex, age, symptom duration before seeking medical care, education or any other predictor tested was shown to predict recovery in patients reporting six symptoms or more.ConclusionA heavy burden of somatic symptoms was generally seen in most patients with stress-related exhaustion. Somatic symptoms are equally common in males and females and in younger and older patients. The somatic symptoms seem to be mostly stress-related since all symptoms, except musculoskeletal pain, reduce with individualised treatment designed for stress-related mental problems. This study brings to attention the complicated burden of both somatic and mental symptoms in patients with stress-related exhaustion, raising several clinical implications of interest to discuss.

Job Dissatisfaction as a Contributor to Stress-related Mental Health Problems among Japanese Civil Servants

Although studies on the association of job dissatisfaction with mental health have been conducted in the past, few studies have dealt with the complicated links connecting job stress, job dissatisfaction, and stress-related illness. This study seeks to determine how job dissatisfaction is linked to common mental health issues. This study surveyed 3,172 civil servants (2,233 men and 939 women) in 1998, taking poor mental functioning, fatigue, and sleep disturbance as stress-related mental health problems. We examine how psychosocial risk factors at work and job dissatisfaction are associated independently with poor mental functioning, fatigue, and sleep disturbance after adjustment for other known risk factors, and how job dissatisfaction contributes to change in the degree of association between psychosocial risk factors at work and mental health problems. In general, psychosocial risk factors were independently associated with mental health problems. When adjusted for job dissatisfaction, not only was job satisfaction independently associated with mental health problems but it was also found that the association of psychosocial risk factors with mental health problems declined. Our results suggest that, although longitudinal research is necessary, attitudes toward satisfaction at work can potentially decrease the negative effects of psychosocial risk factors at work on mental health.

2661 – Psychometric properties of the russian version of the stress vulnerability questionnaire - 23QVS (serra, 2000), in a sample of 556 russian-speaking immigrants in portugal

In literature, individual vulnerability to stress is a predictive factor of a higher risk of developing stress-related disorders and mental health problems. The Stress Vulnerability Questionnaire (23QVS; Serra, 2000, 2004) is a 23-item scale, measuring vulnerability to emotional and social adverse and stressful situations, and overall life satisfaction. The purpose of this study was to assess the psychometric properties of a Russian version of the 23QVS in a sample of Russian-speaking immigrants residing in Portugal. The 23QVS was administered to Russian-speaking immigrants in 12 Local Immigrant Support Centers in Portugal, along with a number of other self-report tests as part of a larger mental health status immigrants' study. The Russian version of the 23QVS has an internally consistent measure Cronbach's α, 710 for the total scale (Item 7 was excluded). PCA was carried out in order to re-examine the factor structure of the scale. Seven factors were identified, overall matching the ones foreseen by the author of the scale. The findings suggest that the Russian version of the 23 QVS addressed adequately the original concepts and dimensions, and demonstrated a high level of equivalence with the original version.

2614 – Interventions to reduce stress in university students: A review and meta-analysis

Background Of late, highly publicized reports have revealed that approximately half of university students report moderate levels of stress-related mental health concerns including anxiety and depression. Other research reveals that university health services are only providing services to a small percentage of these students. Universities must therefore consider the use of accessible programs that address student stress and reduce resultant anxiety and depression. Method A systematic review of the literature and meta-analysis was conducted to examine the effectiveness of interventions aimed at reducing stress in university students. Studies were eligible for inclusion if the assignment of study participants to experimental or control groups was by random allocation or parallel cohort design. Results Twenty-four studies, involving 1431 students were included in the meta-analysis. The findings suggest that cognitive, behavioral and mindfulness-based interventions focused on stress reduction significantly reduce symptoms of anxiety. Further, despite variations in approaches in terms of length of intervention and specific components of the intervention (including such aspects as cognitive restructuring, relaxation and meditation) with students in different programs and in different countries, these results are remarkably consistent. Secondary outcomes included lower levels of depression and cortisol. Conclusion This review and meta-analysis provides strong support that cognitive, behavioral and mindfulness-based approaches are effective in reducing the effects of stress on university students. Given the high rates of stress-related mental health problems reported by university students, universities are advised to examine means to provide opportunities for larger numbers of students to access these interventions.

