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BMC Psychiatry
Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

Course of mental symptoms in patients with stress-related exhaustion: does sex or age make a difference?

Authors: Kristina Glise, Gunnar Ahlborg Jr, Ingibjörg H Jonsdottir

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

Long-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.

Methods

The 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.

Results

There 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.

Conclusions

The 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.
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Literature
1.
van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ: Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design. Occup Environ Med. 2003, 60 (6): 429-437. 10.1136/oem.60.6.429.CrossRefPubMedPubMedCentral
2.
Karlson B, Jonsson P, Palsson B, Abjornsson G, Malmberg B, Larsson B, Osterberg K: Return to work after a workplace-oriented intervention for patients on sick-leave for burnout--a prospective controlled study. BMC Public Health. 2010, 10: 301-10.1186/1471-2458-10-301.CrossRefPubMedPubMedCentral
3.
4.
Somers JM, Goldner EM, Waraich P, Hsu L: Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry. 2006, 51 (2): 100-113.PubMed
5.
Richards D: Prevalence and clinical course of depression: a review. Clin Psychol Rev. 2011, 31 (7): 1117-1125. 10.1016/j.cpr.2011.07.004.CrossRefPubMed
6.
McLean CP, Asnaani A, Litz BT, Hofmann SG: Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011, 45 (8): 1027-1035. 10.1016/j.jpsychires.2011.03.006.CrossRefPubMedPubMedCentral
7.
Carter-Snell C, Hegadoren K: Stress disorders and gender: implications for theory and research. Can J Nurs Res. 2003, 35 (2): 34-55.PubMed
8.
Norlund S, Reuterwall C, Hoog J, Lindahl B, Janlert U, Slunga Birgander L: Burnout, working conditions and gender - results from the northern Sweden MONICA Study. BMC Public Health. 2010, 10 (1): 326-CrossRefPubMedPubMedCentral
9.
Lindblom KM, Linton SJ, Fedeli C, Bryngelsson IL: Burnout in the working population: relations to psychosocial work factors. Int J Behav Med. 2006, 13 (1): 51-59. 10.1207/s15327558ijbm1301_7.CrossRefPubMed
10.
Bakker AB, Demerouti E, Schaufeli WB: Validation of the Maslach Burnout Inventory--General Survey: An Internet study. Anxiety, Stress & Coping: An International Journal. 2002, 15 (3): 245-260. 10.1080/1061580021000020716.CrossRef
11.
Hopcroft R, Burr-Bradley D: The sex difference in depression across 29 countries. Social Forces. 2007, 85 (4): 1484-1507.CrossRef
12.
Parker G, Parker K, Austin MP, Mitchell P, Brotchie H: Gender differences in response to differing antidepressant drug classes: two negative studies. Psychol Med. 2003, 33 (8): 1473-1477. 10.1017/S0033291703007918.CrossRefPubMed
13.
Bremander AB, Holmstrom G, Bergman S: Depression and age as predictors of patient-reported outcome in a multidisciplinary rehabilitation programme for chronic musculoskeletal pain. Musculoskeletal Care. 2010, 9 (1): 41-48.CrossRefPubMed
14.
Stordal E, Bjartveit Kruger M, Dahl NH, Kruger O, Mykletun A, Dahl AA: Depression in relation to age and gender in the general population: the Nord-Trondelag Health Study (HUNT). Acta Psychiatr Scand. 2001, 104 (3): 210-216. 10.1034/j.1600-0447.2001.00130.x.CrossRefPubMed
15.
Eaton WW, Shao H, Nestadt G, Lee BH, Bienvenu OJ, Zandi P: Population-based study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry. 2008, 65 (5): 513-520. 10.1001/archpsyc.65.5.513.CrossRefPubMedPubMedCentral
16.
Huibers MJ, Bleijenberg G, van Amelsvoort LG, Beurskens AJ, van Schayck CP, Bazelmans E, Knottnerus JA: Predictors of outcome in fatigued employees on sick leave: results from a randomised trial. J Psychosom Res. 2004, 57 (5): 443-449. 10.1016/j.jpsychores.2004.03.015.CrossRefPubMed
17.
National Board of Health and Well Fare: Utmattningssyndrom. Stressrelaterad psykisk ohälsa. [Exhaustion Syndrome. Stress related mental poor health]. 2003, Stockholm: Bjurner & Bruno AB, (in Swedish)
18.
National Board of Health and Well Fare: Ändringar I och tillägg till klassifikation av sjukdomar och hälsoproblem 1997 (KSH97) alfabetisk förteckning. [Changes in and supplement toclassifications of diseases and health problems 1997- an alphabetic list]. 2005, Stockholm, (in Swedish)
