To achieve a deeper understanding of the patient's perception regarding individual aspects related to the development of exhaustion, hindering and supporting factors in the recovery process, and ...potential remaining consequences, 7-12 years after receiving an exhaustion disorder diagnosis.
Twenty patients previously diagnosed with and treated for exhaustion disorder were interviewed 7-12 years after onset of the disease. The semi-structured interviews were transcribed verbatim and analyzed with inductive content analysis.
Three main themes with patterns of shared meaning resulted from the analysis: "it's about who I am," "becoming a more authentic me," and "the struggle never ends." The interviewees described rehabilitation from exhaustion disorder as the start of an important personal development toward a truer and more authentic self-image. They perceived this as an ongoing long-lasting process where learned behavior and thought patterns related to overcommitment and overcompliance needed to be re-evaluated. The results also convey long-term consequences such as cognitive difficulties and reduces energy, uncertainty about one's own health, and the need to prioritize among one's relationships.
Patients with exhaustion disorder are still struggling with dysfunctional strategies and functional impairments such as cognitive problems which limit their lives, 10 years after receiving their exhaustion disorder diagnosis. While informants describe some positive consequences of ED, the results also emphasize the importance of acknowledging that the patients are embedded in systems of relationships, in working life as well as in family life. This needs to be considered, together with other aspects, when working toward prevention of stress-related mental health problems.
Objective: To evaluate the effects of adding individually tailored interventions to a standard treatment in patients with stress-related exhaustion disorder, with regard to sick-leave days and ...symptoms of burnout. The study design was a 2-armed randomized controlled intervention, with follow-up after 15 months. Data were obtained from patients referred to the Institute of Stress Medicine, and were collected between 2011 and 2014 in western Sweden.Methods: Inclusion criteria were scoring above cut-off in at least 1 of 4 dimensions; mental and physical exhaustion, disturbed sleep, reduced cognitive function and perceived poor self-esteem. The total study population comprised 142 patients (112 females, 30 males) allocated through block randomization to either the intervention group (n = 71) or the control group (n = 71). The intervention group received 1–4 individually tailored interventions (physical activity, cognitive behaviour therapy for insomnia, computerized memory training, cognitive behavioural therapy for self-esteem), based on the results of screening assessments. The interventions were additional to a standard treatment. The control group received solely the standard treatment. The primary outcome measure was the proportion of participants not sicklisted at the 15-month follow-up.Results: At the 15-month follow-up, 30% of subjects in the intervention group and 34% in the control group had 0% sick-listed (p = 0.58). No change between baseline and follow-up was seen in 42% of the intervention group and 39% of the control group, while an increased sick-leave rate was seen in 1% of the intervention group and 4% of the control group. However, no statistically significant difference was seen between groups.Conclusion: Adding individually tailored interventions to a standard treatment in patients with stress-related exhaustion did not reduce sick-leave days or burnout symptoms.
LAY ABSTRACTThe aim of this randomized controlled study was to investigate whether individually tailored interventions, added to a standard treatment for patients diagnosed with stress-related exhaustion, could reduce sick-leave and symptoms of burnout more in the intervention group than in a control group. Patients were allocated randomly into either the intervention group or a control group. To be included in the study patients had to score above cut-off in 1 or more of the core dimensions characterizing stress-related exhaustion, mental and physical exhaustion, disturbed sleep, cognitive decline, or perceived poor self-esteem. Patients assigned to the intervention group received additional interventions as well as a standard treatment, while the control group received only standard treatment. The results showed no major differences between the intervention group and the control group, with respect to either sick-leave and symptoms of burnout at the 15-month follow-up. The clinical implication from this study is that individually tailored interventions added to the standard treatment are inefficient in reducing both sick-leave days and burden of disease in this patient group, and should be accompanied by interventions targeting the workplace and the work organization level.
Abstract
Background
Exhaustion disorder (ED) is a stress-induced disorder characterized by physical and mental symptoms of exhaustion that can be long-lasting. Although stress exposure is essential ...for the development of ED, little is known regarding the role of stressors in the maintenance of ED. The aim of the study was to investigate the role of work-related stressors, private-related stressors, and adverse childhood experiences in long-term recovery from ED.
Methods
A mixed methods design was used. The design was sequential, and data analysis was performed in two parts, where the first part consisted of qualitative analysis of patient records, and the second part consisted of statistical analysis of the data retrieved from the qualitative coding. Patient records from 150 patients with ED was analysed regarding work-related stressors, private-related stressors, and adverse childhood experiences. For each patient, two patient records were analysed, one from the time of diagnosis (baseline) and one from the follow-up clinical assessment, 7–12 years after diagnosis (follow-up). Out of the 150 patients, 51 individuals still fulfilled the diagnostic criteria for ED at follow-up (ED group) and 99 individuals no longer fulfilled the diagnostic criteria and were thus considered recovered (EDrec). Percentages in each group (ED and EDrec) reporting each stressor at baseline and follow-up were calculated as well as the differences in percentage points between the groups along with the 95% confidence intervals for the differences.