The Effectiveness of a School-Based Mindfulness Training as a Program to Prevent Stress in Elementary School Children

Studies on the effects of mindfulness interventions on mental health and behavioral problems in children show promising results, but are primarily conducted with selected samples of children. The few studies investigating school-based interventions used self-selected samples, provided training outside of the classroom, and did not report longer-term effects. The immediate and longer-term effects of a class-based mindfulness intervention for elementary school children were investigated as a primary prevention program (MindfulKids) to reduce stress and stress-related mental health and behavioral problems. Children (8–12 years) from three elementary schools participated. Classes were randomized to an immediate-intervention group (N = 95) or a waitlist-control group (N = 104), which received the intervention after a waitlist period. Twelve 30-min sessions were delivered in 6 weeks. At baseline, pretest, posttest, and follow-up, variables indicative of stress and metal well-being were assessed with children, variables indicative of mental health problems were assessed with parents, and teachers reported on class climate. Multilevel analysis revealed that there were no significant changes from baseline to pretest. Some primary prevention effects on stress and well-being were found directly after training and some became more apparent at follow-up. Effects on mental health problems also became apparent at follow-up. MindfulKids seems to have a primary preventive effect on stress, well-being, and behavior in schoolchildren, as reported by children and parents. Exploratory analysis revealed that children who ruminate more are affected differently by the intervention than children who ruminate less. It is concluded that mindfulness training can be incorporated in elementary schools at the class level, letting all children benefit from the intervention.

Cognitive impairment in patients with stress-related exhaustion

Patients who seek medical care for stress-related mental health problems frequently report cognitive impairments as the most pronounced symptom. The purpose of the present study was to compare cognitive function in patients with stress-related exhaustion with that in healthy controls, using a comprehensive battery of cognitive tests. We also explored whether neuropsychological findings were related to severity of illness measured using the Shirom–Melamed burnout questionnaire and hospital anxiety and depression scale. Thirty-three patients (15 males) and 37 healthy controls (11 males), mean age 46 years [standard deviation (SD) 3.9] and 47 years (SD 4.3), respectively, were included in the final analysis. Five cognitive domains were assessed: (1) speed, attention and working memory, (2) learning and episodic memory, (3) executive functions, (4) visuospatial functions and (5) language. The most pronounced difference between patients and controls was seen on executive function, when tested with a multidimensional test, including aspects of speed, control and working memory. The patients also performed poorer on Digit span, measuring attention span and working memory as well as on learning and episodic memory, when measured as delayed recall and the difference between immediate and delayed recall. Delayed recall was the only test that was significantly related to severity of burnout symptoms among the patients. This could reflect poor cognitive sustainability in the patients with the highest burnout scores, as this particular test was the last one performed during the test session. This study clearly shows that cognitive impairment should be considered when evaluating and treating patients who seek medical care for stress-related exhaustion.

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.

Assessing the mental health consequences of military combat in Iraq and Afghanistan: a literature review

The aim of this paper was to explore how a military career may affect the mental health of serving and ex-service personnel, to identify the accessibility and helpfulness of support (both during and after military service) and to make recommendations for change. A literature search was undertaken using the MetaFind meta search engine with keywords: mental health, psychological health, emotional health, soldier, British army, army, ex-army, military, military personnel, armed forces, resettlement, impact, family relationship, divorce, health, support services. The search was applied to the following databases: EBSCO Host, CINAHL, Cochrane Library, Ingenta Connect, Medline, PsyArticles, PubMed, Web of Knowledge, together with the specific journals American Journal of Psychiatry, British Journal of Psychiatry and ProQuest Nursing journals. 110 relevant publications were identified and from these 61 papers were retrieved for further analysis. Poor mental health is associated with increased risk of social exclusion on leaving the services, which further exacerbates mental health problems. An increasing number of ex-service personnel are expected to develop stress-related mental health problems in the future.