19.
Griffith JP, Zarrouf FA: A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression. Prim Care Companion J Clin Psychiatry. 2008, 10 (2): 120-128. 10.4088/PCC.v10n0206.CrossRefPubMedPubMedCentral
20.
Nampiaparampil DE, Shmerling RH: A review of fibromyalgia. Am J Manag Care. 2004, 10 (11 Pt 1): 794-800.PubMed
21.
Jonsdottir IH, Hagg DA, Glise K, Ekman R: Monocyte chemotactic protein-1 (MCP-1) and growth factors called into question as markers of prolonged psychosocial stress. PLoS One. 2009, 4 (11): e7659-10.1371/journal.pone.0007659.CrossRefPubMedPubMedCentral
22.
Spitzer RL, Williams JB, Kroenke K, Linzer M, Linzer M, deGruy FV, Hahn SR, Brody D, Johnson JG: Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994, 272 (22): 1749-1756. 10.1001/jama.1994.03520220043029.CrossRefPubMed
23.
DSM-IV: Diagnostic and statistical manual of mental disorder. 1994, Washington DC: American Psychiatric Association, 4
24.
Melamed S, Kushnir T, Shirom A: Burnout and risk factors for cardiovascular diseases. Behav Med. 1992, 18 (2): 53-60. 10.1080/08964289.1992.9935172.CrossRefPubMed
25.
Grossi G, Perski A, Evengard B, Blomkvist V, Orth-Gomer K: Physiological correlates of burnout among women. J Psychosom Res. 2003, 55 (4): 309-316. 10.1016/S0022-3999(02)00633-5.CrossRefPubMed
26.
Stenlund T, Ahlgren C, Lindahl B, Burell G, Knutsson A, Stegmayr B, Birgander LS: Patients with burnout in relation to gender and a general population. Scand J Public Health. 2007, 35 (5): 516-523. 10.1080/14034940701271874.CrossRefPubMed
27.
Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67 (6): 361-370. 10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMed
28.
Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002, 52 (2): 69-77. 10.1016/S0022-3999(01)00296-3.CrossRefPubMed
29.
Herrmann C: International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results. J Psychosom Res. 1997, 42 (1): 17-41. 10.1016/S0022-3999(96)00216-4.CrossRefPubMed
30.
OECD: Education at a Glance 2010: OECD Indicator. 2010, Paris: OECD PUBLICATIONS, 2010-
31.
Leone SS, Huibers MJ, Knottnerus JA, Kant I: A comparison of the course of burnout and prolonged fatigue: a 4-year prospective cohort study. J Psychosom Res. 2008, 65 (1): 31-38. 10.1016/j.jpsychores.2008.03.018.CrossRefPubMed
32.
Schimmele CM, Wu Z, Penning MJ: Gender and remission of mental illness. Can J Public Health. 2009, 100 (5): 353-356.PubMed
33.
Nijrolder I, van der Windt D, van der Horst H: Prediction of outcome in patients presenting with fatigue in primary care. Br J Gen Pract. 2009, 59 (561): e101-109. 10.3399/bjgp09X420329.CrossRefPubMedPubMedCentral
34.
Cornelius LR, van der Klink JJ, Groothoff JW, Brouwer S: Prognostic Factors of Long Term Disability Due to Mental Disorders: A Systematic Review. J Occup Rehabil. 2011, 21 (2): 259-274. 10.1007/s10926-010-9261-5. ReviewCrossRefPubMed
35.
Frank E, Rucci P, Katon W, Barrett J, Williams JW, Oxman T, Sullivan M, Cornell J: Correlates of remission in primary care patients treated for minor depression. Gen Hosp Psychiatry. 2002, 24 (1): 12-19. 10.1016/S0163-8343(01)00173-6.CrossRefPubMed
36.
Strahler J, Berndt C, Kirschbaum C, Rohleder N: Aging diurnal rhythms and chronic stress: Distinct alteration of diurnal rhythmicity of salivary alpha-amylase and cortisol. Biol Psychol. 2010, 84 (2): 248-256. 10.1016/j.biopsycho.2010.01.019.CrossRefPubMed
37.
McEwen BS: Protective and damaging effects of stress mediators. N Engl J Med. 1998, 338 (3): 171-179. 10.1056/NEJM199801153380307.CrossRefPubMed
38.
Demyttenaere K, Verhaeghen A, Dantchev N, Grassi L, Montejo AL, Perahia DG, Quail D, Reed C, Tylee A, Bauer M: "Caseness" for Depression and Anxiety in a Depressed Outpatient Population: Symptomatic Outcome as a Function of Baseline Diagnostic Categories. Prim Care Companion J Clin Psychiatry. 2009, 11 (6): 307-315. 10.4088/PCC.08m00748blu.CrossRefPubMedPubMedCentral
Metadata
Title
Course of mental symptoms in patients with stress-related exhaustion: does sex or age make a difference?
Authors
Kristina Glise
Gunnar Ahlborg Jr
Ingibjörg H Jonsdottir
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-18

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