Results
At baseline, significantly more EDrec patients reported quantitative demands (73% EDrec, 53% ED) and managerial responsibilities (14% EDrec, 2% ED). Private-related stressors did not differ at baseline. At follow-up, significantly more ED patients reported managerial responsibilities (8 ED, 0% EDrec) and caregiver stress (child) (24% ED, 6% EDrec) and significantly more EDrec patients reported caregiver stress (parent) (6% EDrec, 0% ED). There were no differences regarding adverse childhood experiences.
Conclusions
The main conclusion is that neither adverse childhood experiences nor any of the stressors at baseline are associated with long-term ED. Ongoing stressors related to having responsibility for other people, such as managerial responsibilities or caring for a child with a chronic disease or psychiatric disorder, may be associated with long-term exhaustion.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
Recovery from stress‐related diagnoses can, in some cases, be long‐lasting, and several different factors could be related to such a lengthy recovery. One plausible aspect is ...obsessive–compulsive personality disorder (OCPD), which has previously been seen to be related to stress‐related mental health. Thus, the aim of this study was to investigate whether recovery from exhaustion disorder (ED) is associated with OCPD.
Methods
This study includes data from 147 patients (78% women, mean age 52.4 ± 9.8 years) who have been treated for ED. Clinical assessment was performed 7–10 years after first seeking care identifying patients with residual exhaustion. Symptoms of OCPD were concomitantly measured and several aspects of work‐ and private‐related stress exposure.
Results
The main result of this study is that patients with residual clinical ED report OCPD to a greater extent, compared with patients who no longer fulfill the clinical criteria for ED, 7–10 years after seeking care. Patients with OCPD that have not recovered report “excessive devotion to work” to a higher degree than patients with OCPD that have recovered.
Conclusion
The results indicate that factors related to OCPD may be of clinical importance for the patient's recovery from ED. However, prospective studies should be conducted and studies elucidating whether symptoms of exhaustion among patients with OCPD can be affected by therapeutic interventions.
Recovery from stress‐related diagnoses can, in some cases, be long‐lasting and several different factors could be related to such a lengthy recovery. The aim of this study was to investigate whether recovery from exhaustion disorder (ED) is associated with OCPD in 147 former patients with ED. The main result is that patients with residual clinical ED report OCPD to a greater extent compared with patients who do not longer fulfill the clinical criteria for ED, 7‐10 years after seeking care. Patients with OCPD that have not recovered report “excessive devotion to work” to a higher degree than patients with OCPD that have recovered.
Primary health care is the setting for most patients with stress-related mental health problems. Good care processes are important for patients with stress-related mental health problems and the ...complex needs of these patients has become a challenge for primary care settings which is traditionally designed to manage acute episodes of one illness. The care process of these patients is thus interesting to investigate. The aim of this study was to explore psychologists´ involvement and experiences regarding the organisation of the care process and treatment of patients seeking care for stress-related exhaustion.
Fifteen psychologists (14 women and 1 man, age range 27-72 years)c from fifteen different primary health care centres in the western part of Sweden, located in both rural and urban areas were included. Qualitative content analysis of individual semi-structured interviews was conducted.
The analysis resulted in eight subcategories within the two main categories studied illuminating psychologists' involvement and experiences regarding the organisation of the care process and challenges regarding treatment of patients seeking care for stress-related exhaustion.
The care process of patients with stress-related exhaustion is perceived to be ineffective and not congruent with the needs of the patients. A lack of holistic overview of the care process, a lack of collaboration and poor utilization of the health care professionals' competence leads to an unstructured process forcing the patients to be the carriers and coordinators of their own care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objectives
Few studies have investigated the relationship between stress‐related mental health problems and obsessive‐compulsive personality disorder (OCPD). Similarly, little research has focused on ...the moderating effect of OCPD on recovery in clinical patients with stress‐related mental health problems. The general aim of this study was to investigate the prevalence of OCPD and the associations between OCPD and level of burnout, anxiety, and depression symptoms, during a 7‐years follow‐up in a clinical longitudinal sample of female patients with stress‐related exhaustion.
Method
The included patients (n = 84) were referred to a specialist outpatient clinic for patients with stress‐related exhaustion between 2006 and 2011. Data was collected at the initial examination and during a 7‐year treatment follow‐up.
Results
OCPD was the most common personality disorder in the present clinical sample, with 40% of patients fulfilling the criteria. There was a significant association between OCPD and the degree of burnout symptoms as well as the degree of depression, both at baseline and during the 7‐year follow‐up. No significant association between OCPD and levels of anxiety was observed.