Cost-effectiveness of a minimal intervention for stress-related sick leave in general practice: Results of an economic evaluation alongside a pragmatic randomised control trial

Background Stress-related mental health problems negatively impact quality of life and productivity. Worldwide, treatment is often sought in primary care. Our objective was to determine whether a general practitioner-based minimal intervention for workers with stress-related sick leave (MISS) was cost-effective compared to usual care (UC). Methods We conducted an economic evaluation from a societal perspective. Quality-adjusted life years (QALYs) and resource use were measured by the EuroQol and cost diaries, respectively. Uncertainty was estimated by 95% confidence intervals, cost-effectiveness planes and acceptability curves. Sensitivity analyses and ancillary analyses based on preplanned subgroups were performed. Results No statistically significant differences in costs or QALYs were observed. The mean incremental cost per QALY was − €7356 and located in the southeast quadrant of the cost-effectiveness plane, whereby the intervention was slightly more effective and less costly. For willingness-to-pay ( λ) thresholds from €0 to €100,000, the probability of MISS being cost-effective was 0.58–0.90. For the preplanned subgroup of patients diagnosed with stress-related mental disorders, the incremental ratio was − €28,278, again in the southeast quadrant. Corresponding probabilities were 0.92 or greater. Limitations Non-significant findings may be related to poor implementation of the MISS intervention and low power. Also, work-presenteeism and unpaid labor were not measured. Conclusions The minimal intervention was not cost-effective compared to usual care for a heterogeneous patient population. Therefore, we do not recommend widespread implementation. However, the intervention may be cost-effective for the subgroup stress-related mental disorders. This finding should be confirmed before implementation for this subgroup is considered.

International Military Leaders' Survey on Operational Stress

Despite the importance of military leaders in moderating the impact of deployment stressors on unit members, little attention has focused on the training leaders receive in managing unit stress. As part of a NATO Research Panel (Human Factors and Medicine (HFM)-081/Research and Technology Organization Task Group (RTG)), 16 nations participated in a needs assessment survey of military leaders who had returned from an operation within the previous 2 years. Findings from 172 leaders emphasized the lack of training specifically geared for leaders to address operational stress issues for unit members and their families and the need for integrated mental health support across the deployment cycle. In general, most leaders regarded stress-related mental health problems as normal and were supportive of help-seeking. The information obtained here was used to develop a Human Factors and Medicine -081/RTG Leader's Guide on operational stress.

Chapter 10.

Stress-related mental health problems are among the most common and disabling medical conditions in the United States, and they have increased in frequency over the past 100 years. Lifestyle changes such as diet, sleep, activity level and the nature of modern stresses may all play a role in the increasing frequency of depression, and these changes are seen clearly among college students. Treatment for depression falls short when these factors are not addressed and we rely too heavily upon medication and very brief psychotherapy. This article presents a vision of depression as a holistic illness and points towards a more comprehensive and effective approach to its treatment and prevention.

Development of a workplace intervention for sick-listed employees with stress-related mental disorders: Intervention Mapping as a useful tool

BackgroundTo date, mental health problems and mental workload have been increasingly related to long-term sick leave and disability. However, there is, as yet, no structured protocol available for the identification and application of an intervention for stress-related mental health problems at the workplace. This paper describes the structured development, implementation and planning for the evaluation of a return-to-work intervention for sick-listed employees with stress-related mental disorders (SMDs). The intervention is based on an existing successful return-to-work intervention for sick-listed employees with low back pain.MethodsThe principles of Intervention Mapping were applied to combine theory and evidence in the development, implementation and planning for the evaluation of a participatory workplace intervention, aimed at an early return-to-work for sick-listed employees with SMDs. All stakeholders were involved in focus group interviews: i.e. employees recently sick-listed with SMDs, supervisors and occupational health professionals.ResultsThe development of the participatory workplace intervention according to the Intervention Mapping principles resulted in a structured return-to-work intervention, specifically tailored to the needs of sick-listed employees with SMDs. Return-to-work was proposed as a behavioural change, and the Attitude – Social influence – self-Efficacy model was identified as a theoretical framework. Stakeholder involvement in focus group interviews served to enhance the implementation. The cost-effectiveness of the intervention will be evaluated in a randomised controlled trial.ConclusionIntervention Mapping was found to be a promising method to develop interventions tailored to a specific target group in the field of occupational health.Trial registrationISRCTN92307123

63. Developing a program for resident wellness at the postgraduate medical education office, University of Torontos

Prevalence of stress-related mental health problems in residents is equal to, or greater than, the general population. Medical training has been identified as the most significant negative influence on resident mental health. At the same time, residents possess inadequate stress management and general wellness skills and poor help-seeking behaviours. Unique barriers prevent residents from self-identifying and seeking assistance. Stress management programs in medical education have been shown to decrease subjective distress and increase wellness and coping skills. 
 The University of Toronto operates the largest postgraduate medical training program in the country. The Director of Resident Wellness position was created in the Postgraduate Medical Education Office to develop a systemic approach to resident wellness that facilitates early detection and intervention of significant stress related problems and promote professionalism. 
 Phase One of this new initiative has been to highlight its presence to residents and program directors by speaking to resident wellness issues at educational events. Resources on stress management, professional services, mental health, and financial management have been identified and posted on the postgraduate medical education website and circulated to program directors. Partnerships have been established with physician health professionals, the University of Toronto, and the Professional Association of Residents and Internes of Ontario. Research opportunities for determining prevalence and effective management strategies for stress related problems are being identified and ultimately programs/resources will be implemented to ensure that resident have readily accessible resources. 
 The establishment of a Resident Wellness Strategy from its embryonic stags and the challenges faced are presented as a template for implementing similar programs at other medical schools.
 Earle L, Kelly L. Coping Strategies, Depression and Anxiety among Ontario Family Medicine Residents. Canadian Family Physician 2005; 51:242-3.
 Cohen J, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education; 5(21).
 Levey RE. Sources of stress for residents and recommendations for programs to assist them. Academic Med 2001; 70(2):142-150.

Escaping the Pain: Examining the Use of Sexually Compulsive Behavior to Avoid the Traumatic Memories of Combat

Studies suggest that as many as 30% of U.S. service members are returning from Iraq with stress-related mental health problems. Between 10–15% of troops leaving theatre have been diagnosed with combat-related post-traumatic stress disorder (PTSD). Plagued by nightmares, flashbacks, and a host of family and work–related problems, these individuals will often turn to mood-altering substances and behaviors as an escape from their memories. This article examines the use of compulsive sexual behavior as a means of escaping the memories of combat. A case study will illustrate theoretical aspects of addiction, as well as critical intervention issues related to the underlying trauma.

Occupational stress in special education: a challenge for school health professionals.

Results of this study support the hypothesis that the majority of special educators, their support personnel, and general education administrators do not experience more job dissatisfaction than comparable occupational groups. However, they do report lower levels of subjective well-being when compared with normal populations. Furthermore, 18% of the educators in the study perceived themselves as failing to cope with their job, experienced more frequent symptoms of poor physical health, and reported significantly poorer subjective well-being. Health promotion programs for public school personnel should initiate prevention-oriented health education programs for all employees. For those identified as more vulnerable to stress-related mental and physical health problems, therapeutic approaches may be necessary. However, self-help and mutual support groups may offer both groups a social support system to help meet human needs in addition to offering the potential for reducing perceived occupational stress. School health personnel may be in the best position to influence policies, procedures, and practices in schools that would support the work-related needs of all employees.