Conclusion
The results support the hypothesis that there might be an association between OCPD and stress‐related exhaustion, including preservation of symptoms over time. OCPD and its related traits, such as perfectionism, may be important factors to consider when constructing effective treatment and rehabilitation plans for these patients.
The overall aim of this study was to investigate self‐reported cognitive difficulties, daily life activities, and health/sleep factors in former patients with exhaustion disorder (ED) who still ...fulfill the clinical criteria for exhaustion 7–12 years after seeking care. The Sahlgrenska Self‐reported Cognitive Impairment Questionnaire (SASCI‐Q) was used to measure cognitive difficulties, daily life activities, and health/sleep factors. Three groups were compared: previous patients still judged to be clinically exhausted seven years or more after seeking care (n = 51); previous patients considered clinically recovered (n = 98); and healthy controls (n = 50). Patients who still fulfilled the diagnostic criteria for ED reported widespread problems related to cognition, fatigue, and daily life functioning compared to the clinically recovered group. Furthermore, despite no longer fulfilling the clinical criteria, the recovered patients still reported more problems related to cognitive functioning and fatigue compared to healthy controls. Thus, this group appeared intermediary between the non‐recovered group and healthy controls regarding self‐reported cognitive functioning. To conclude, ED may have considerable negative long‐term effects, and it is possible that some of these residual symptoms, particularly the cognitive problems and persistent fatigue, are permanent in some patients. Preventive measures should be the primary focus for all stakeholders, since the consequences of stress‐related mental health problems seem to be extensive and long‐lasting.
Cognitive impairment has frequently been shown in patients who seek medical care for stress-related mental health problems. This study aims to extend the current knowledge of cognitive impairments in ...these patients by focusing on perceived fatigue and effects of distraction during cognitive testing. Executive function and attention were tested in a group of patients with stress-related exhaustion (n = 25) and compared with healthy controls (n = 25). Perceived fatigue was measured before, during and after the test session, and some of the tests were administered with and without standardized auditory distraction. Executive function and complex attention performance were poorer among the patients compared to controls. Interestingly, their performance was not significantly affected by auditory distraction but, in contrast to the controls, they reported a clear-cut increase in mental tiredness, during and after the test session. Thus, patients with stress-related exhaustion manage to perform during distraction but this was achieved at a great cost. These findings are discussed in terms of a possible tendency to adopt a high-effort approach despite cognitive impairments and the likelihood that such an approach will require increased levels of effort, which can result in increased fatigue. We tentatively conclude that increased fatigue during cognitive tasks is a challenge for patients with stress-related exhaustion and plausibly of major importance when returning to work demanding high cognitive performance.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Cognitive impairment is one of the most pronounced symptoms reported by patients with stress‐related mental health problems. Impairments related to executive function and to some extent speed and ...attention are therefore common in patients with stress‐related burnout/exhaustion. In this paper we present a follow‐up of cognitive performance in patients with stress‐related exhaustion several years after they initially sought medical care. Thirty patients and 27 healthy controls, mean age 49 years (SD 6.5) and 55 years (SD 6.7) respectively, were included, all of whom had undergone baseline measurements of neuropsychological functioning. The mean follow‐up time was three years. Half of the patients still reported mental health problems at follow‐up and over time no major changes in cognitive performance were noted. The patients still performed significantly poorer than controls with regard to cognitive functions, mainly related to speed, attention and memory function. Long‐lasting impairment of cognitive functions related to speed, attention and memory function noted in patients with stress‐related exhaustion should be acknowledged and taken into consideration during treatment and when discussing a return to work. Follow‐up periods longer than three years are needed to explore the persistence of the cognitive impairment.
The health care system is facing an increased number of patients seeking care for burnout/stress-related exhaustion. One of the core features of this condition is cognitive impairment-effective and ...easy tools are needed to assess cognition in this patient group. Our objective was to determine whether the Cognitive Assessment Battery (CAB) could be used for this purpose.
Ninety-three patients diagnosed with exhaustion disorder (ED) and 111 controls were included in the study and tested with CAB. CAB consists of six short tests covering the cognitive domains speed and attention, episodic memory, visuospatial, language, and executive functions. The patients also completed questionnaires on subjective memory problems, degree of burnout, anxiety, and depression.
The patients performed worse than the controls on four tests of speed and attention, language, and executive function. Subjective memory problems, degree of burnout, and anxiety did not influence cognitive performance, only degree of depression influenced performance negatively on an executive test.
CAB is a useful instrument for rapid, comprehensive screening of cognitive status in patients with stress-related exhaustion. Using it, we confirmed the most replicated findings regarding cognitive impairments in patients with stress-related exhaustion.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
PDF
